Introduction

Rising temperatures, extreme weather, and ecosystem disruptions due to global warming have major impacts on human physical [1] and mental health [2]. Negative emotions about climate change (i.e., “climate distress”) are common and linked to experiencing acute weather events (e.g., hurricane, flood, heatwave, which increase in frequency and severity due to global warming), chronic climate change effects (e.g., biodiversity loss, changing landscapes) or climate change awareness [3–7]. Over 60% of youth worldwide experience climate distress [3], and between 5–27% of individuals with climate distress [8–10] experience adverse psychiatric symptoms such as impaired sleep or intrusive thoughts [11].

While substantial research examines mental health impacts of acute weather events (e.g., [12,13]), relatively little addresses distress associated with chronic climate change effects and climate change awareness [6]. Recent work has documented links between negative climate emotions and poor mental health, such as clinical depression and anxiety [14,15]. Some research has begun identifying protective mechanisms [14,16], contributors to psychological resilience [17], and opportunities for screening and intervention [18,19]. Scientific interest in climate distress is growing rapidly. A PubMed search performed by the authors retrieved 2596 manuscripts addressing “climate anxiety” or “climate distress” published between 1959–2024, with over 50% published after 2020.

Climate distress poses a systemic challenge that implicates the many sectors involved in climate action [20]. For instance, food systems vulnerabilities [21], trade and economic disruptions [20], and sociopolitical unrest [22] due to climate change also result in heightened stress and psychological distress. Experts increasingly recognize that the mental health co-benefits of actions to mitigate and adapt to climate change and emphasize a focus on long-term social and psychological resilience [23]. Furthermore, climate actions targeted specifically to protecting health (“health adaptation”) have been identified as key corollaries to climate-focused adaptation [24]. The inclusion of mental health in the sixth Intergovernmental Panel on Climate Change was lauded as a critical advance [25], highlighting its central importance and interest to the climate science community at large.

Much of the published biomedical and public health research relevant to climate distress focuses on ascertaining or quantifying the mental health impacts related to climate change, with relatively less attention focused on actionable implications for climate and health adaptation [24]. By contrast, research focused on climate adaptation demonstrate insufficient integration of on-the-ground, community-based public health expertise relevant to mental health [26]. Indeed, the multiple practice-based sectors with which public health is frequently engaged, including but not limited to education, community-based organizations, and clinical care [27–29], are actively engaged in addressing negative climate emotions. Unfortunately, the majority of extant research fails to include this interdisciplinary, applied expertise, disproportionately favoring epidemiological research [30,31] while neglecting practice-based input. Calls for increased interdisciplinary integration to drive effective climate and health adaptation efforts [20,24] can be met by drawing on and learning from the wealth of public health and practice-based expertise.

It is critical for climate change work to transcend disciplinary divides and overlap with community-based participatory research, co-production, and translation science [32]. The current paper contributes to advance this literature. We present results from a series of focus groups with multidisciplinary perspectives on health adaptation priorities for addressing climate distress. Findings highlight immediate opportunities for collaborative action and provide an overarching, interdisciplinary framework to guide future work.

Materials and methods

Study design

The current study uses data from five 60-minute focus groups (Table 1). Focus groups were organized by disciplinary field in order to foster conversation and avoid misunderstandings due to field-specific terminology or norms. Data were analyzed using a content analysis framework [33]. The study’s adherence to consolidated criteria for reporting qualitative studies are reported in S1 Appendix.

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Table 1. Focus group recruitment.

https://doi.org/10.1371/journal.pclm.0000833.t001

Results

Participants (N = 27) were professionals in the United States and Canada exposed to and/or engaged in addressing young adult climate distress through their work (Table 2). Three themes emerged regarding interdisciplinary opportunities for action (Knowledge Generation, Framing and Communication, Resource Allocation). In addition, two meta-themes emerged which went beyond our research question to address underlying principles to guide the process of climate distress action (Most-Impacted Populations, Systemic Change).

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Table 2. Description of focus group participants.

https://doi.org/10.1371/journal.pclm.0000833.t002

Theme 3. Resource Allocation: Strategies to optimize co-benefits of climate and health actions in under-resourced settings

Across focus groups, participants noted the critical role of funding and discussed resource allocation strategies. Three potential directions emerged.

First, participants discussed the need for increased resources and highlighted the need for public health data to “create more funding opportunities.” Many participants (e.g., public health professionals, social scientists) worked within grant-funded programs in which data demonstrating public health impact are critical. The lack of epidemiological data on climate distress represented a notable barrier to seeking new funding sources.

Second, participants discussed integrating climate distress into ongoing work. Rather than developing new programs, professionals could integrate climate distress into existing programs supporting “wellbeing in general” and “trauma informed work”.

Third, clinicians in particular described the potential role of health insurance in supporting climate distress treatment. One noted, “There needs to be some way for insurance to…ensure that people feel like this is a thing that they can actually seek therapy for.” Another commented about “folks needing to use or wanting to use insurance…[I] don’t want to pathologize a very real condition that likely generates mental health distress. But…you have to for payment insurance purposes.” While we note the potential role of health insurance in supporting climate distress treatment, we discuss the downsides of pathologizing climate distress below.

We summarize these three themes and their respective sub-themes, present exemplar quotes, and note the disciplinary fields in which they were discussed in Table 3.

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Table 3. Summary of themes with exemplar quotes.

https://doi.org/10.1371/journal.pclm.0000833.t003

Discussion

This paper presents a guiding framework intended to assist professionals in public health and related disciplines in identifying collaborative opportunities to address adolescent and young adult climate distress. Our qualitative study contributes to addressing the relative dearth of research on chronic climate change exposures and awareness and leverages public health perspectives to inform health-focused climate adaptation [6,30,31]. The ability for public health practitioners to engage in community-based participatory research, practice, and design to advance climate and health adaptation is underutilized, particularly with respect to supporting mental health—despite its notable potential for building community capacity and power towards health equity [35].

We summarize our results in a visual framework (Fig 1). The top of the figure highlights multiple sectors involved in supporting mental well-being amidst climate change, though the list is not exhaustive. Arrows direct professional energy towards the three shared interdisciplinary priorities: Knowledge Generation, Framing & Communication, and Resource Allocation. These shared priorities help unify disparate disciplines. Two guiding principles (Center Most-Impacted Populations, Focus on Systemic Change) are fundamental in the pathway. Under each shared priority are listed specific action areas. Listed action areas remain broad, allowing for discipline-specific expertise to inform choices.

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Fig 1. Visual summary of results.

https://doi.org/10.1371/journal.pclm.0000833.g001

One key takeaway from the framework is that interdisciplinary collaboration is critical to achieve transdisciplinary progress. This finding emerged through the qualitative data as well as the rich knowledge that emerged within our interdisciplinary study team. Experts highlight interdisciplinary collaboration as critical in effectively supporting mental health in the face of climate change [36,37]. The process of developing and disseminating climate distress treatments may be illustrative. Such treatments require etiologic research (social and health scientists) as well as clinical expertise (clinicians). Their dissemination and implementation requires collaboration with community leaders. This process is consistent with theories describing transdisciplinary work, which emphasizes building and collaboration such that each discipline simultaneously contributes and evolves [32,35]. Rooting climate distress work in transdisciplinary practices also emphasizes the importance of community-led programming and policy supported by multi-sector agencies.

The proposed framework provides an organizing structure and shared language intended to guide and organize cross-sectoral climate and health adaptation [20]. Few contest that climate change is a systemic issue requiring collaborative, interdisciplinary solutions. For instance, prior work has illustrated links between food security, extreme weather, and mental well-being [21]. Experts then encourage systemic collaboration to develop new policies. The current framework offers an alternate approach by outlining priorities shared across disciplines that reflect existing work and interests. This allows professionals currently engaged in distinct projects to understand areas of overlap. Our framework thus has the potential to accelerate and catalyze action to address psychological distress linked to climate change by providing professionals across sectors with a shared language for understanding and situating their work within the broader landscape of climate adaptation. We encourage professionals engaged in climate adaptation who do not see themselves as addressing mental health, as well as mental health professionals who do not see themselves as addressing climate change, to examine their work and skills using the proposed framework to identify opportunities for cross-sectoral collaboration in support of climate adaptation.

The current framework, while specific to psychological distress linked to climate change, remains broad in its definition of shared priorities and action areas. While broad in nature, this approach ensures an inclusive umbrella for health adaptation under which a range of professionals can see themselves. For instance, social scientists conducting population health research as well as clinicians or community leaders with front-line experience can view themselves as engaged in “Knowledge Generation.” We believe this approach can support greater engagement and inclusion in climate adaptation efforts across fields.

Successful cross-sectoral climate adaptation demands systems-level thinking and approach. This lies in contrast to prior strategies focused on individual pro-environmental behaviors (e.g., [38,39]) or individual-level characteristics and risk-factors [7]. This tension is particularly notable in the context of mental distress and well-being, given the historic focus on individuals via diagnostic criteria, symptoms, and treatment. Indeed, the need for systemic change emerged as an unexpected theme across disciplinary perspectives and highlights an understudied tension between climate distress as an individual as opposed to a structural issue. On the one hand, clinical language can be used to characterize and treat symptoms of climate distress (e.g., intrusive thoughts, poor sleep, anxiety [40]). Participants largely agreed on the importance of providing evidence-based mental health treatment to meet individual needs. On the other hand, participants acknowledged that such interventions, by not addressing the underlying cause (i.e., climate change), remained incomplete without corollary systemic action. Current emphasis on climate distress as an individual menta health issue ignores the deep link between climate distress and environmental justice, as highlighted by Meta-Theme 1: Most-Impacted Populations.

Such tensions mirror growing concern about whether a biomedical approach to psychological well-being is sufficient to achieve population mental health [41]. As highlighted by focus group participants, the forces shaping individual mental health in the modern world go beyond the individual’s sphere of influence. Multiple participants observed that other societal issues, such as gun violence or political polarization, can also shape mental health via chronic exposures and awareness. Yet, population health structures ranging from diagnostic criteria, treatment allocation, and insurance billing largely rest on the individual-focused biomedical model. Focus group discussions highlighted how effectively addressing climate distress may require a broader discussion regarding societal approaches to mental health and well-being.

Consequently, addressing mental well-being linked to climate change will require shifting the conversation away from a biomedical disease model towards a strengths-based resilience framework. Structural resilience aims to support individual agency within competing structural stressors [41,42]. Resilience theory focuses on disrupting the link between negative stressors and negative outcomes to achieve better psychological outcomes [43]. Substantial literature on acute weather events is grounded in resilience theory (e.g., [44,45]), informed by the expertise among professionals engaged in climate adaptation and mitigation with regards to community-level resilience and the importance of structural interventions.. Yet, such approaches remain secondary in the mental health field. There thus exists powerful opportunities for synergistic collaboration across fields to better support mental health amidst collective stressors such as climate change.

Findings emphasizing the importance of agency and collective efficacy hold implications for institutions concerned with supporting mental health, including but not limited to governments, NGOs, and educational institutions. Supporting “realistic hope” by encouraging collective action emerged as a central to effective framing and communication of climate change information. On the ground, this may translate into integrating concrete opportunities for civic action within climate curricula; this would be a departure from current approaches focused on increasing students’ scientific knowledge of the drivers and consequences of global warming [46]. Lesson plans and curriculum (e.g., [47]) that support project-based learning may be more effective in preparing students for a green workforce. Given the importance of local, on-the-ground action, state and local governments may provide critical funding and resources to community-based climate adaptation projects, rather than providing top-down directive guidance.

Furthermore, supporting self-efficacy and resilience through climate adaptation projects is likely to produce mental health co-benefits [48]. To date, mental health is an understudied outcome of climate change [25,49]. This has clear implications for public health, which is consequently limited in its ability to mitigate or intervene to prevent poor health outcomes, or to participate in health adaptation relevant to climate. This also has clear implications for climate adaptation work. Failing to account for the mental health co-benefits raises the risk of underestimating the positive impacts of investment in climate adaptation. Adaptation specialists may draw on our proposed framework to identify opportunities to integrate mental health into the development and evaluation of national adaptation plans [48].

This study had several limitations. First, convenience sampling may have narrowed the perspective, despite successful recruitment across a range of settings (e.g., rural, politically conservative, non-US). Multiple clinician focus groups may have resulted in greater emphasis on clinical perspectives. Second, participants did not differentiate between climate impacts specific to greenhouse gases (i.e., climate change) and ecological degradation more broadly (e.g., air pollution, biodiversity loss). Third, disciplinary differences were minimized within focus groups in order to avoid potential differences in professional language and norms that could obstruct lively and organic discussion. With these three limitations in mind, future research may build on the current study by convening repeated, interdisciplinary focus groups to foster conversation across sectors.

Finally, these conversations occurred prior to the 2024 U.S. presidential election, before shifts in federal climate policy. While there may be concerns that our findings are no longer relevant given the changed circumstances, we argue the opposite is true. Indeed, the opportunities raised by participants (e.g., build local community, integrate climate work into neighboring fields) offer helpful guidance for navigating the current political landscape. Participants mentioned suggestions for how to support community needs and communicate across political leanings by using language that connects with individuals and centers what is important to them.

Creative, interdisciplinary action to mitigate the mental health impacts of climate change is more important today than ever before with communities facing increasing and compounding mental health challenges and climate events. Participants’ discussions of sensitive populations highlight the critical need for future work to be (1) cross-cultural, (2) involve multiple languages, and (3) consider multiple countries. To avoid exacerbating existing systemic challenges, it will be important to prioritize community-directed solutions that build local capacity [50]. Existing frameworks, such as afro-indigenous futurism frameworks [51], may support the demand to the “hold two truths” of hope alongside reality. Continued work to quantify the public health burden of climate distress, modifiable risk factors, and downstream health outcomes is critical. Multiple participants noted the foundational role of robust qualitative and quantitative data in knowledge generation, communication, and resource allocation, as well as a lack of representative, population-level data on climate distress. It will be important for future research to address this gap.

Our results emphasize that the communities most impacted by climate change must be “at the table” to effectively address climate distress. Mitigating the mental health impacts of chronic climate change requires preventive measures that address systemic root causes, with particular attention to minimizing the dissonance between the known threats of climate change, local community values, and collective action. Such action may occur within local communities and need not rely on federal or national action. Mental health and climate change work may be integrated into ongoing programs and frameworks as opposed to addressed as a separate issue. Finally, public health framing and communication around climate distress must avoid pathologizing the “valid and adaptive” response of climate distress and overemphasizing individual responsibility or treatment. Mental health is a critical aspect of climate adaptation with notable potential for synergistic benefits that will benefit from continued attention across disciplinary perspectives.

Supporting information

Acknowledgments

We would like to thank our undergraduate research assistants Amal Deria, Cordelia Plymale, and Mallory Sparks for their invaluable contributions to this project. Thanks to Cat Hartwell and Meg Yoder for providing additional perspectives on the manuscript from local public health and the earth sciences.

Most importantly, we thank our participants for sharing their time and expertise.