Questions
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.”
Zora is a new mother who is concerned about bringing up her new baby, Imani, 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
For each patient, consider:
- What are your primary diagnostic considerations for each patient?
- What screening tools would you use?
- What are your priority interventions (clinical and social)?
- What community resources or referrals would be most helpful?
- What equity considerations or barriers might this patient face?
Suggested approaches
- Clinical Assessment
- Child presenting with trauma re-experiencing (nightmares, weather-triggered agitation) and developmental regression (refuses to sleep alone) following hurricane displacement.
- Use CPSS-5 (Child PTSD Symptom Scale) for age-appropriate screening.
- Working diagnosis: Pediatric PTSD with environmental trauma reminders.
- Management Priority
- Refer for trauma-focused CBT adapted for children (evidence-based first-line treatment).
- Address housing instability immediately: Temporary housing perpetuates trauma exposure and prevents recovery.
- Assess parent mental health: Caregiver wellness directly impacts child’s treatment outcomes.
- Clinical Pearl
- Marcus demonstrates why disaster mental health requires treating the environment alongside the individual—addressing housing instability is both a social intervention AND a clinical intervention for PTSD recovery.
- Clinical Assessment
- Older adult presenting with anhedonia, social withdrawal, and loss of identity following destruction of long-term home.
- Screen with PHQ-9 and distinguish grief symptoms from major depression.
- Working diagnosis: Major depressive disorder with complicated grief (loss of home as loss of identity/life narrative).
- Management Priority
- Initiate antidepressant (SSRIs first-line) and refer for grief-focused therapy or interpersonal therapy.
- Address safety: Older adults with depression and “feeling like a burden” language = high suicide risk; conduct thorough assessment.
- Rebuild social connections: Reconnect with church community and card club; social isolation compounds depression in older adults.
- Clinical Pearl
- “That house was my whole life” signals identity loss, not just property loss—older adults are particularly vulnerable when disasters destroy spaces that held decades of memory and community connection, requiring attention to existential grief alongside clinical depression.
- Clinical Assessment
- College student with severe, functionally impairing anxiety about climate change considering dropping out due to hopelessness about the future.
- Screen with GAD-7 and assess for suicidal ideation (hopelessness is a red flag).
- Working diagnosis: Generalized anxiety disorder with climate anxiety/eco-distress as primary trigger.
- Management Priority
- Refer for CBT targeting anxiety management and tolerating uncertainty; consider SSRI if severe or therapy insufficient.
- Assess safety: “No point in a future” language requires screening for suicidal thoughts and safety planning.
- Connect to campus counseling and climate action groups: Channeling anxiety into meaningful action reduces paralysis and provides purpose.
- Clinical Pearl
- Ahmed illustrates the distinction between adaptive climate concern and clinical disorder—when eco-distress causes functional impairment (academic, occupational, social), it requires treatment, but effective care often includes channeling concern into constructive action rather than eliminating it entirely.
- Clinical Assessment
- Postpartum mother with climate-related worries intersecting with worsening mood and impaired maternal-infant bonding (“I don’t know how to be happy with my new daughter”).
- Screen with EPDS (Edinburgh Postnatal Depression Scale) and Climate Anxiety Scale.
- Working diagnosis: Postpartum depression with comorbid climate anxiety affecting bonding.
- Management Priority
- Screen for safety:
- Assess for suicidal ideation.
- Infanticide thoughts.
- Postpartum psychosis symptoms (critical in perinatal period).
- Refer for perinatal-specific therapy (interpersonal therapy or CBT for postpartum depression); consider psychiatry referral for medication management if severe.
- Address practical barriers:
- Ensure childcare for appointments.
- Check insurance coverage for maternal mental health services.
- Assess partner support.
- Screen for safety:
- Clinical Pearl
- Postpartum depression is underdiagnosed and undertreated, especially in marginalized communities (Black and Indigenous mothers face the greatest disparities). Zora’s case highlights how climate anxiety can compound perinatal mental health challenges and how addressing both conditions is essential for maternal-infant well-being.
Summary table: Clinical pearls across cases
| Patient | Integration theme | Key clinical pearl |
|---|---|---|
|
Marcus |
Environment as treatment
|
Housing instability is both social determinant AND clinical barrier to PTSD recovery
|
|
Mrs. Johnson |
Identity and existential loss |
Property loss in older adults = identity/life narrative loss requiring grief work alongside depression treatment |
|
Ahmed |
Adaptive concern vs. disorder |
Climate anxiety becomes clinical when functionally impairing; effective treatment channels concern into action |
|
Zora |
Intersectionality and disparities |
Comorbid conditions affect bonding; maternal mental health faces systemic access barriers, especially in marginalized groups |
Image credits
Unless otherwise noted, images are from Adobe Stock.