Long-term Exposure to Ambient Air Pollution and its Association with Mental Well-Being, Depression and Anxiety: A Nationally Representative Study
DOI:
https://doi.org/10.20344/amp.21245Keywords:
Air Pollution/adverse effects, Anxiety Disorders, Depressive Disorders, Environmental Exposure, Mental Health, Particulate Matter/adverse effects, Stress, PsychologicalAbstract
Introduction: Exposure to ambient air pollution may play a role in the onset of common mental disorders like depressive and anxiety disorders. The association of long-term exposure to particles smaller than 10 μm (PM10) with these diseases remains unclear. This study aimed to estimate the association of long-term exposure to PM10 with mental well-being and the frequency of probable diagnosis of common mental disorders.
Methods: A nationally representative cross-sectional study was done in mainland Portugal. Long-term exposure was estimated through one-year average concentrations of PM10, calculated with data from the Portuguese Environment Agency, attributed individually considering individuals’ postal codes of residence. The mental well-being and the probable diagnosis of common mental disorders were ascertained through the five-item Mental Health Inventory scale. Linear and Robust Poisson regression models were computed to estimate change percentages, prevalence ratios (PR), and their 95% confidence intervals (95% CI).
Results: The median (interquartile range) concentration of PM10 was 18.6 (15.3 - 19.3) μg/m3. The mental well-being score was 72 (56 - 84) points, on a scale from 0 to 100. A probable diagnosis of common mental disorders was found in 22.7% (95% CI: 20.0 to 25.6). Long-term exposure to PM10 was associated with a non-statistically significant decrease in the mental well-being score [for each 10 μg/m³ increment in one-year average PM10 concentrations, there was a 2% (95% CI: -8 to 4) decrease], and with a non-statistically significant increase in the common mental health frequency (PR = 1.012, 95% CI: 0.979 to 1.045).
Conclusion: We did not find statistically significant associations between long-term exposure to PM10 and mental well-being or the frequency of probable diagnosis of common mental disorders. These results may be explained by the reduced variability in the exposure values, given the geographical distribution and functioning of the network of air quality monitoring stations. This study contributes with evidence for low levels of air pollutants, being one of the first to adjust for individual and aggregate-level variables. Moreover, to the best of our knowledge, this was the first nationally representative, population-based study conducted on the Portuguese population using real-life data. Maintaining a robust and nationwide air quality monitoring network is essential for obtaining quality exposure data.
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References
Manisalidis I, Stavropoulou E, Stavropoulos A, Bezirtzoglou E. Environmental and health impacts of air pollution: a review. Front Public Health. 2020;8:14.
Institute of Health Metrics and Evaluation. Global health data exchange (GHDx). [cited 2022 Nov 14]. Available from: https://vizhub.healthdata.org/gbd-results/.
World Health Organization. Mental health and COVID-19: Early evidence of the pandemic’s impact. Geneva: WHO; 2022.
National Collaborating Centre for Mental Health. Common mental health disorders: identification and pathways to care. Leicester: British Psychological Society; 2011.
Pelgrims I, Devleesschauwer B, Guyot M, Keune H, Nawrot TS, Remmen R, et al. Association between urban environment and mental health in Brussels, Belgium. BMC Public Health. 2021;21:635.
World Health Organization. WHO global air quality guidelines: particulate matter (PM2.5 and PM10), ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide. Copenhagen: WHO Regional Office for Europe; 2021.
Borroni E, Pesatori AC, Bollati V, Buoli M, Carugno M. Air pollution exposure and depression: a comprehensive updated systematic review and meta-analysis. Environ Pollut. 2022;292:118245.
Liu Q, Wang W, Gu X, Deng F, Wang X, Lin H, et al. Association between particulate matter air pollution and risk of depression and suicide: a systematic review and meta-analysis. Environ Sci Pollut Res Int. 2021;28:9029-49.
Zeng Y, Lin R, Liu L, Liu Y, Li Y. Ambient air pollution exposure and risk of depression: a systematic review and meta-analysis of observational studies. Psychiatry Res. 2019;276:69-78.
Braithwaite I, Zhang S, Kirkbride JB, Osborn DP, Hayes JF. Air pollution (particulate matter) exposure and associations with depression, anxiety, bipolar, psychosis and suicide risk: a systematic review and meta-analysis. Environ Health Perspect. 2019;127:126002.
Trushna T, Dhiman V, Raj D, Tiwari RR. Effects of ambient air pollution on psychological stress and anxiety disorder: a systematic review and meta-analysis of epidemiological evidence. Rev Environ Health. 2021;36:501-21.
Cuijpers P, Miguel C, Ciharova M, Kumar M, Brander L, Kumar P, et al. Impact of climate events, pollution, and green spaces on mental health: an umbrella review of meta-analyses. Psychol Med. 2023;53:638-53.
Zundel CG, Ryan P, Brokamp C, Heeter A, Huang Y, Strawn JR, et al. Air pollution, depressive and anxiety disorders, and brain effects: a systematic review. Neurotoxicology. 2022;93:272-300.
Kim H, Kim WH, Kim YY, Park HY. Air pollution and central nervous system disease: a review of the impact of fine particulate matter on neurological disorders. Front Public Health. 2020;8:575330.
Ehsanifar M, Montazeri Z, Taheri MA, Rafati M, Behjati M, Karimian M. Hippocampal inflammation and oxidative stress following exposure to diesel exhaust nanoparticles in male and female mice. Neurochem Int. 2021;145:104989.
Salvi A, Liu H, Salim S. Involvement of oxidative stress and mitochondrial mechanisms in air pollution-related neurobiological impairments. Neurobiol Stress. 2020;12:100205.
Thomson EM, Filiatreault A, Guenette J. Stress hormones as potential mediators of air pollutant effects on the brain: rapid induction of glucocorticoid-responsive genes. Environ Res. 2019;178:108717.
Herting MM, Younan D, Campbell CE, Chen JC. Outdoor air pollution and brain structure and function from across childhood to young adulthood: a methodological review of brain MRI studies. Front Public Health. 2019;7:332.
Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: a systematic review and meta-analysis. J Affect Disord. 2017;221:36-46.
Nunes B, Barreto M, Gil AP, Kislaya I, Namorado S, Antunes L, et al. The first Portuguese National Health Examination Survey (2015): design, planning and implementation. J Public Health. 2019;41:511-7.
Gaio V, Roquette R, Monteiro A, Ferreira J, Rafael S, Dias CM, et al. Exposure to ambient particulate matter increases blood count parameters with potential to mediate a cardiovascular event: results from a population-based study in Portugal. Air Qual Atmos Health. 2021;14:1189-202.
Gaio V, Roquette R, Monteiro A, Ferreira J, Matias Dias C, Nunes B. Investigating the association between ambient particulate matter (PM(10)) exposure and blood pressure values: results from the link between the Portuguese Health Examination Survey and air quality data. Rev Port Cardiol. 2023;42:251-8.
Gaio V, Roquette R, Monteiro A, Ferreira J, Lopes D, Dias CM, et al. PM10 exposure interacts with abdominal obesity to increase blood triglycerides: a cross-sectional linkage study. Eur J Public Health. 2022;32:281-8.
Berwick DM, Murphy JM, Goldman PA, Ware JE Jr., Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991;29:169-76.
Santos AM, Novo RF. Mental health inventory: sensitivity and specificity of the portuguese version of the MHI-38 and MHI-5. Psychol Rep. 2020;123:1452-69.
Pais-Ribeiro J. Mental health inventory: a study of adaptation to Portuguese population. Psicologia, Saúde & Doenças. 2001;2:77-99.
Rumpf HJ, Meyer C, Hapke U, John U. Screening for mental health: validity of the MHI-5 using DSM-IV Axis I psychiatric disorders as gold standard. Psychiatry Res. 2001;105:243-53.
Cuijpers P, Smits N, Donker T, ten Have M, de Graaf R. Screening for mood and anxiety disorders with the five-item, the three-item, and the two-item Mental Health Inventory. Psychiatry Res. 2009;168:250-5.
Rautio N, Filatova S, Lehtiniemi H, Miettunen J. Living environment and its relationship to depressive mood: a systematic review. Int J Soc Psychiatry. 2018;64:92-103.
Hajat A, Diez-Roux AV, Adar SD, Auchincloss AH, Lovasi GS, O’Neill MS, et al. Air pollution and individual and neighborhood socioeconomic status: evidence from the Multi-Ethnic Study of Atherosclerosis (MESA). Environ Health Perspect. 2013;121:1325-33.
Ribeiro AI, Launay L, Guillaume E, Launoy G, Barros H. The Portuguese version of the european deprivation index: development and association with all-cause mortality. PLoS One. 2018;13:e0208320.
Caldas de Almeida JM, Xavier M. Estudo Epidemiológico Nacional de Saúde Mental: 1.º relatório. Lisboa: Universidade Nova de Lisboa; 2013.
United Nations Educational, Scientific and Cultural Organization. International Standard Classification of Education: ISCED. Montréal: UNESCO; 2012.
Santos AJ, Kislaya I, Gil AP, Namorado S, Barreto M, Gaio V, et al. Psychological distress – prevalence and associated factors in the portuguese population in 2015: results from the National Health Examination Survey. Lisboa: Boletim Epidemiológico Observações; 2017.
International Labour Office. International Standard Classification of Occupations: ISCO-08. Geneve: ILO; 2012.
Ribeiro AI, Launay L, Guillaume E, Launoy G, Barros H. The Portuguese Version of the European Deprivation Index. figshare. Dataset. (2011). [cited 2022 Nov 14]. Available from: https://figshare.com/articles/dataset/Portuguese_version_of_the_European_Deprivation_Index_version_2011_/7188554.
National Oceanic and Atmospheric Administration. Climate Data Online. 2022. [cited 2022 Nov 14]. Available from: https://www.ncdc.noaa.gov/cdo-web/datasets.
Instituto Nacional de Saúde Doutor Ricardo Jorge. 1.º Inquérito Nacional de Saúde com Exame Físico (INSEF 2015): relatório metodológico. Lisboa: INSA; 2016.
Conroy RM. What hypotheses do “nonparametric” two-group tests actually test? Stata J. 2012;12:182-90.
Gnardellis C, Notara V, Papadakaki M, Gialamas V, Chliaoutakis J. Overestimation of relative risk and prevalence ratio: misuse of logistic modeling. Diagnostics. 2022;12:2851.
Kim SY, Bang M, Wee JH, Min C, Yoo DM, Han SM, et al. Short- and long-term exposure to air pollution and lack of sunlight are associated with an increased risk of depression: a nested case-control study using meteorological data and national sample cohort data. Sci Total Environ. 2021;757:143960.
Yang T, Wang J, Huang J, Kelly FJ, Li G. Long-term exposure to multiple ambient air pollutants and association with incident depression and anxiety. JAMA Psychiatry. 2023;80:305-13.
Li X, Li Y, Xia B, Han Y. Pathways between neighbourhood walkability and mental wellbeing: a case from Hankow, China. J Transp Health. 2021;20:101012.
Berke EM, Gottlieb LM, Moudon AV, Larson EB. Protective association between neighborhood walkability and depression in older men. J Am Geriatr Soc. 2007;55:526-33.
Ribeiro AI, Fraga S, Kelly-Irving M, Delpierre C, Stringhini S, Kivimaki M, et al. Neighbourhood socioeconomic deprivation and allostatic load: a multi-cohort study. Sci Rep. 2019;9:8790.
Yang X, Jiang L, Zhao W, Xiong Q, Zhao W, Yan X. Comparison of ground-based PM(2.5) and PM(10) concentrations in China, India, and the U.S. Int J Environ Res Public Health. 2018;15:1382.
White E, Kushi LH, Pepe MS. The effect of exposure variance and exposure measurement error on study sample size: implications for the design of epidemiologic studies. J Clin Epidemiol. 1994;47:873-80.
Mlinaric A, Horvat M, Supak Smolcic V. Dealing with the positive publication bias: why you should really publish your negative results. Biochem Med. 2017;27:030201.
Heo S, Lee W, Bell ML. Suicide and associations with air pollution and ambient temperature: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18:7699.
Faisal-Cury A, Ziebold C, Rodrigues DM, Matijasevich A. Depression underdiagnosis: prevalence and associated factors. A population-based study. J Psychiatr Res. 2022;151:157-65.
Paksarian D, Cui L, Angst J, Ajdacic-Gross V, Rossler W, Merikangas KR. Latent trajectories of common mental health disorder risk across 3 decades of adulthood in a population-based cohort. JAMA Psychiatry. 2016;73:1023-31.
Lipfert FW. Air pollution and mortality: timing is everything. Atmosphere. 2020;11:1274.
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