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

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)678-685
Number of pages8
JournalBritish Journal of Psychiatry
Volume219
Issue number6
Early online date19 Aug 2021
DOIs
Accepted/In press2021
E-pub ahead of print19 Aug 2021
Published18 Dec 2021

Bibliographical note

Funding Information: J.B.N. is supported by a Sir Henry Wellcome Postdoctoral Fellowship from the Wellcome Trust (218632/Z/19/Z) and was also supported by a Postdoctoral Fellowship (ES/S011196/1) from the Economic and Social Research Council (ESRC) and an Early Career Bridging and Career Development Grant (IS-BRC-1215-20018) from the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) during the course of this research. This study therefore represents independent research part funded by the NIHR Maudsley BRC at the South London and Maudsley NHS Foundation Trust and King's College London. I.B., M.H. and S.L.H. are supported by the NIHR Maudsley BRC and I.B. and R.S. are supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust, King's College London. This work was further supported by the UK Medical Research Council via the MRC Centre for Environment and Health. H.L.F., S.L.H. and N.S. are supported by the ESRC Centre for Society and Mental Health at King's College London (ES/S012567/1). I.S.M.'s involvement in this study was part funded by the NIHR Health Protection Research Unit in Environmental Exposures and Health, a partnership between Public Health England and Imperial College London. M.H. is supported by multiple grants from NIHR. The views expressed are those of the authors and not necessarily those of the ESRC, King's College London, the NHS, the NIHR or the Department of Health and Social Care. Funding Information: J.B.N. is supported by a Sir Henry Wellcome Postdoctoral Fellowship from the Wellcome Trust (218632/Z/19/Z) and was also supported by a Postdoctoral Fellowship (ES/S011196/1) from the Economic and Social Research Council (ESRC) and an Early Career Bridging and Career Development Grant (IS-BRC-1215-20018) from the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) during the course of this research. This study therefore represents independent research part funded by the NIHR Maudsley BRC at the South London and Maudsley NHS Foundation Trust and King’s College London. I.B., M.H. and S.L.H. are supported by the NIHR Maudsley BRC and I.B. and R.S. are supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South London at King’s College Hospital NHS Foundation Trust, King’s College London. This work was further supported by the UK Medical Research Council via the MRC Centre for Environment and Health. H.L.F., S.L.H. and N.S. are supported by the ESRC Centre for Society and Mental Health at King’s College London (ES/S012567/1). I.S.M.’s involvement in this study was part funded by the NIHR Health Protection Research Unit in Environmental Exposures and Health, a partnership between Public Health England and Imperial College London. M.H. is supported by multiple grants from NIHR. The views expressed are those of the authors and not necessarily those of the ESRC, King’s College London, the NHS, the NIHR or the Department of Health and Social Care. Publisher Copyright: Copyright © The Author(s), 2021.

King's Authors

Abstract

Background 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. Aims 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. Method 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. Results 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. Conclusions 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.

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