“Literature reveals limited evidence for heat-related morbidity or mortality for well-known mental health conditions such as schizophrenia, bipolar disorder, depression, alcohol use disorder, or neurocognitive disorders like dementia,” says Susanne Steinberg, MD, Medical Director of the Women’s Program at Princeton House’s Moorestown outpatient site.
“There may be higher numbers of Emergency Department visits during heat waves by those with certain behavioral health conditions – especially for men – but this may be to seek assistance or refuge from the heat rather than being directly linked to increased morbidity,” she adds. “Homeless people are particularly susceptible to increased physical and mental illness during heat waves as they have neither shelter nor adequate hydration.”
Suicide and Homicide
Dr. Steinberg notes that murder and assault rates tend to be higher in the heat. While more research is needed, a six-year California study measuring the impact of increased ambient temperature on self-harm and violence found that suicide mortality was higher in women and seniors and homicide rates were higher in men. Likewise, researchers in China have suggested that higher temperatures may be associated with the risk of suicide death in that country. These findings mark another illustration of the need for policymakers worldwide to develop long-term action plans related to global warming, according to Dr. Steinberg.
Medication Considerations
Certain behavioral health medications can become degraded during temperature changes, while others may increase heat intolerance. For example, some antipsychotics and antidepressants can alter central thermoregulation, while lithium levels can become toxic when paired with inadequate hydration during hot weather.
The Role of Health Providers
Behavioral health providers can help by communicating some relatively straightforward recommendations to help patients deal with summer heat. These include avoiding outdoor activities during the hottest part of the day, wearing appropriate clothing, eating a healthy diet, applying sleep hygiene techniques, using distress tolerance skills, reaching out to others, and following their treatment plan.
“In addition to also reviewing medications and their potential heat-related risks with patients, one of the most important suggestions is to emphasize hydration,” adds Dr. Steinberg. “In fact, I always tell my patients that the brain is composed mostly of water.”
Sources
Paulus. Heat and mental health. July 31, 2023.ADAA.org.
Cedeno-Laurent. PLOS Medicine. 2018 Jul 10;15(7):e1002605.
Thompson et al. Public Health. 2018 Aug;161:171-191.
Nori-Sarma et al. JAMA Psychiatry. 2022;79(4):341-349.
Rahman et al. Science of the Total Environment. 2023 May 20;874:162462.
Zhou et al. JAMA Psychiatry. 2023;80(5):488-497.
