Long-term Exposure to Ambient Air Pollution and its Association with Mental Well-Being, Depression and Anxiety: A Nationally Representative Study

Authors

  • Lara Pinheiro Guedes Department of Epidemiology. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon. & Public Health Unit. Unidade Local de Saúde Tâmega e Sousa. Amarante. & EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto.
  • Mafalda Sousa-Uva Department of Epidemiology. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon. & Public Health Research Center. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisbon. & Comprehensive Health Research Center. Universidade NOVA de Lisboa. Lisbon.
  • Ricardo Gusmão EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto. & Laboratory for Integrative and Translational Research in Population Health (ITR). Universidade do Porto. Porto. & Department of Public Health and Forensic Sciences, and Medical Education. Faculdade de Medicina. Universidade do Porto. Porto.
  • Clarisse Martinho Public Health Unit. Unidade Local de Saúde Tâmega e Sousa. Amarante.
  • Carlos Matias Dias Department of Epidemiology. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon. & Public Health Research Center. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisbon. & Comprehensive Health Research Center. Universidade NOVA de Lisboa. Lisbon.
  • Virgínia da Conceição EPIUnit. Instituto de Saúde Pública. Universidade do Porto. Porto. & Laboratory for Integrative and Translational Research in Population Health (ITR). Universidade do Porto. Porto.
  • Carlos Gomes Quelhas Public Health Unit Amélia Leitão. Agrupamento de Centros de Saúde de Cascais. Cascais.
  • Daniel Saldanha Resendes Public Health Unit. Unidade Local de Saúde São José. Lisbon.
  • Vânia Gaio Department of Epidemiology. Instituto Nacional de Saúde Doutor Ricardo Jorge. Lisbon. & Public Health Research Center. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisbon. & Comprehensive Health Research Center. Universidade NOVA de Lisboa. Lisbon.

DOI:

https://doi.org/10.20344/amp.21245

Keywords:

Air Pollution/adverse effects, Anxiety Disorders, Depressive Disorders, Environmental Exposure, Mental Health, Particulate Matter/adverse effects, Stress, Psychological

Abstract

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.

Downloads

Download data is not yet available.

References

Manisalidis I, Stavropoulou E, Stavropoulos A, Bezirtzoglou E. Environmental and health impacts of air pollution: a review. Front Public Health. 2020;8:14. DOI: https://doi.org/10.3389/fpubh.2020.00014

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. DOI: https://doi.org/10.1186/s12889-021-10557-7

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. DOI: https://doi.org/10.1016/j.envpol.2021.118245

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. DOI: https://doi.org/10.1007/s11356-021-12357-3

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. DOI: https://doi.org/10.1016/j.psychres.2019.04.019

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. DOI: https://doi.org/10.1289/EHP4595

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. DOI: https://doi.org/10.1515/reveh-2020-0125

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. DOI: https://doi.org/10.1017/S0033291722003890

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. DOI: https://doi.org/10.1016/j.neuro.2022.10.011

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. DOI: https://doi.org/10.3389/fpubh.2020.575330

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. DOI: https://doi.org/10.1016/j.neuint.2021.104989

Salvi A, Liu H, Salim S. Involvement of oxidative stress and mitochondrial mechanisms in air pollution-related neurobiological impairments. Neurobiol Stress. 2020;12:100205. DOI: https://doi.org/10.1016/j.ynstr.2019.100205

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. DOI: https://doi.org/10.1016/j.envres.2019.108717

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. DOI: https://doi.org/10.3389/fpubh.2019.00332

Read JR, Sharpe L, Modini M, Dear BF. Multimorbidity and depression: a systematic review and meta-analysis. J Affect Disord. 2017;221:36-46. DOI: https://doi.org/10.1016/j.jad.2017.06.009

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. DOI: https://doi.org/10.1093/pubmed/fdy150

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. DOI: https://doi.org/10.1007/s11869-021-01007-9

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. DOI: https://doi.org/10.1016/j.repc.2022.02.011

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. DOI: https://doi.org/10.1093/eurpub/ckab190

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. DOI: https://doi.org/10.1097/00005650-199102000-00008

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. DOI: https://doi.org/10.1177/0033294119850490

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. DOI: https://doi.org/10.1016/S0165-1781(01)00329-8

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. DOI: https://doi.org/10.1016/j.psychres.2008.05.012

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. DOI: https://doi.org/10.1177/0020764017744582

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. DOI: https://doi.org/10.1289/ehp.1206337

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. DOI: https://doi.org/10.1371/journal.pone.0208320

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. DOI: https://doi.org/10.1177/1536867X1201200202

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. DOI: https://doi.org/10.3390/diagnostics12112851

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. DOI: https://doi.org/10.1016/j.scitotenv.2020.143960

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. DOI: https://doi.org/10.1001/jamapsychiatry.2022.4812

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. DOI: https://doi.org/10.1016/j.jth.2021.101012

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. DOI: https://doi.org/10.1111/j.1532-5415.2007.01108.x

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. DOI: https://doi.org/10.1038/s41598-019-45432-4

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. DOI: https://doi.org/10.3390/ijerph15071382

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. DOI: https://doi.org/10.1016/0895-4356(94)90190-2

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. DOI: https://doi.org/10.11613/BM.2017.030201

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. DOI: https://doi.org/10.3390/ijerph18147699

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. DOI: https://doi.org/10.1016/j.jpsychires.2022.04.025

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. DOI: https://doi.org/10.1001/jamapsychiatry.2016.1921

Lipfert FW. Air pollution and mortality: timing is everything. Atmosphere. 2020;11:1274. DOI: https://doi.org/10.3390/atmos11121274

Published

2024-07-22

How to Cite

1.
Pinheiro Guedes L, Sousa-Uva M, Gusmão R, Martinho C, Matias Dias C, da Conceição V, Gomes Quelhas C, Saldanha Resendes D, Gaio V. Long-term Exposure to Ambient Air Pollution and its Association with Mental Well-Being, Depression and Anxiety: A Nationally Representative Study. Acta Med Port [Internet]. 2024 Jul. 22 [cited 2024 Dec. 13];37(9):589-600. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/21245

Issue

Section

Original