Speaking of Psychology - Mental health in a warming world, with Kim Meidenbauer, PhD, and Amruta Nori-Sarma, PhD

Episode Date: June 19, 2024

Last year -- 2023 -- was the world’s warmest on record, and 2024 could bring another record-shattering summer. Psychologist Kim Meidenbauer, PhD, and public health researcher Amruta Nori-Sarma, PhD, discuss how heat affects people’s mental health, emotions and even cognitive abilities; the link between heat, violence and aggression; who is most vulnerable to the effects of extreme heat; and what policy makers could be doing to mitigate its effects. Learn more about your ad choices. Visit megaphone.fm/adchoices

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See Home Depot.com slash price match for details. 2020 was the world's warmest year on record, and 2024 could bring another record-shattering summer. In April, the National Weather Service released an outlook that predicted hotter than average conditions across most of the U.S. this summer. When we think of the consequences of extreme heat, physical dangers may come to mind first, things like heat exhaustion or heat stroke. But psychologists and public health researchers have found that heat can affect our mental health as well as our physical health. So what do those effects look like? How does extreme heat affect our mental health, our emotions, and even our cognitive abilities? What is the link among heat, violence, and aggression?

Who is most vulnerable to the effects of extreme heat? And what should policymakers and others be doing to mitigate the effects of extreme heat in a world that's only getting hotter? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science. and everyday life. I'm Kim Mills. We have two guests today. First is Dr. Kim Middenbauer, an assistant professor in the Washington State University Department of Psychology, where she heads the social, cognitive, and environmental neuroscience laboratory. Dr. Maddenbauer's research focuses on how the physical and social environment affects people's brain and behavior. She's particularly interested in the negative effects of heat stress and air pollution, as well as how

interacting with natural spaces can improve our physical and mental health. Our second guest is Dr. Amruda Norese Sarma, an assistant professor in the Environmental Health Department at the Boston University School of Public Health. She studies the relationship between climate change and health outcomes in vulnerable communities. She has also examined the impact of heat waves and air pollution on health in India, South Korea, and across the U.S. Her current research aims to understand the effects of extreme weather events on mental health. Thank you both for joining me today. Thank you for having us.

Great to be here. Now, you're both interested in heat and mental health, and you both come to it from different backgrounds. Dr. Nouri Sarma, your PhD is in public health. Dr. Madenbauer, you're a psychologist who's interested in how our environments affect us. Can you each tell us a little bit about your background and how you came to study the topic? And maybe Dr. Mindbauer, we'll start with you. Yeah. So my background and kind of my PhD work was focused in environmental psychology, really focused on how interacting with nature benefits us and why.

And so studying kind of the effects of the physical environment on individuals, I mean, it's hard to not think about heat and the effects of heat stress in the wake of an ever warming planet. And in the context of climate change, I was just increasingly more concerned with, you know, how is heat affecting us? And we know a lot about how nature is good for us. And I was doing a lot of work on why. But it was sort of like, well, we know nature is good for us. We know a lot less about how heat is affecting us psychologically. And it seemed like a natural kind of next step to look at an undoubtedly important one. And Dr. Norisarma, how did you get interested in this topic? So, as you mentioned, my PhD work is really focused on the environmental side. So I'm coming at this from the perspective of environmental epidemiology. And I've always been really interested in leveraging different data resources to try and understand the impacts of climate-related exposures in understudied communities and underserved communities and also on outcomes that we don't really understand as well.

So it seemed to me like the mental health implications of environmental exposures was a natural next step in progression of my research. We understand relatively a lot more about the physical health impacts of extreme heat, for example, and we understand a lot less about the ways in which extreme heat and other types of climate-related extreme weather events are impacting people's mental health and well-being. Now, Dr. Nori-Sama, you did a study several years ago that found a link. between hot days and mental health-related emergency room visits. Can you talk about this? What did you do? What did you find?

Absolutely. So the work that we were doing a couple of years ago that you mentioned, which was published in JAMA Psychiatry in 2022, was leveraging data among commercial health insurance beneficiaries. So we looked at all U.S. adults with commercial health insurance through this one particular commercial insurance provider to understand the impact. act of extreme heat or elevated temperatures on mental health outcomes, particularly emergency department visits associated with mental illness. So what we were able to do is between 2010 and 2019 in the summers of each of those years, we were able to look at changes in the rates of

emergency department visits associated with mental health as summertime temperatures were increasing. And additionally, we were able to look at potentially vulnerable groups within commercially insured beneficiary. So we looked at differences by region across the U.S. We also looked at differences between men versus women and differences by different age groups. And what we found in that study is that as summertime temperatures were increasing, we found a direct increase in the rates of emergency department visits, both for any mental health outcome as well as for specific causes. So we looked at, for example, increases in the rates of emergency department visits for substance use disorders, for schizophrenia, for self-harm,

for mood disorders, for different types of stress and anxiety disorders. And we found increasing rates of emergency department visits for each of these different mental health endpoints, which suggested to me that Extreme Heat is an exogenous stressor that's exacerbating people's underlying mental health symptoms because we found such similar rates of increases in mental health emergencies across very, very different health endpoints. One other thing that I want to highlight, which I thought was an interesting finding from that study, is that we found that people living in higher latitudes, so people in more northern parts of the U.S. had higher rates of emergency department visits as summertime temperatures increased, which was a little bit counterintuitive.

You might expect to see higher rates in the southern U.S. where temperatures are higher. So I think that spoke a little bit to community level adaptation. So in the more northern, parts of the U.S., maybe there's not as much air conditioning penetration, maybe people aren't used to these summertime temperatures already. And so as summertime temperatures were increasing, we saw increased need for emergency care in some of those more northern communities. There's also been research that's found a connection between heat waves and higher crime rates. How is heat related to aggression and violence? And what have you and other researchers found out? Dr. Madenbauer? The link between heat and aggression is something that

I mean, people have been saying it for literal decades like Craig Anderson doing some of the kind of early work on it and still doing an excellent work on it. And yeah, it sort of started when people noticed, you know, crime on hot days. There's a real relationship. It was, it's obvious, I think, to people even just anecdotally. I think people notice it. And it kind of generated all these questions about like, well, what's happening and why? And kind of the dominant theories sort of early on were all about, well, maybe it's just bringing more people outside. And when you have more people outside, you have more

opportunity. So this is the idea of what's called routine activities theory. But then Dr. Anderson comes in and sort of like, well, actually, we also know that he makes people angry, right? It makes them feel uncomfortable. It makes them feel hostile. It maybe even changes our perceptions of other individuals. So you might see others as looking like they're more threatening or hostile to us. And so he and a few other researchers, you know, they did a lot of work looking at, you know, why does heat cause aggression? And kind of one of the main things they really did focus on is the fact that it makes us angry. It affects our social perception. And increasingly, I think there's more of an interest and sort of something I'm starting to tease apart is whether heat's effects on cognition can also be playing a role here because we know cognitive control, like your ability to stop yourself.

from engaging in aggression, right? Like that is something that matters, and that is also something that's affected by heat. And Dr. Nori Sarma, are these things that you found as well? I mean, is there research that says basically on a hot day? Maybe you're, I don't know, not thinking as clearly as you might on a more temperate day? Yes, I think that that's very plausible. One other biological pathway that I want to mention is sleep disruption. I think that sleep disruption also plays an important role here.

And we know that especially as summertime extreme heat periods last longer and they're more frequent and they're more severe, the daily maximum temperature is increasing, but also the overnight temperatures are increasing as well. And so I think these patterns of more sustained in duration and more intense heat waves that also afford people less of an opportunity to cool off during the nighttime period can also lead to sleep disruption, which I think is directly relevant to some of these increases in aggression and different behavioral disruptions. that Dr. Middendvara was mentioning as well. Let's talk for a minute about climate equity. We know that some groups of people are more vulnerable to the harms of extreme heat than others. Who is the most vulnerable in both the United States and around the world to extreme heat? Sure. So I think that this is a very complicated question.

And I think that vulnerability goes hand in hand with intersectionality. So there might be a lot of different components of individual and community. level factors that convey vulnerability to different populations. The one that we always think about is socioeconomic status, and we know that that's a huge issue for populations in the U.S. and both around the world as well. And I think that plays into two different scenarios. So the first one is that people who have lower socioeconomic means have fewer resources to prepare them to adapt and cope in the face of climate stressors. I think that also socioeconomic status is influenced, both influenced by and also influences your neighborhood level characteristics. So maybe

you have, you're living in more of an interior urban environment in a big city where there's an urban heat island. So that inability to regulate your temperature to cool off during the nighttime period is exacerbated if you live in an urban heat island. So I think it's an individual level characteristic as well as a neighborhood level characteristic that conveys vulnerability. But additionally, I think that what we've seen across the U.S. is that access to mental health services is also a problem. So people who don't have access to regular care, preventative treatment, people who don't have access to clinicians. And particularly on the mental health side, this is a problem that's only increasing in scope, independent of exposure to climate hazards. So I think, you know, there are a lot of different factors that convey vulnerability to mental health impacts from extreme heat.

Yeah, I couldn't agree more. and the effects of socioeconomic status is also the main thing that comes to my mind too, right? Because the ability to adapt and mitigate both, as you say, on a personal level, right, that can you afford AC if you even have it? Can you afford to pay the electrical bill? It's expensive to, so people that might have it still might just not turn it on due to the expense. If you're living in an area with an urban heat island effect, you're also probably have less green space. Green space cools the area, right?

like both of these things are tightly linked with socioeconomic status and in some of my work in Chicago, I've also found this very tight coupling between, you know, urban heat island effect, access to resources for cooling and, you know, being of like lower SES background. And obviously that intersects with things like racialization and marginalization. So I think that kind of the importance of these sort of structural factors in predicting vulnerability is huge. the mental health thing, of course, as Dr. Norris-Sarma says, is obviously a major part of it. The other thing that I think about, and I've sort of increasingly started looking at more, is the sort of individual differences actually at a personality level. So, I mean, individual differences

are when it comes to things like thermal comfort or just your likelihood of experiencing negative emotions, both of those things seem to matter a lot. So people vary a lot in what they perceive as uncomfortable, people vary a lot in, you know, are they likely to experience negative emotions, period? And so some of my recent work has been looking at the effects of personality traits like neuroticism, which, you know, people that are higher on neuroticism, they're more likely to experience negative affect. We also have some data to suggest that they are more affected by uncomfortable heat than people that are lower on neuroticism. So this is some work that my PhD student has been looking into and following up on.

And so thinking about, you know, heat that's not necessarily like dangerous physically, but just might be uncomfortable and how even just heat that's a little uncomfortable, if you're prone towards negative emotions, if you're prone towards feeling uncomfortable in the heat, like those could have very real psychological consequences, even if you're not in, you know, a level of heat that is physically harmful or dangerous biologically, you know, just even feeling that discomfort could make someone who is higher on neuroticism or, you know, more uncomfortable, more likely to experience the mental health issues. Are there differences based on other factors such as sex, for example, how do men and women

react differently to heat? I mean, and I think we know older people can be more susceptible to heat problems. So what about children? Yeah, children definitely are like kind of either extreme is where you see the differences and it's in part due to just individual differences in thermal regulation ability, right? Like older adults and younger children, their thermoregulation efficiency is just not where it is with kind of middle adulthood, basically. The gender question is interesting. I have, it's really mixed.

I found a lot of really mixed evidence word. I found in some of my data, no effect. Some researchers seem to find it, I don't know. Dr. Norris-Harmah, if you've encountered this, but I think the gender question is, it's a bit of a mess. I haven't made heads or tails of it from the literature or my own data. Yeah, I think that that's the same messaging that we're seeing, the relationship between extreme heat and mental health outcomes between men and women. We see really different results depending on the work that's being done. And one other thing that I want to mention, just going back

to the age-related differences, I think one of the new areas of research thought I've been really interested in and following closely that I haven't really worked in myself is the relationship between extreme heat and other environmental risk factors and neurological disorders, which I think is maybe a separate category, but kind of belongs within this world. So the impact on Alzheimer's disease and related dementias is really interesting. And there's a couple of different components of that. So there's the stress that is conveyed to the patient. There's also caregiver stress that happens in those scenarios. So I think elderly patients, particularly for a different set of mental health related and well-being-related outcomes that I think are very much associated with this question

is an up-and-coming area of research that I think deserves more investigation as well. I totally agree. And it's also interesting to think about the relationship between, like, well-being and resilience and how that might lead to Alzheimer's and related dimensions, right? Like there's a link between those two and there's a link. between heat and cognition. And so I'm actually starting to do some work looking at this and looking at heat-related impairments in cognition in older adults. And does that predict, you know, neurocognitive decline?

So I agree. I think it's a really interesting and kind of important step forward and understanding kind of the scope of some of these effects in the more vulnerable populations like older adults. You said this place was steps from the water. We just haven't found the steps yet. How much did we save? Enough. Enough to get lost.

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Maybe a little bit of an unfair question because you're not economists, But is there a relationship between heat and productivity? I'm just wondering because people who live in warmer climates, we have the sense that, well, they're all basking on the beach all day. And the people who live in more temperate places, well, they go to work because there's no beach. It's too cold to go to the beach. Am I just making this up or is there some correlation here? I think there's definitely a correlation here.

And I think this is something that we're starting to see more and more, particularly in highly occupationally exposed environments where the background exposure to extreme heat is already quite high. Climate change is exacerbating these risk factors. The areas that I think come to mind specifically are outdoor workers, such as agricultural workers, people in construction industries. These are all areas where occupational exposures are just going to be elevated as a result of summertime extreme heat. And it leads to a lot of loss of productivity. And I think one of the things that's really important is to consider worker well-being and worker health in the face of different summertime extreme temperatures. And I don't know that there's any standard related to extreme

heat exposure in the workplace, which I think can serve to exacerbate people's vulnerability in these highly occupational-exposed settings. Now, many of us have heard about seasonal effective disorder, which is a seasonal mood problem that's mostly associated with winter and light. But what about heat and summer-related mood issues? Are there such things? Summer sad is a thing, and it's so understudied. I'm not in this space, so I won't speak much on it, but I do know it's very much a thing, and our understanding of it appears to be pretty poor at this point. I don't know if Dr. Norisarma has, knows more about it than I do. Honestly, I don't know that I know more about the biological mechanism, but one thing that I can say is that

when we look at year-round mental illness, emergency department visits associated with mental health, when we look at the year-round trends, we actually don't see increases in the rates of emergency department visits for mental health outcomes among commercially insured individuals during wintertime periods. There's a pretty straightforward increase as temperatures are increasing. So maybe there's something subclinical that's happening with seasonal effective disorder, whereas the presentation during the summertime is just more severe. So more people are presenting to emergency departments in the summer for their summer sad, as Dr. Midinbarar said.

But I think maybe there is something very severe that's happening during the summertime periods that we're just not seeing evidence of the same effect in the winter. Dr. Norisarma, I know that because of the work that you've done, you've talked about how psychotropic medications are affected, right? So is it possible that, you know, with your work on the emergency department visits, you know, you're seeing kind of the extreme cases, the subclinical sad, like stereotypical winter sad, right? Does cold affect psychotropic medications? And maybe that's or not affect them. And maybe that's part of the puzzle here. I'm curious what you think. I think that the mechanism for psychotropic medications is really thermal dysregulation that happens with extreme heat.

So that's why sometimes in the summertime when you see patients who are men's, ill, they'll be bundling up with more and more clothing. And I think I haven't seen any evidence of the linkage between psychotropic drugs and extreme cold exposures. I think it really is a lack of ability to regulate your body's core temperature during extreme heat periods. But I think that likely what we're seeing in the emergency department visits is that a lot of the need for care or the people's experience of their symptoms during the winter is really just thought. So it's hard to capture. There are going to be a lot of people who will be interacting with the health care system that we're not capturing in things like emergency department visit claims or even if we

looked at preventative care, even if we looked at, you know, visits to your regular mental health professional. I think those would still fail to capture some of the subclinical outcomes that we might be really concerned about as a result of ongoing climate anxiety or other types of regular stressors from our environment. What about the impact of heat on people who are taking other kinds of medications? For example, if you're on blood thinners or you're on medication for blood pressure, does heat affect that? I don't know that heat affects, I don't know the effects by medication status, but I do know that heat definitely has adverse impacts on patients who have chronic illnesses. So we do see a lot of evidence of increased cardiovascular disease risk and increases in another

area that I think has been really interesting is cardiometabolic outcomes. So patients with diabetes who need insulin or require insulin have been particularly distressed during periods of extreme heat. So this is also an area that I think needs more research, but there is evidence of increased impacts on physical and mental health among patients with chronic illnesses as summertime temperatures are increasing. What about the other side of the coin? Can heat be beneficial to physical and mental health? I think that's a really interesting question. I mean, I will say that there's some research that looks at like using saunas for health benefits, right? It's a very different type of heat

exposure, right? But, like, there is some work looking at, you know, acute heat exposure under, like, you know, a medical professional or someone who's there to protect the patients and, you know, kind of actually boosting your thermoregulation ability through kind of repeated heat exposure because we know that adaptation is a thing. So I think the idea of kind of acute, safely administered short-term heat exposure, to protect against both later heat and just kind of some other things like I've heard. So because there's a relationship between like core temperature and depression, I've heard some arguments for like if you use saunas, get people to thermoregulate better, maybe this can actually address some of the depressive symptoms, which again, a little understudied, hard to know really what's going on there biologically. But I think it's a really interesting idea. And so I think kind of like acute heat exposure through sauna or infrared light or

something like that is a really interesting idea. I don't know about like exposure to heat in summer in general. It seems to be like some people like it more, but I don't know if it's necessarily good for them. Yeah. I think that the important point that Dr. Meidenbauer brings up, which I want to underscore here, is that I think there's a meaningful difference between acute exposure to very short periods of intense temperatures versus a general change in your chronic exposure to extreme heat. And a lot of evidence in places of the world that are already experiencing more extreme and longer lasting and frequent heat waves has shown that there are thresholds beyond which our body just loses the capacity to cope with extreme heat exposure.

So I think even, you know, even if we're thinking about it in terms of what is the ideal temperature for humans to thrive, there is a temperature beyond which we just kind of start to lose that ability to adapt and to cope and be resilient. in the face of these environmental stressors. And so I think there's maybe potentially two different discussions to be had there. One is acute heat as potentially restorative and curative for mental health and well-being. But then there's the separate conversation of our more chronic exposure to heat extremes, which I think is a separate risk factor.

So what's that level where we lose it? I mean, you know, we're seeing the ambient temperature, the average temperature around the world going up. Are we getting close in some places where they're regularly hitting 120 degrees Fahrenheit during the summer? Is that close to the threshold? Yeah, and I think that this is part of the broader conversation around the global climate changes that we're seeing. You know, if we talk about the thresholds that have been declared by our international conventions, some people talk about one and a half degree centigrade of overall warming. Some people talk about two degrees centigrade of overall warming.

But the thing that I think we need to keep in mind is that there are some places. in the world where they've already hit those thresholds and they've consistently seen those systemic increases in our summertime ambient temperatures across the course of the last few summers. And these are places that will already experience additional weeks of extreme heat. We've seen it across South Asia in the last couple of weeks since the beginning of the 24 summertime heat period. We're starting to see evidence of this in Europe. I think we're going to experience this overall change in our exposure to extreme heat in a variety of different contexts globally.

Well, let's try for a moment to talk about possible solutions. Do you have thoughts about what policymakers, governments can do to kind of mitigate the mental health and physical health effects of extreme heat? Yeah, I mean, I think it's a really complex problem and it's going to require approaching it from a lot of different angles. I mean, for me, again, as someone who's done a lot of research before on the benefits of nature exposure, like the first thing that comes to my mind is green space infrastructure as something that can both reduce the heat, especially in urban heat island affected areas. But also, you know, exposure to nature has its own mental health benefits, right? We see that spending time or even just having more tree canopy in your neighborhood has mental health.

and can reduce a lot of other behaviors that we care about. Like, it can reduce aggression. It can improve cognition. So I like to think of green space infrastructure as kind of like a one-two punch for addressing some of these issues, you know, reducing temperatures, potentially mitigating against global warming and climate change effects and then cleaning the air and, you know, having these sort of mental health benefits directly. but at the same time, there's an argument that, well, even if you planted all the trees

and the urban heat island disappeared in an area, you're still going to have really hot days. And if people don't have ways to cool themselves, like, that's still going to be a problem. So it's tricky because I don't want to be like, we should install air conditioning everywhere because that actually makes the, that also has negative effects on climate change. So it's like such a, but at the same time, for really vulnerable populations, it's like, what do you do, right? You don't want to put people at risk on really, really hot days. So I don't know, it's complicated. It's hard. Yeah, no, I think that the ones that you've listed are really important. And I think that hand in hand with this conversation around nature-based solutions,

I think there's a conversation to be had around accessibility of those solutions. I think that one of the communities that is very vulnerable that often gets left out of the discussion. is the disability community, people with other existing disabilities that may also intersect with their vulnerability to extreme heat. And so accessibility to nature-based solutions is really important. And I think it's important to keep in mind that different communities may have differential access to those solutions. So making it as equitable as possible is really important. The other component of that that I think plays into vulnerability is that there's a new concept of, so everyone has probably heard of gentrification. There's a new concept.

of climate gentrification where greening neighborhoods and making built environment more sustainable can often price the most vulnerable communities out of their native place or out of the place where they've been living up until now. So I think making sure that in the process of implementing these solutions, we're also improving accessibility and equity in the implementation of these solutions so that the most vulnerable folks still have access to these more cool and safe environments and better physical health, better mental health in these urban communities and worldwide as well as across the U.S. The other thing that I think is really important, that has been a factor in a lot of the different interventions that I've seen around the U.S.

is access to public spaces that have cooling. So instead of implementing air conditioning within homes, providing access to publicly available air conditioned spaces in different communities. And for example, here in Boston, the cooling centers in the summer are also warming centers in the winter. So providing access to a safe and warmed space in the wintertime storms. Boston is a cold city. So that's really where those interventions started. And now they've been implemented also as cooling centers. And so one of the things that I think is another area of work is I don't know that we have a good understanding of who's actually using those solutions and how we can make sure that those solutions are targeted towards the most vulnerable.

So I think that's also an area that needs to be studied a little bit more, but potentially has really big implications for the effectiveness of interventions to reduce the harmful effects of heat exposure and other types of exposures. Yeah, totally. And I might add on to that that like obviously then also SES intersects with whether or not you can easily get to one of those cooling centers too, right? So I mean, exactly what you said about the green gentrification, right? And kind of the role of. affordability. Like, that's huge. But then I'm thinking personally, we had a, we had a heat wave here in Pullman, Washington last summer at like the very start of the school year. And most places here do not have AC because we've not usually had this as an issue. And, you know, I saw, I like shared with some of my students like, hey, the library is one of those spaces that is, you know, it's always cool. It's open late. But I was like, you know, at the same time, not everyone has a car getting to the library.

Like, do you want to get on a hot bus? Do you want to walk in 110 degrees, right? Thinking about just the accessibility of these cooling centers, because I do think they have a huge role in protecting vulnerable populations, but also having enough of them and having them close by where people aren't exposing themselves further to get to them, I think is another kind of tricky piece of the puzzle. Yeah. And the puzzle gets even trickier as you start to look more broadly, not just limiting to the United States, but looking at other populations and other countries worldwide. So, for example, this concept of a cooling center is very relevant in a relatively higher income country like in the U.S. or in Europe.

But I've done a lot of work, for example, in India looking at interventions and development of heat adaptation plans and strategies. And the concept of a cooling center just doesn't really translate in that community because, the most vulnerable populations don't have, you know, the money to pay for a movie theater ticket so that they could go into an air-condition space, for example. So in the development of different adaptation strategies for different communities and different contexts, instead of conceptualizing a building that is a public space with air conditioning, you might conceptualize a public park that stays open for longer hours and provides a green, cool space within a city center so that people have access to cooling, it just looks a little bit different. Or another, for example,

another strategy was at public transportation centers, drinking water, cold drinking water was provided on the hottest days. Turns out that that had really important benefits for different communities that were in transit in those spaces. So I think, you know, the talk about complicating the matter, it increases as you start to increase the scale of what you're thinking about in terms of solutions. So just to wrap up, what are the next big questions that you would like to see answered, whether it's stuff you're working on or in, you know, in an ideal world, what would we be studying to further the issues that you're looking at? Dr. Madenbauer, you want to start with that one? Sure, yeah. So a lot of kind of what I am doing right now is, is really focusing on

those sort of not super, super extreme temperatures because, you know, as we have climatitude, we have more of these extreme weather events, but we also just have an increased warming overall. And one of the things that I'm trying to start looking at is, you know, like, what are just the effects of being, like, uncomfortable? Not necessarily, again, at risk or dangerous, but just feeling uncomfortable. Like, what are the consequences of that? What are who's vulnerable? What are, what, like, at what scale do we need to have a temperature increase for this to show up? And then also, again, the effects of just uncomfortable temperatures on cognition, again, not dangerous. But if you're focusing on how awful you feel because you're like, oh, I hate the heat, it's so hot,

I'm so comfortable. You know, that's like a cognitive load in and of itself. It's a distractor. And so a lot of what I'm kind of turning my research tube is looking at this sort of like less extreme change in temperature, but, you know, noticeable and potentially harmful nonetheless. and then what might be solutions. So like there's an increase in like personal cooling devices. Do we need to just like give people a little like the fan and the water bottle in summer? Does everybody just need to have one of those, right? If you're vulnerable to like changes in temperature.

But even like if it's not, if you're at a level that's not dangerous, can we be teaching people a little bit better have like just emotion regulate, right? Is that actually a viable solution where we're not talking about dangerous heat? And so that's kind of where I think my research is headed, but I think there's there's too many questions. And it's going to take a village of scientists to really kind of understand how do we how do we cope with, you know, all the mental health effects of a changing climate. And Dr. Norris-Sarma, what questions do you want to answer? Yes. And I just want to say that I couldn't agree more with the last part of what Dr. Madenbar said, which is that there are so many questions. All of them are really vitally important in order to make.

sure that communities are more resilient, more well adapted, can cope with the summertime temperatures that we're going to be facing. Because, you know, even if we immediately address the climatic changes that we're seeing in terms of the different regulations that would be required to do so to meet some of these lower overall temperature change thresholds that we've been talking about, we would still experience some version of climate change for the next few decades while things go back to normal. So it's really crucial to make sure that we have these resilient strategies and adaptation strategies in place. So my own research is really focused on leveraging all of these different big data resources

to try and understand the impacts of extreme heat and other climate-related extreme weather on mental health outcomes in different communities and populations. I'm really interested in understanding who is most vulnerable and how we can protect those vulnerable populations. So the previous work that I've done that we've talked about has been focused on people with commercial insurance, but I'm really interested across the U.S. and people who are on public insurance, people who don't have access to health insurance, potential vulnerability among people experiencing homelessness, and how that might

lead to elevated risks for mental health. And then also, I'm really interested in clinicians as potentially on the front line of trying to reduce the adverse mental health impacts of extreme heat exposure. So a lot of my upcoming work is talking with clinicians who are working with patients in different settings, emergency department settings across Boston, hopefully expanding that to look at clinicians who are working across the U.S. at this intersection of environmental risk factors and mental health outcomes to see what they're observing among their patients, what are the patterns that they're seeing, what are the potential points of intervention upstream from visiting an emergency department? So can we find who is the most vulnerable and give them some of the

tools that they need to protect themselves before they need to go to the emergency room? And so, development of those types of relationships in order to partner with the folks who are providing care along the spectrum, I think is really important. Well, I want to thank you both for joining me today. This has been really interesting, and thanks for the important research and work that you are doing. Thank you. Thank you.

It's been great. Thank you so much. I'm really happy that this conversation is happening and looking forward to all of the continued work to be done. And if you'd like to learn more about this topic, check out the article how heat affects the mind in the June issue of APA's magazine, Monitor on Psychology. Go to www.apa.org backslash monitor. You can find previous episodes of Speaking of Psychology on our website at www.

www. speakingof psychology.org or on Apple, Spotify, YouTube, or wherever you get your podcasts. And if you like what you've heard, please subscribe and leave us a review. If you have comments or ideas for future podcasts, you can email us at Speaking of Psychology at APA.org. Speaking of psychology is produced by Lee Wynerman. Thank you for listening. For the American Psychological Association, I'm Kim Mills.

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