As the Country Heats Up, ERs May See an Influx of Young Patients Struggling With Mental Health

Researchers are now connecting the dots between the climate crisis and the havoc heat can wreak on developing minds. 

Extreme heat and other climate calamities “impact our first and worst, our most vulnerable,” said Jennifer Runkle, an environmental epidemiologist at the North Carolina Institute for Climate Studies. She is the lead author of a recent study which found that during periods of intense drought and heat, children and young adults showing signs of mood disorders and suicide risks visited emergency rooms at alarming rates. The risk soared in the hardest-hit parts of the state, especially in lower-income areas and densely-populated cities.

Within that span, around 1,800 young emergency department admits were for mood disorder cases, including 1,300 for suicide attempts.

The most at-risk children were from low-income families with a history of mental health issues. A higher proportion of emergency admissions were Black or girls younger than 12, according to Runkle’s study. 

In a separate paper published in 2023, another team of scientists documented similar trends with pediatric patients in New York City. Dr. Perry Sheffield, lead author of the study and associate professor of environmental medicine, climate science and pediatrics at the Mount Sinai School of Medicine, has been interested in how climate affects children for years. 

He notes that thermoregulation, a person’s ability to maintain a stable body temperature despite external conditions, is often dysfunctional in children predisposed to mental illnesses. If children are also taking medications to treat those mental illnesses, heat exposure could be even more dangerous. Some antipsychotics reduce sweat production—a cooling process—while simultaneously altering the hypothalamus, which Wortzel calls “the main thermostat of the brain.” 

Temperature and a therapeutic neurotransmitter called serotonin have a close relationship as well. When it’s suddenly too warm out, levels of serotonin can rise, according to Wortzel. With too much serotonin, other regions of the brain, including those that regulate temperature, lose their ability to function properly. 

What’s especially tricky with physical activity is that being active does prime the brain’s hypothalamus-pituitary-adrenal axis to better regulate depression and aggression, and keep stress hormones from going awry. But most kids don’t—and shouldn’t—play outside when it’s excessively hot. By moving around less, Paulus is concerned about the various ways stress can slip into children’s lives and elevate their risk for mood swings.

Both experts feel metabolic imbalances that affect energy levels and inflammation sparked by heat are additional areas of concern. Inflammation left unchecked, they believe, can affect levels of serotonin, dopamine and hormones. According to Wortzel and Paulus, when stress hormones are constantly in flux, it could lead to poor mental health now and in the future. 

Parents and other adults in kids’ lives need to be on the lookout for changes such as mood swings and isolation from other children, Wortzel said, along with “statements about hopelessness, helplessness, worthlessness, thoughts of not wanting to be around anymore.” Whenever it’s hot out, adults should pay extra attention if children mention overexertion and dehydration. Cooling centers and cooling pillows that pull heat away from the body will be increasingly important in hot cities as temperature spikes become more normal.

Clinicians, too, must be vigilant, and ready to urge psychotherapy for young people affected by heat. Wortzel acknowledges this is a problem that might not be easily or widely accepted. How the climate and environment affect mental health is still broadly debated, despite plenty of research. So doctors must be “fairly aggressive” in advocating for better public awareness of the problem, he said. Paulus agrees, and has encouraged clinician scientists to adopt monitoring systems that identify trends in childhood mental wellness and extreme weather. 

That enhanced awareness could protect kids from the ramifications of a warming world. It starts with clinicians themselves, many of whom aren’t aware of the climate-mental health connection, experts said. “I think it’s important to start bringing extreme heat and other climate stressors to the clinical community as a risk factor,” Runkle said, “so that we can get better clinical [and] school guidance out there.”