Climate and Health Program, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
University of Washington School of Medicine, Department of Emergency Medicine, Seattle.
JAMA Netw Open. 2024 Feb 5;7(2):e2356466. doi: 10.1001/jamanetworkopen.2023.56466.
Wildfires, intensified by climate change, have known effects on physical health but their effects on mental health are less well characterized. It has been hypothesized that the residential proximity to a large wildfire can exacerbate underlying mental health conditions as evidenced by increased prescriptions of psychotropic medications.
To evaluate the association between the occurrence of large wildfires and the prescription rates of psychotropic medications immediately following the start of the fire.
DESIGN, SETTING, AND PARTICIPANTS: This cohortstudy used an interrupted time-series analysis to compare psychotropic medication prescriptions in the 6 weeks before and after each of 25 wildfires. The setting was California counties within metropolitan statistical areas (MSAs) experiencing large wildfires from 2011 through 2018. Participants included individuals residing in California MSAs with prescriptions of psychotropic medications recorded in the Merative MarketScan Research Database (MarketScan) during the study period. Statistical analysis was performed for these 25 large wildfires occurring between September 2011 and November 2018.
Residential proximity to large wildfires that burned more than 25 000 acres occurring in a California county within an MSA.
Prescriptions of psychotropic medications, including antidepressants, antipsychotics, anxiolytics, hypnotics, and mood-stabilizers, with statins as a negative control outcome.
For the study period, prescription data and patient-level attributes were extracted for 7 115 690 unique individuals (annual mean [range]: 889 461 [455 705-1 426 928] individuals) enrolled in MarketScan and residing in fire-affected MSAs. This study found a statistically significant increase in prescriptions of antidepressants (rate ratio [RR], 1.04 [95% CI, 1.01-1.07]), anxiolytics (RR, 1.05 [95% CI, 1.02-1.09]), and mood-stabilizing medications (RR, 1.06 [95% CI, 1.01-1.13]) in the fire period compared with the prefire baseline. However, the prescriptions of antipsychotics, hypnotics, and the negative control outcome, statins, showed no significant association.
In this cohort study of large California wildfires, the occurrence of wildfire was associated with increased mental health burden as reflected in increased prescription rates of certain psychotropic medications. The findings underscore the need for further scientific examination into the mental health effects of wildfires and the allocation of mental health resources in disaster responses. California experienced a substantial burden of wildfires from 2011 to 2018, and as wildfires become more intense and frequent in the context of anthropogenic climate change, it is increasingly important to understand and address their mental health effects.
野火受气候变化影响加剧，对身体健康有已知影响，但对心理健康的影响则不太为人所知。据推测，居住在大型野火附近可能会加剧潜在的心理健康状况，因为这会导致精神药物处方增加。
评估大型野火发生前后，精神药物处方率与火灾开始时的关联。
设计、地点和参与者：这项队列研究采用中断时间序列分析，比较了 2011 年至 2018 年间发生在加利福尼亚大都市统计区（MSA）的 25 起大型野火前后 6 周内的精神药物处方情况。该研究地点为加利福尼亚州 MSA 内经历大型野火的县，在此期间，Merative MarketScan Research Database（MarketScan）中记录了精神药物处方。对 2011 年 9 月至 2018 年 11 月期间发生的 25 起大型野火进行了统计分析。
居住在加利福尼亚州 MSA 内野火燃烧面积超过 25000 英亩的大型野火附近。
包括抗抑郁药、抗精神病药、抗焦虑药、催眠药和情绪稳定剂在内的精神药物处方，以他汀类药物作为阴性对照结果。
在研究期间，从 MarketScan 中提取了 7115690 名（年平均[范围]：889461[455705-1426928]名）患有精神药物处方且居住在受火灾影响的 MSA 内的个体的处方数据和患者特征。本研究发现，与火灾前基线相比，抗抑郁药（RR，1.04[95%CI，1.01-1.07]）、抗焦虑药（RR，1.05[95%CI，1.02-1.09]）和情绪稳定剂（RR，1.06[95%CI，1.01-1.13]）的处方率在火灾期间显著增加。然而，抗精神病药、催眠药和阴性对照结果他汀类药物的处方没有显示出显著的关联。
在这项对加利福尼亚州大型野火的队列研究中，野火的发生与某些精神药物处方率的增加有关，这反映出心理健康负担的增加。这些发现强调了需要进一步科学研究野火对心理健康的影响，并在灾害应对中分配心理健康资源。2011 年至 2018 年期间，加利福尼亚州经历了大量的野火，随着野火在人为气候变化背景下变得更加剧烈和频繁，了解和应对其对心理健康的影响变得越来越重要。
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