These questions are for self-study only. Answers will not be evaluated or saved. Apply your knowledge of climate justice and clinical interventions.
Question 1
An undocumented farmworker presents with anxiety and depression following crop failures from drought. Which factors create intersecting vulnerabilities for this patient's mental health? (Select all that apply)
This patient exemplifies intersecting vulnerabilities. As a farmworker, they face occupational stress from climate-related crop failures and economic instability. Their undocumented status creates fear of seeking help and potential ineligibility for disaster assistance. Language barriers may limit access to mental health services and information. Understanding these compounding factors is essential for providing trauma-informed, equity-centered care. Your approach should address immigration-related fears, provide language-appropriate services, and connect to community resources.
Question 2
A 19-year-old college student tells you: "I'm so anxious about climate change that I can barely focus on studying. What's the point of getting a degree if the world is ending?" What is your best initial response?
This response demonstrates the key therapeutic principles for eco-anxiety:
- Validation: Acknowledging that climate concern is rational and adaptive
- Assessment: Determining whether the distress is proportional and functional vs. impairing.
After validation and assessment, you can explore connecting the patient to climate action and collective efforts.
- Option A: Dismisses valid concerns.
- Option B: Over-pathologizes a potentially adaptive response, and
- Option C: Suggests avoidance rather than healthy engagement.
Question 3
According to research on disaster mental health recovery, which factor is among the strongest predictors of positive mental health outcomes?
Research consistently demonstrates that social capital and social support are among the strongest predictors of mental health recovery following disasters. Communities with strong social networks, trusted institutions, and collective efficacy experience better mental health outcomes. This is why community resilience interventions—support groups, peer support programs, and social prescribing—are so important. While the other factors can contribute to outcomes, social connection is uniquely powerful for psychological recovery.
Think about this
What is one concrete action you can take—in your clinical practice, your advocacy, or your personal life—to address climate mental health?
Final integration
You are Dr. Chen, a family medicine physician in a coastal community. It’s been four months since a major hurricane. Today you see the following patients:
Mother brings him for “acting out” at school. He’s having nightmares about the hurricane, refuses to sleep alone, and becomes agitated when it rains. The family is still in temporary housing.
She feels “lost” since the hurricane destroyed her home of 40 years. She’s living with her daughter but feels like a burden. She’s stopped attending church and her card club. “I just don’t feel like myself anymore,” she says. “That house was my whole life.”
College student with severe anxiety about climate change that interferes with studying. He’s considering dropping out because “there’s no point in a future career when everything is collapsing.”
Maddie is a new mother who is concerned about bringing up her new baby, Olivia in a world with a changing climate. She thinks her post-partum depression is worsening. She says, “I don’t know how to be happy with my new daughter.”
Reflection questions
- What are your primary diagnostic considerations for each patient?
- What screening tools would you use?
- What individual interventions would you recommend?
- How would you address social and practical needs?
- What community resources might be helpful?
- How do equity considerations apply to each case?
Suggested approaches
Screening: Use age-appropriate PTSD screening (CPSS-5: Child PTSD Symptom Scale).
Diagnosis: Likely PTSD with trauma reminders triggered by rain/weather.
Individual interventions:
- Refer for trauma-focused CBT adapted for children.
- Involve parents in treatment: Assess their mental health, too.
- Provide psychoeducation about normal disaster reactions in children.
Social/practical needs: Address housing instability as a major social determinant (temporary housing perpetuates trauma).
Community resources: School-based counseling, pediatric disaster mental health services
Equity considerations: Families in temporary housing face compounded vulnerabilities; ensure Marcus has equal access to school-based mental health services.
Screening: PHQ-9 for depression, assess for suicidal ideation.
Diagnosis: Major depression with features of solastalgia (grief over lost home/identity) and loss of social supports.
Individual interventions:
- Consider SSRI and/or therapy.
- Validate her grief: “That house wasn’t just walls—it held 40 years of your memories and identity.”
- Social prescribing: Actively work to reconnect her to church and card club
Social/practical needs: Living situation creating strain; explore housing options that provide autonomy.
Community resources: Senior centers, faith community, disaster recovery support groups.
Equity considerations: Older adults may face barriers to accessing services; may need home visits or transportation assistance.
Screening: GAD-7 and PHQ-9 to assess for anxiety/depression disorders.
Diagnosis: Generalized Anxiety Disorder with climate change as primary focus.
Individual interventions:
- Validate: “Your concern about climate change is completely rational—it shows you understand what’s happening.”
- Assess function: Is the distress impairing his ability to live according to his values?
- Explore action: “What climate actions are you taking? Being involved often helps people feel less helpless.”
- Consider CBT or ACT (Acceptance and Commitment Therapy) approaches.
- Connect to campus climate action groups—collective action reduces anxiety.
Social/practical needs: If anxiety severely impairs academics, provide disability documentation.
Community resources:
- Campus mental health services.
- Environmental/sustainability clubs.
- Climate advocacy organizations.
Equity considerations: Young people bear disproportionate burden of climate futures they didn’t create; validate intergenerational injustice while fostering agency.
Screening: ?
Diagnosis: ?
Individual interventions:
- Validate: ?
- Assess function: ?
- Explore action: ?
Social/practical needs: ?
Community resources: ?
Equity considerations: ?
Key takeaways
Next steps for learning
- Work with disaster-affected populations.
- Volunteer with climate organizations.
Complete Psychological First Aid training.
Follow emerging research on climate and mental health.
Use your voice as a future physician to support climate action and health equity.
Final thoughts
"The greatest threat to our planet is the belief that someone else will save it."
You are not “someone else.” You are future physicians who will encounter climate-related mental health impacts throughout your careers. You have the knowledge, the skills, and the credibility to make a difference—in individual patient encounters, in community resilience, and in advocacy for systemic change.
Climate change is overwhelming. But remember you don’t have to solve the whole problem. Focus on what you can control:
- The compassion you show to the patient whose home burned in a wildfire.
- The support group you help establish for disaster survivors.
- The screening question you add about climate-related stress.
- The collective action you engage in with others.
These actions matter. They create ripples of resilience in your communities and meaning in your own life.
"In the end, we will conserve only what we love, we will love only what we understand, and we will understand only what we are taught."
You are now equipped to recognize, assess, and address the mental health impacts of climate change in your future patients. Use this knowledge with care and intention to create meaningful change—one patient, one community, one action at a time.
- Psychological First Aid: Free training at NCTSN PFA Training.
- Climate Psychiatry Alliance.
- Lancet Countdown.
- SAMHSA Disaster Resources.
- Medical Society Consortium on Climate and Health.
- Climate Migration Resources. Migration Policy Institute.
- Climate displacement: Forced movement of people due to environmental changes linked to climate change.
- Eco-anxiety: Chronic fear and worry about environmental doom and the future of the planet; a rational response to climate change, not a mental disorder.
- Ecological grief: Emotional distress from observing environmental degradation, biodiversity loss, and ecosystem collapse.
- EMDR: Eye Movement Desensitization and Reprocessing; evidence-based trauma therapy.
- Psychological First Aid (PFA): Evidence-informed approach for supporting people in acute distress after disasters.
- Social prescribing: Prescribing non-medical interventions like community activities, volunteer work, or support groups to address health needs.
- Solastalgia: Distress experienced when one’s home environment undergoes negative transformation; like nostalgia, but for a place that’s changing around you while you’re still there.
- TF-CBT: Trauma-Focused Cognitive Behavioral Therapy; gold standard treatment for PTSD.
- The “Second Storm”: The surge of mental health impacts (PTSD, depression, anxiety) that follows the physical devastation of climate disasters.
Image credits
Unless otherwise noted, images are from Adobe Stock.
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