Surveillance and Monitoring

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Headshot of Anne Grossman, MD, FACP · Assistant Professor, Medical Education and Clinical Sciences
Anne Grossman
MD, FACP · Assistant Professor, Medical Education and Clinical Sciences
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Effective public health response requires surveillance systems to track trends, identify vulnerable populations, allocate resources, and evaluate interventions.^31,32^

Why Surveillance Matters

Climate-related mental health surveillance serves several critical functions:

  • Early detection of emerging mental health crises before they become severe
  • Resource allocation to direct services where they’re most needed
  • Identification of vulnerable populations requiring targeted intervention
  • Evaluation of interventions to assess what’s working
  • Trend analysis to understand how the burden evolves over time

Surveillance Approaches

Public health systems use multiple complementary approaches:^31,32^

Traditional epidemiological surveillance tracks emergency department visits and hospital admissions for mental health conditions, insurance claims data, and suicide rates to identify patterns over time.

Population-based surveys assess mental health in affected communities using validated screening tools (such as the PHQ-9 for depression, PCL-5 for PTSD, and GAD-7 for anxiety), often stratified by climate exposure level.

Syndromic surveillance monitors real-time indicators including crisis hotline call volumes, emergency medical services dispatches for psychiatric emergencies, and patterns in emergency department chief complaints related to mental distress.

Research using these methods has documented clear relationships between climate stressors and mental health outcomes, such as associations between extreme heat and increased suicide rates, and between agricultural losses and farmer mental health crises.

Key Indicators Across Disaster Timeline

Time Period

Key Mental Health Indicators

Pre-Event (Baseline)

Mental health service use, suicide rates, prescription patterns

Acute (0-30 days)

Crisis hotline calls, ED visits, acute stress reactions

Recovery (1-6 months)

PTSD, depression, anxiety disorders, substance use

Long-term (6+ months)

Chronic mental health conditions, functional outcomes

Equity in Surveillance

Surveillance systems must be designed to capture disparities. This requires disaggregating data by race, ethnicity, income, age, and geography; partnering with community organizations to reach marginalized populations; offering surveys in multiple languages; and using mobile outreach to bring services to affected communities rather than waiting for people to seek care.^32^

💡 Clinical Pearl: As a clinician, you contribute to surveillance when you document climate-related factors in patient records (e.g., “PTSD symptoms following wildfire evacuation”). This documentation enables researchers and public health officials to identify patterns and allocate resources appropriately.

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