A Pathways Framework for Understanding Climate Change and Mental Health in Informal Settlements

Background and purpose: Climate change and related extreme weather events (EWEs) profoundly impact mental health—a critical focus of the Lancet Climate Change and Health Countdown and an area of focus within the Social Work Grand Challenge to Create Social Responses to a Changing Environment. Residents of informal settlements—defined as residential areas lacking durable housing, sufficient living and public spaces, access to basic infrastructure and other services, and secure tenancy—are especially vulnerable to climate change-related EWEs as they often live in unstable structures in ecologically sensitive areas (e.g., riverbanks, floodplains, waste dumps or industrial sites) and face barriers to adaptation including political and social marginalization, poverty, and exclusion from formal essential services and legal land tenure. Globally, an estimated one billion people live in rapidly expanding informal settlements; however, theories and frameworks highlighting direct and indirect pathways between climate change and related weather events and mental health outcomes in these climate vulnerable communities are sparse. The purpose of this study is to propose a general pathways framework for conceptualizing the relationship between climate change-related EWEs and common mental health outcomes in informal settlements.

Methods: We draw from evidence in the scientific literature to demonstrate existing empirical relationships between the factors in the conceptual framework. Through this model we illustrate potential direct and indirect pathways between EWEs such as flooding, heatwaves, cold spells, drought, heavy downpours, and extreme wind and common mental health disorders, including depression, anxiety, and posttraumatic stress disorder.

Results: We highlight possible individual and household-level moderators, including history of mental illness, suicidality, and non-communicable diseases; self-efficacy; access to health insurance; and socio-economic variables as well as community- and macro-level policy and regulatory moderators related to water and electricity, sewerage and solid waste, and early warning systems. We also highlight mediators that have been shown to be both affected by EWEs and affecting mental health outcomes, including physical health, coping, substance use, social support, and social capital of individual and household members; intimate partner, domestic, and community violence; household resources such as sources and size of income and expenditures; residential stability; materials and condition of household; availability and accessibility of health-related services; community cohesion and disorder; and availability and accessibility of water, sanitation, electricity, and food. Finally, we use existing evidence to discuss the possible bidirectionality of relationships between factors and outcomes.

Conclusion and implications: We propose a new pathways framework that captures not only direct pathways between climate change-related weather events and mental health but, importantly, the indirect pathways and potential bi-directionality between factors that are increasingly affecting the one billion residents around the world currently residing in informal settlements and those quickly moving in. This framework can provide social workers, policy-makers, development organizations, meteorological and risk management departments, and health practitioners with critical information about the factors that are affected by climate change and subsequently affect mental health and well-being and relationships between them. These insights will help key stakeholders understand and better support targeted adaptation strategies alongside residents of these climate-vulnerable communities.