One of the reasons for the observed extreme hot weather is the worsening climate change. Climate change has been described as a global challenge likely to affect mankind in substantial ways. Climate change will likely affect human beings in many ways especially through increasing ambient temperatures, spreading of vector-borne diseases, storms, heatstroke, droughts and floods which will affect crop yields and subsequently in some countries, can cause malnutrition. Other negative impacts on the African continent include economic strain, migration and acculturation stress and the lowering of social capital.
Based on all these, the effect of global climate change is likely to be more severe in developing countries that may have not prepared in any way for it. The health impact of global climate change is likely to be extensive. Not only is climate change expected to affect physical health but it can also seriously affect mental health. The impact of heat on physical health is well documented but few studies have examined the effects of extreme heat on mental health and the association between extreme hot weather and mental health conditions remains poorly understood. This discussion views the mental health impact of global climate change from the point of a middle-and low-income country such as Nigeria.
Scientific studies have severally shown that extremely hot weather can cause serious sleep problems, especially for the people living in poor shelters. Increased sweating can lead to loss of body water and one may experience muscle cramps, constipation, headaches and lowered cerebral functions, which can lead to mild confusion. The consequences of constant high temperatures could precipitate increased rates of aggression, domestic violence, post-traumatic stress disorder, adjustment disorder and depression. Again, prolonged droughts due to climate change can lead to more farmers’ suicides. Global warming may cause some populations of people to migrate, which can lead to acculturation stress.
For those already living with mental health conditions, extreme heat can cause a change in their body temperature to make them become uncomfortable and may also precipitate bipolar conditions (depression and mania). The vulnerable elderly may also be at increased risk of developing severe cognitive impairment, even dementia.
One American study that surveyed over three million people on whether high temperatures were associated with an increased risk of visits to the medical emergency departments for mental health conditions noted a significant increase in mental health disorders. Similarly, there were increases in the relapse of those experiencing severe mental health disorders during the extremely hot weather. Empirical evidence showed that frequent visits to the medical emergency were one of the costliest services within the healthcare system, therefore, it is pertinent that the medical needs of vulnerable people, like the elderly, be met to further preempt individual out of pocket health and costs, as well as preserve healthcare resources for other emergencies.
The associations between extremely hot weather and frequent visits to the emergency department of hospitals were found to be significantly high, especially for certain types of certain mental health conditions such as drug addictions, including excessive use of alcohol, generalised anxiety disorder, stress-related disorders, somatoform disorders, depression, mania, bipolar disorder, schizophrenia, delusional disorders, attempted suicide and childhood-onset behavioural disorders. Extreme heat can also lead to a sudden change in behaviour, precipitate increased aggression including domestic violence. This research concluded that days of extreme heat were associated with higher rates of mental health-related emergency department visits. This study and other similar research implied that mental health care doctors providing mental health services should prepare for increased stress on individuals and the health care system during times when extreme heat is anticipated.
One of the common health consequences of extremely hot weather is dehydration. When you are dehydrated, it means that your body loses more fluids through breathing, sweating, defecating and urinating than you take in. The human body is roughly 75 per cent water. Without this water, it cannot survive. Water is found inside cells, within blood vessels and between cells. We lose water constantly through breathing, sweating, urinating and defecating. The body’s water management system alerts us through thirst and tells us when we need to increase fluid intake. Therefore, the lost body water is replenished by drinking fluids. Sometimes, it is not possible to consume enough fluids because we are too busy, lack the facilities or strength to drink, or are in an area without potable water.
When one is dehydrated for a long period, it can get worse and become a serious medical condition. During extreme hot weather conditions, the vulnerable ones such as babies, children and the elderly are more at risk of dehydration. When one becomes dehydrated, one’s blood becomes more concentrated, making one’s heart work harder to efficiently pump blood. The kidneys retain more water, which makes one urinate less. Dehydration can also affect the brain and prevent optimum functioning of the brain which can lead to reduced cerebral performances such as poor concentration, attention and memory. In severe cases, it can cause delirium or confusion.
However, during extreme and persistent high temperatures—higher than 40 degrees and if one stays in the hot sun for too long, and if one does not replenish lost body fluids—one may start to experience the signs and symptoms of dehydration such as feeling thirsty, dizziness, lightheaded, weakness of the muscles, muscle cramps, dry mouth, lips and eyes, frequent sweating, not urinating as usual and urine become dark coloured, headaches, bad breath, headaches, lethargy, constipation and mild confusion. Other medical causes of dehydration are diarrhoea, diabetes and vomiting.
If the lost body fluid is not replenished, it could lead to severe dehydration which occurs when one loses about 10 to 15 per cent of the body’s water. The manifestations of severe dehydration include sunken eyes, dry skin, low blood pressure, increased heart rate, fever, confusion, unconsciousness, seizures and formation of kidney stones. Nonetheless, mild to moderate cases of dehydration can be reversed by increasing fluid intake, but severe cases of dehydration require immediate medical attention. The rule of thumb is that dehydration can occur without being thirsty. This is why it is necessary to drink more water during extremely hot weather.
So how does one overcome dehydration caused by extremely hot weather? Dehydration must be treated by replenishing the fluid level in the body. This can be done by consuming clear fluids such as water or sports drinks. Those who are dehydrated should avoid drinks containing caffeine and sweet beverages. One sure way to rehydrate the lost body fluids is to drink plenty of water. There are ways of drinking water to promptly rehydrate lost body fluids. These are ways of drinking water to further prevent dehydration: Drink water thirty minutes before you eat lunch or dinner; slowly sip the water and avoid drinking water too fast; if possible, avoid very cold water and drink water at room temperature; sit down and sip water slowly rather than standing; avoid drinking too much water. Do not intoxicate or flood your body with water; avoid drinking the wrong fluids such as sweet beverages and coffee or tea. As an alternative to water, one can consume fruits that have high water content such as watermelon, pineapple and oranges.
To cope with the extremely hot weather, wear loose non-synthetic dresses and if possible wear a cap or hat to protect one’s brain from getting too hot; don’t wait until you are thirsty before you drink water. Avoid alcoholic wine and spirits; take a cold bath or shower as many times as possible during the day and night; go out with an umbrella or find places where you can take shelter on hot sunny days
For those living in Nigeria and other West African Countries, during extremely hot weather, the multiple effects of environmental, social, spiritual and cultural factors are likely to exacerbate existing physical and mental health conditions, it is, therefore, pertinent that public mental health policymakers should continue to carry out public health education and prevention programmes to alleviate the expected mental health challenges associated with hot weather. When the heat becomes unbearable, as we have been observing recently, we should become our brothers’ keepers by checking on neighbours who may be susceptible to the health impacts of the heat waves. This current heatwave can seriously impact the mental health of people regardless of age, sex, or wealth. This is why the public mental health experts need to identify the vulnerable populations and give them more than adequate information to help them adapt to the continuous hot weather.
In sum, this discussion will be useful and informative for mental health policymakers, general practitioners, family physicians and mental health services providers to prepare for and also provide health services needed in times of extreme heat.
Coker, a professor of public mental health, writes from Lagos and can be reached at cokerrotimi@gmail.com
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