随着气候变化产生广泛的健康影响,对气候因素与精神和行为障碍(MBDs)之间的关联的兴趣激增.现有的定量合成主要集中在热和高温暴露上,忽视其他气候因素的影响及其协同作用。本研究的目的是对气候暴露与综合心理和行为健康状况和特定精神障碍(例如,精神分裂症,痴呆症)。2022年4月11日至16日,使用WebofScience进行了系统搜索,Medline,ProQuest,EMBASE,PsycINFO,CINAHL,环境完整。筛选和资格筛选遵循基于人群的纳入标准,暴露,比较器,和结果指南。进行了偏见风险评估,首先为所有研究提供了叙事综合,当至少有三项针对特定暴露-结局对的研究可用时,进行随机效应荟萃分析.在对建议进行分级评估后,对证据的确定性进行了评估,开发和评估(GRADE)工具。搜索过程产生了7696个初步结果,我们从中确定了88项研究纳入审查集。报告的气候因素包括气温,太阳辐射/阳光,大气压力,降水,相对湿度,风向/风速,和热舒适指数。结果包括MBD发病率(例如,精神分裂症,情绪障碍,神经症),心理健康相关死亡率,和自我报告的心理状态。Meta分析显示,热浪(合并RR=1.05,95%CI=1.02-1.08)和极端高温(第99百分位数:合并RR=1.18,95%CI=1.08-1.29)与较高的MBD风险相关。极端寒冷,然而,与MBD风险无关。研究结果进一步确定了热指数增加之间的关联(即,表观温度)和MBD风险升高(合并RR=1.06,95%CI=1.03-1.12);具体而言,第99百分位数的高温与精神分裂症风险增加相关(合并RR=1.07,95%CI=1.01-1.12).偏见风险评估显示大多数研究具有低或中度低风险,虽然一些研究在混淆方面被评为很高,选择偏差,结果测量,和报告偏见。等级评估显示,热舒适指数和MBD的证据具有中等确定性,但与气温或日照时间有关的确定性较低。这些发现提请注意暴露措施的异质性以及考虑气象因素协同作用的热指数的实用性。讨论了线性假设和累积效应等方法论问题。
As climate change exerts wide ranging health impacts, there is a surge of interest in the associations between climatic factors and mental and behavioral disorders (MBDs). Existing quantitative syntheses focus mainly on heat and high temperature exposure, neglecting the effects of other climatic factors and their synergies. The objective of this study is to conduct a systematic
review and meta-analysis of the evidence of associations between climatic exposure and combined mental and behavioral health conditions and specific mental disorders (e.g., schizophrenia, dementia). A systematic search was conducted April 11-16, 2022 using Web of Science, Medline, ProQuest, EMBASE, PsycINFO, CINAHL, and Environment Complete. Screening and eligibility screening followed inclusion criteria based on population, exposure, comparator, and outcome guidelines. Risk of bias assessment was performed, a narrative synthesis was first presented for all studies, and random-effect meta-analyses were performed when at least three studies were available for a specific exposure-outcome pair. Certainty of evidence was evaluated following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The search process yielded 7696 initial results, from which we identified 88 studies to include in the
review set. Climatic factors reported included air temperature, solar radiation/sunshine, barometric pressure, precipitation, relative humidity, wind direction/speed, and thermal index. Outcomes including MBD incidences (e.g., schizophrenia, mood disorders, neurotic disorders), mental health-related mortality, and self-reported psychological states. Meta-analysis showed that heatwaves (pooled RR = 1.05, 95 % CI = 1.02-1.08) and extreme high temperatures (99th percentile: pooled RR = 1.18, 95 % CI = 1.08-1.29) were associated with higher risk of MBD. Cold extremes, however, were not associated with MBD risk. The findings further identified an association between increases in a thermal index (i.e., apparent temperature) and elevated risk of MBD (pooled RR = 1.06, 95 % CI = 1.03-1.12); specifically, a 99th percentile high temperature was associated with increased schizophrenia risk (pooled RR = 1.07, 95 % CI = 1.01-1.12). Risk of bias assessment showed most studies to have low or moderately low risks, while a few studies were rated probably high in confounding, selection bias, outcome measurement, and reporting bias. GRADE evaluation revealed moderate certainty of evidence on thermal comfort index and MBD, but low certainty related to air temperature or sunshine duration. These findings call attention to the heterogeneity of exposure measures and the utility of thermal indices that consider the synergistic effects of meteorological factors. Methodological concerns such as the linearity assumption and cumulative effects are discussed.