Addressing the Mental Health Effects of Pollution

When we talk about air pollution, it’s usually the physical effects we worry about. Yet a growing body of research suggests that we should also be concerned about the impact on our emotional wellbeing. Numerous studies have found a correlation between poor air quality and mental health problems. Because of the complexity of the factors involved, scientists are wary of suggesting a direct link. But Jane, a mother and teacher from Australia who has been living in Beijing since last year, certainly recognises the relationship between the two.

“The first thing I do in the morning is look out of the window,” she says. “If I see clear sky, I know it’s going to be a good day. If I see smog, I know things are going to be tough. On bad days I just want to crawl back to bed. If I could I’d just lie there and wait for it to pass.” For Jane, it can be hard to disentangle physical and mental effects. “I feel burning in my eyes. That might be real, but it becomes bigger in my mind. I can feel damage happening to my eyes, my skin.”

She finds too that anti-pollution devices become psychological crutches. “I have the purifier running non-stop,” she says. “And although it’s a horrible thing to have to wear a mask when you go out, I always make sure I have it, because it’s become something to hold onto. I had really severe headaches until I started wearing a second mask. I don’t know whether wearing two masks really helps or whether it’s just psychological.”

Michelle, also a mother and a teacher, grew up in an industrial town in the north of England, and thought she was used to grey skies. But a bout of bronchitis triggered a psychological malaise that lasted months. “I’d always been an active person, but I just didn’t want to go out and socialize,” she says. “My new hobby was pizza and Netflix!”

Jane agrees that it is easy to become isolated. “When it’s polluted and you can’t go out, for a week, two weeks, it’s terrible. Even if I have the energy to leave the apartment, my friends don’t. All our social arrangements fall apart. Everyone’s just hanging onto their air purifiers.”

When you’re feeling low, it gets harder to maintain a fitness regime. “Going for a walk with the dog used to be a daily thing, a way to breathe and relax,” Jane says. “Now I’m too worried to exercise outside, even to walk fast. I don’t want to move faster because I know I’ll use my lungs more, inhale more.”

Unhealthy eating and drinking habits can be another problem. “Your body feels like it’s fighting an infection, so you have the urge to eat more,” Michelle says. “And you want to eat fresh food, but you feel like it’s contaminated.” Both Jane and Michelle talk about increased use of alcohol. “I suppose I was self-medicating,” Michelle admits.

So depression can lead to an unhealthy lifestyle, which then further reduces energy and confidence, in what threatens to become a vicious circle.

We talked to Rachel Heffield about this issue. Rachel is a professional clinical counselor from the US, who has lived in Beijing for over seven years. Since 2014 she has been part of the mental health team at International SOS’s Beijing Clinic.

“It’s wise to take appropriate precautions with mental health, just as you would to protect your physical health,” Heffield tells us. “One of the significant ways that pollution affects mental health is through the anxiety it causes for parents and the ways that it may limit normal activities. It’s a good to check our own attitudes and words as the AQI rises. Are we speaking words of fear and negativity? Or are we taking reasonable precautions and seeking to make the best of less than desirable conditions? This is an example of ‘problem-focused’ or ‘active’ coping.

“Another effect of pollution that we have observed working with our own patients is that it can trigger the symptoms of Seasonally Affective Disorder (SAD),” Heffield says. “Some individuals are significantly affected by the loss of sunlight for one or a number of days, and are often prone to depression and anxiety. Air pollution, especially when high, can cause the day to look overcast and gloomy, which can cause individuals who are susceptible to SAD to become triggered, especially if conditions continue for a number of days.”

Children will respond differently according to their age and level of understanding, Heffield tells us. She says that psychologically, very young children are not likely to have any concept of AQI, but they will pick up on the emotions of their caregivers. “Preschool and school age children begin to learn the lingo of air quality, masks, air purifiers, and red alerts. They may have their own fears or frustration at having their plans altered. Older kids and teens are likely to be more independent, so help them have good information and resources for steps to take when the air is bad and empower them to care for themselves.”

We ask her what warning signs we should be looking out for. “As parents, you likely know your own children best and what is normal for their behavior and moods,” says Heffield. “If you observe patterns of obsessing over the air quality, being fearful of going outdoors, expressing fear of getting sick, or other negative repercussions of pollution, then it would be a good time to talk to them about their fears, and consider whether these are becoming detrimental to their well-being.”

So what can we do, in practical terms, to keep ourselves and our children in good mental health at times of poor air quality? “Parents can help children cope by planning ahead and managing their own responses,” Heffield says. “If you want your child to wear a mask when the AQI is high, have fun, colored masks ready for each member of the family and make it part of the routine, as ordinary as putting on a coat when the weather is cold.”

On days when air quality confines families indoors, Heffield recommends having a basket of books and indoor games that are set aside for this time, or preparing a special treat. “Create an environment that is comfortable and well lit when pollution has turned the outside world to grey. It’s easy to feel a bit stir crazy, but look for ways to use the time at home as a gift rather than focusing on the negatives.”

And if parents are worried about the mental health of their children, what can they do? Heffield recommends calling in the experts if necessary. “Psychologists and counselors can meet with children or adults, to help you maintain mental health and navigate the ups and downs and unique challenges of life as an expat in Beijing. Your child’s teacher and school counselor can also be a great resource for feedback regarding any changes in a child’s mood or mental state and appropriate development.”

We ask Jane what strategies she uses to cope. “Crying,” she says, and then laughs. “Talking to friends and family, to people back home who care is good, but I have to be careful. If I complain too much, they just say ‘come home’, and that doesn’t help.”

Both Jane and Michelle agree that the best thing is a break; to go home or on holiday somewhere with less pollution. Jane also finds that she has come to appreciate what others take for granted. “When people back home complain that there’s nothing good on TV, I think, ‘but you have clean air, and clean water!’”

She is also more sympathetic to the challenges faced by native Beijingers. “It makes me sad when I see a baby in a pram, or little children walking by. In the end we’ll go home, but they’re growing up here, breathing this air day after day,” she says. “I admire people’s resilience. I’m not sure whether they don’t know about the risks, or don’t care, but on high pollution days I see them in in the park, chanting and dancing. Nothing stops them enjoying the simple things in life. It’s even made me more forgiving of spitting. Of course they have to spit when they’re inhaling all this poison!”

*Some names have been changed

Written by Andrew Killeen