Association of Psychiatric Emergency Visits and Warm Ambient Temperature during Pregnancy: A Time-Stratified Case-Crossover Study.

Publisher: National Institute of Environmental Health Sciences Country of Publication: United States NLM ID: 0330411 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-9924 (Electronic) Linking ISSN: 00916765 NLM ISO Abbreviation: Environ Health Perspect Subsets: MEDLINE

Original Publication: Research Triangle Park, N. C. National Institute of Environmental Health Sciences.

Emergency Service, Hospital*/statistics & numerical data ; Mental Disorders*/epidemiology ; Hot Temperature*/adverse effects ; Cross-Over Studies*; North Carolina/epidemiology ; Pregnancy Complications/epidemiology ; Humans ; Female ; Pregnancy ; Adult ; Young Adult ; Seasons

Background: Acute exposure to high ambient temperature and heat waves during the warm season has been linked with psychiatric disorders. Emerging research has shown that pregnant people, due to physiological and psychological changes, may be more sensitive to extreme heat, and acute exposure has been linked to increased risk of pregnancy complications; however, few studies have examined psychiatric complications.
Objective: Our objective was to examine the association between acute exposure to warm ambient temperatures and emergency department (ED) visits for mental disorders during pregnancy.
Methods: A time-stratified case-crossover design with conditional logistic regression was performed on INLINEMATH psychiatric ED visits for pregnant patients in North Carolina, from May to September 2016 to 2019. Daily average ambient temperature was the main exposure and was linked to daily visits by maternal zip code of residence for prenatal mood and anxiety disorders (PMAD), severe mental illness (SMI), mental disorder of pregnancy (MDP), suicidal thoughts (SUIC), and any psychiatric disorder (Any). Effect modification by trimester, residential segregation, economic segregation, urbanicity, and availability of greenspace was also investigated.
Results: Each INLINEMATH increase in same-day exposure to warm ambient temperature on case days was associated with an increase in incidence rate ratio (IRR) for any psychiatric disorder [IRR = 1.07; 95% confidence interval (CI): 1.01, 1.14] including anxiety (IRR = 1.14; 95% CI: 1.00, 1.30), bipolar disorder (IRR = 1.28; 95% CI: 0.98, 1.67), and suicidal thoughts (IRR = 1.28; 95% CI: 1.00, 1.65) compared to control days. In general, the associations were strongest for warm season temperatures on the same day of exposure or for temperatures averaged over the 3 or 6 d preceding the ED visit. The greatest risk of an incident ED admission for PMAD (RR = 1.20; 95% CI: 1.04, 1.39), particularly for anxiety (RR = 1.30; 95% CI: 1.07, 1.59), and any psychiatric disorder (RR = 1.17; 95% CI: 1.07, 1.28) occurred following cumulative exposure to hot temperatures the week before admission. Higher psychiatric burden from temperature was observed in urban areas and on extreme heat days.
Conclusions: For this pregnant population in the southeastern United States, short-term exposure to high ambient temperatures during the warm season was associated with a greater risk of ED visits for an array of psychiatric disorders. Findings show that climate-related increases in ambient temperature may contribute to psychiatric morbidity in pregnant people. https://doi.org/10.1289/EHP13293.

Am J Epidemiol. 2018 Apr 1;187(4):726-735. (PMID: 29020264)
Environ Health. 2021 Feb 11;20(1):11. (PMID: 33573648)
Bipolar Disord. 2004 Feb;6(1):90-3. (PMID: 14996147)
Soc Sci Med. 2007 Dec;65(12):2458-63. (PMID: 17761378)
Environ Res. 2017 Apr;154:109-114. (PMID: 28056406)
Sci Total Environ. 2019 Jan 10;647:127-133. (PMID: 30077842)
N C Med J. 2020 Jan-Feb;81(1):45-50. (PMID: 31908334)
J Epidemiol Community Health. 2016 Mar;70(3):253-9. (PMID: 26560759)
Front Endocrinol (Lausanne). 2023 Apr 05;14:1149284. (PMID: 37091849)
PLoS One. 2020 Mar 25;15(3):e0230316. (PMID: 32210473)
Epidemiology. 2005 Nov;16(6):717-26. (PMID: 16222160)
Curr Environ Health Rep. 2022 Jun;9(2):263-275. (PMID: 35194749)
BMJ. 2021 Nov 24;375:e065653. (PMID: 34819309)
Int J Environ Res Public Health. 2021 Jul 20;18(14):. (PMID: 34300149)
BMC Pregnancy Childbirth. 2020 Aug 14;20(1):464. (PMID: 32795335)
Womens Health Issues. 2023 May-Jun;33(3):289-299. (PMID: 36621340)
Arch Gynecol Obstet. 2020 Oct;302(4):801-819. (PMID: 32671543)
Health Aff (Millwood). 2021 Oct;40(10):1597-1604. (PMID: 34606342)
Int J Environ Res Public Health. 2020 Aug 05;17(16):. (PMID: 32764502)
Environ Res. 2017 Oct;158:421-430. (PMID: 28689033)
Am J Physiol. 1999 Jun;276(6):H1961-7. (PMID: 10362676)
Int J Environ Res Public Health. 2018 Jul 18;15(7):. (PMID: 30021956)
PLoS One. 2022 Jan 28;17(1):e0262962. (PMID: 35089963)
Cancer Causes Control. 2016 Sep;27(9):1139-51. (PMID: 27503397)
Arch Womens Ment Health. 2016 Oct;19(5):741-51. (PMID: 27324912)
BMC Public Health. 2021 Jan 21;21(1):176. (PMID: 33478445)
Glob Health Action. 2013 Mar 11;6:19538. (PMID: 23481091)
PLoS One. 2021 Oct 12;16(10):e0258302. (PMID: 34637463)
Curr Opin Psychol. 2020 Apr;32:12-16. (PMID: 31349129)
BMC Psychiatry. 2016 Jul 26;16:263. (PMID: 27455845)
Sci Total Environ. 2019 Dec 1;694:133582. (PMID: 31394323)
Am J Public Health. 2005 Jul;95(7):1149-55. (PMID: 15983270)
Environ Health. 2009 Sep 16;8:40. (PMID: 19758453)
Environ Int. 2020 Oct;143:105938. (PMID: 32688157)
Environ Res. 2016 Jan;144(Pt A):106-116. (PMID: 26599589)
Int J Environ Res Public Health. 2022 Jul 31;19(15):. (PMID: 35954764)
BMC Womens Health. 2020 Jul 23;20(1):150. (PMID: 32703202)
World Psychiatry. 2018 Jun;17(2):187-195. (PMID: 29856559)
Sci Total Environ. 2021 Oct 20;792:148246. (PMID: 34144243)
J Womens Health (Larchmt). 2021 Feb;30(2):230-235. (PMID: 33181043)
Sci Total Environ. 2018 Mar;616-617:688-694. (PMID: 29126638)
Epidemiology. 2008 Mar;19(2):176-8. (PMID: 18277157)
Health Aff (Millwood). 2021 Oct;40(10):1592-1596. (PMID: 34606355)
Environ Res. 2020 Jan;180:108800. (PMID: 31634719)
Sci Total Environ. 2019 Jan 1;646:1021-1029. (PMID: 30235587)
Environ Health. 2020 Jul 6;19(1):79. (PMID: 32631375)
J Mol Cell Cardiol. 1992 Feb;24(2):113-24. (PMID: 1583697)
Int J Environ Res Public Health. 2014 Dec 23;12(1):227-53. (PMID: 25546282)
Sci Total Environ. 2019 Jul 1;672:1-6. (PMID: 30954808)
Environ Health Perspect. 2023 May;131(5):55001. (PMID: 37255302)
Sci Total Environ. 2022 Feb 20;808:152145. (PMID: 34871679)
Am J Epidemiol. 2003 Aug 15;158(4):385-91. (PMID: 12915504)
Eur Heart J Qual Care Clin Outcomes. 2021 Oct 28;7(6):548-555. (PMID: 32592466)
Public Health. 2018 Aug;161:171-191. (PMID: 30007545)
Environ Health Perspect. 2016 Jan;124(1):75-80. (PMID: 26069051)
Int J Environ Res Public Health. 2019 Jan 21;16(2):. (PMID: 30669579)
Lancet Planet Health. 2020 Nov;4(11):e538-e543. (PMID: 33159881)
Psychiatr Serv. 1998 Aug;49(8):1088-90. (PMID: 9712220)
Environ Res. 2017 Oct;158:301-317. (PMID: 28672128)
Sci Total Environ. 2017 Jul 15;590-591:281-286. (PMID: 28274603)
JAMA Psychiatry. 2022 Apr 01;79(4):341-349. (PMID: 35195664)

R03 ES031228 United States ES NIEHS NIH HHS; R15 ES033817 United States ES NIEHS NIH HHS

Date Created: 20240603 Date Completed: 20240603 Latest Revision: 20240613

20260130

PMC11166382

10.1289/EHP13293

38829735