P3.E087: Climate Anxiety in Young People: at the Generational Crossroads of Environmental and Mental Health

Background: Every child will be affected by climate change. Healthcare providers are expected to address the effects of climate change as a social determinant of health, in accordance with American Academy of Pediatrics policy statements. Psychological impacts of climate change occur through perceived threats to well-being from observation of climate events and concern about future risks and/or opportunity. Concurrently, a youth mental health epidemic has reached crisis levels. Emergency department (ED) providers commonly address patient anxiety, which may contribute to the presenting medical complaint. Our preliminary analysis examined the association between generalized anxiety and climate anxiety among young people and their caregiver seen in a pediatric ED.

Methods: This is an exploratory study among patients aged 12-17 years and their caregivers presenting to the ED at Children’s Hospital of Orange County. We enroll patients presenting with either primary medical or mental health complaints. Patient-caregiver dyads complete a selection of validated surveys and established instruments of environmental and mental health, notably the Climate Change Anxiety Score (CCAS), which includes Cognitive-Emotional and Functional Impairment subscales, and Generalized Anxiety Disorder-7 (GAD-7). The CCAS was adapted to a standard reading level for this age group. Analyses included the Mann-Whitney U test for comparing separate group medians, Wilcoxon test for dyads, and Pearson’s correlation test measuring the strength of linear relationships.

Results: We analyzed 169 adolescent patients and 144 caregivers (124 dyads) who had complete CCAS and GAD-7 data. Among families, ethnic and racial identities included: Hispanic (39%), White (17%), Asian (8%); multiracial (4%); preferred not to answer or missing (32%). Education levels among caregivers included: some high school (5%); high school diploma (24%); vocational training (4%); some college (22%); two-year college degree (5%); four-year college degree (28%); preferred not to answer or missing (12%). The patient sample was self-reported 52% female and 48% male. Median patient age was 15.2 years (mean=15.1, SD=1.7, range=12-17.9). Six of 169 patients scored at least a 3 on the CCAS (moderate to high climate anxiety). As separate groups, patients and caregivers did not significantly differ in their median CCAS scores (Table 1), and dyadic differences were likewise nonsignificant (p=0.40). However, patients and caregivers did significantly differ in their GAD-7 scores as separate groups (p < 0.001) and as dyads (p=0.002). In both the patient and caregiver samples, CCAS and GAD-7 scores were significantly correlated (p < 0.001; Table 2).

Conclusion: Climate anxiety appears to be one manifestation of generalized anxiety. This is the first study to implement the validated CCAS among young people in the ED. We anticipate our findings informing newly created regional and national organizations that advocate for pediatric health in the face of climate change. This study may also support efforts to integrate climate health-related items into routine pediatric mental health screening.