
- Psychiatric Times Vol 36, Issue 2
- Volume 36
- Issue 2
Trouble in Paradise: Carbon-Fuel Air Pollution Linked to Disorders Across the Lifespan
We cannot protect our patients without protecting our planet. This means a personal and professional commitment to green our activities by considering the carbon effects of how we do our work.
The flames that swept through
What is air pollution?
The particles that make up air pollution are organized by size, from ultrafine particles (UFPs) 1 micron in diameter to PM 2.5 and PM 10, which are 25 and 100 times larger, respectively. They share a similar structure: various (poly) circular (aromatic) hydrocarbons (PAHs) with a high surface charge bind to a core of organic carbon-the carbon naturally in the air-that attracts heavy me- tal ions and oxidative elements, which allows them to aggregate into the particles of various sizes (
Ultrafine particles and PM 2.5’s enter the brain by mechanisms that include vascular uptake and transport across the blood-brain barrier and retrograde neuronal transport similar to the herpes virus, along both pulmonary nerves that track to the vagal system and through the olfactory bulb. Ultrafine particles can penetrate the cell nucleus, causing both epigenetic changes and oxidatative damage.
Air pollution and children
Studies of the effects of these air pollution particles show dramatic effects across the lifespan, including impaired fetal growth in utero and smaller head circumference at birth, decreased scores for verbal and nonverbal intelligence, memory restriction, and poor performance on tests of visual reaction time, pursuit aiming, and others by ages 8 to 11 years.1,2
There are associations with a wide range of developmental disorders including autism, ADHD, learning disorders and other disorders of child behavior.3
In parallel to Perera’s work on the topic,
In a
Using transmission electron microscopy, the researchers documented UFPs-strongly magnetic combustion-derived nanoparticles (CDNPs)-present in the neurons, glia, choroid plexus, and neurovascular units of young Mexico City residents compared with matched clean air controls. CDNPs were associated with pathology in mitochondria, endoplasmic reticulum, mitochondria-endoplasmic reticulum contacts (MERCs), axons, and dendrites. The researchers concluded that “exposed children and young adults need early neuroprotection and multidisciplinary prevention efforts to modify the course of Alzheimer disease at early stages.”
General health impacts
With the frequent fires and increasing carbon in the air, many American adults now also have urgent questions for their doctors about how air pollution may be affecting their health, and for their psychiatrists, their brains. Fortunately, there is a beautifully curated and frequently updated source for all the articles documenting these effects, run by
The systemic inflammatory reaction to air pollution is similar to that of cigarette smoke and raises mortality at any level of the air pollution index, even those rated acceptable by the EPA.7 Air pollution increases the risk for pulmonary illnesses, particularly asthma and COPD.8 Moreover, it is associated with stroke and myocardial infarction; cancers such as brain, breast, lung, prostate, stomach, and childhood leukemia; and other physical illness.
Increasingly, the psychological stress of being unable to escape exposure to air pollution contributes to morbidity. The total mortality burden of particle and ozone pollution is estimated at 5.5 million premature deaths per year.9 In the US, the cost of air pollution damage has been estimated at $131 billion per year, most due to health effects, and would be expected to climb this year.10
Air pollution and dementia
The link between air pollution and dementia is similarly dire, with further evidence of impact found in several large studies published in 2017 and 2018. Previous studies have established strong associations between air pollution exposure and cognitive decline in older adults.
Given that many locations are regularly experiencing increases in particle count that are 5 to 20 times higher than this, one might extrapolate to 1- to 4-point drops in global cognitive scoring every 6 years in several affected areas, if this linear relationship were to hold. Using MRI studies and data from EPA monitoring sites,
Most recently, in the more naturalistic setting of looking at records of primary care practices in London,
Conclusion and recommendations
Comparable risk factors for dementia include lower education, hearing loss, isolation, depression, hypertension, diabetes, obesity, smoking, and inactivity (
Patients should know about the importance of air pollution for the brain. They can learn to track local air quality levels through sites such as
At a professional level, we must advocate for clean air policies that reduce fossil fuel combustion as avidly as we work for smoking cessation. While it can be harder to conceptualize one’s oil heater as a toxin comparable to a cigarette, we must find ways to connect these dots in our own minds and in those of our patients, so that the mental image associated with the word “inhale” is as closely connected to fossil fuel use as to the puff of smoke at the end of a cigarette. These conceptual changes can be difficult to make but are facilitated by concrete visible measures such as tracking AQI data in one’s home. Such measures shift awareness and begin a process of reflection that precedes personal change.
Air pollution is inextricably linked to climate change, which is the result of fossil fuel combustion and the cause of temperature and wind and weather changes that make large fires ever more likely. We cannot protect our patients without protecting our planet. This means a personal and professional commitment to green our activities by considering the carbon effects of how we do our work. We can reduce the carbon footprint of our inpatient units, through smaller units, efficiencies of staff transport, and other measures. We can consider alternatives when we use medications with particularly large carbon footprints or changing medications often. We can lessen the distance and frequency of travel both for ourselves and for our patients by living close to our work sites and by taking ourselves to rural settings rather than having each patient come to us. We can bring our personal and our profession’s financial practices in line with this awareness, divesting of assets that worsen patient health in direct and significant ways.
Disclosures:
Dr Haase is Associate Professor of Psychiatry, University of Nevada School of Medicine at Reno, and Medical Director, Carson Tahoe Outpatient Behavioral Health.
References:
1. Suglia SF, Gryparis A, Wright RO, et al.
2. Wang S, Zhang J, Zeng X, Chen S.
3. Peterson BS, Rauh VA, Bansal R, et al.
4. Perera F.
5. Calderón-Garcidueñas L, Leray E, Heydarpour P, et al.
6. Calderon-Garciduenas L, Gonzalez-Heredia T, Acuna-Ayala H, et al.
7. Di Q, Wang Y, Zanobetti A, et al.
8. Ozlem KK, Zhang JJ, Pinkerton KE.
9. Global Disease Collaborative Network.
10. Jaramillo P, Muller N.
11. Weuve J, Puett RC, Schwartz J, et al.
12. Chen JC, Wang XH, Wellenius GA, et al.
13. Best EA, Juarez-Colunga E, James K, et al.
14. Cacciottolo M, Wang X, Driscoll I, et al.
15. Carey IM, Anderson HR, Atkinson RW, et al.
16. Livingston G, Sommerlad A, Ortega V, et al.
Articles in this issue
over 6 years ago
Introduction: Convergence of Thought?over 6 years ago
Immunotherapy as Personalized Medicine for Schizophrenia?over 6 years ago
Project Untangled: A Journey of Hope and Healingover 6 years ago
Anxiety Disorders in Children and Adolescents: New Findingsover 6 years ago
Coaching Families to Address Addictionover 6 years ago
Embracing Changesover 6 years ago
US Life Expectancy: The Mental Health Perspectiveover 6 years ago
The Changing Face of Psychiatry in the Age of Climate ChangeNewsletter
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