Association between air pollution exposure and mental health service use among individuals with first presentations of psychotic and mood disorders: retrospective cohort study

• Published in: British journal of psychiatry 2021-12, Vol.219 (6), p.678-685
• Main Authors: Newbury, Joanne B., Stewart, Robert, Fisher, Helen L., Beevers, Sean, Dajnak, David, Broadbent, Matthew, Pritchard, Megan, Shiode, Narushige, Heslin, Margaret, Hammoud, Ryan, Hotopf, Matthew, Hatch, Stephani L., Mudway, Ian S., Bakolis, Ioannis
• Format: Article
• Language: English
• Subjects: Air; Air Pollutants - adverse effects; Air Pollutants - analysis; Air pollution; Air Pollution - adverse effects; Causality; Censuses; Cohort analysis; Community mental health services; Emotional disorders; Emotions; Environmental Exposure - adverse effects; Environmental Exposure - analysis; Estimates; Ethnicity; Health care expenditures; Health services; Health services utilization; Humans; Inpatient care; Mental Disorders; Mental health; Mental health care; Mental Health Services; Mood; Mood disorders; Mood Disorders - epidemiology; Nitrogen dioxide; Nitrogen Dioxide - adverse effects; Nitrogen Dioxide - analysis; Outdoor air quality; Particulate matter; Particulate Matter - adverse effects; Patients; Pollutants; Population density; Psychiatry; Psychosis; Recurrence; Relapse; Retrospective Studies; Risk; Schizophrenia
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.2021.119

Growing evidence suggests that air pollution exposure may adversely affect the brain and increase risk for psychiatric disorders such as schizophrenia and depression. However, little is known about the potential role of air pollution in severity and relapse following illness onset. To examine the longitudinal association between residential air pollution exposure and mental health service use (an indicator of illness severity and relapse) among individuals with first presentations of psychotic and mood disorders. We identified individuals aged ≥15 years who had first contact with the South London and Maudsley NHS Foundation Trust for psychotic and mood disorders in 2008-2012 (n = 13 887). High-resolution (20 × 20 m) estimates of nitrogen dioxide (NO2), nitrogen oxides (NOx) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. In-patient days and community mental health service (CMHS) events were recorded over 1-year and 7-year follow-up periods. Following covariate adjustment, interquartile range increases in NO2, NOx and PM2.5 were associated with 18% (95% CI 5-34%), 18% (95% CI 5-34%) and 11% (95% CI 3-19%) increased risk for in-patient days after 1 year. Similarly, interquartile range increases in NO2, NOx, PM2.5 and PM10 were associated with 32% (95% CI 25-38%), 31% (95% CI 24-37%), 7% (95% CI 4-11%) and 9% (95% CI 5-14%) increased risk for CMHS events after 1 year. Associations persisted after 7 years. Residential air pollution exposure is associated with increased mental health service use among people recently diagnosed with psychotic and mood disorders. Assuming causality, interventions to reduce air pollution exposure could improve mental health prognoses and reduce healthcare costs.