A Three-Phase Qualitative Study to Create a Brief Climate Change Distress Measure for Large Epidemiological Surveys

Background: Climate change, experienced by many youth today as an existential threat, can lead to psychological distress and related adverse mental and behavioral health outcomes. Climate distress is a general term referring to psychological distress associated with awareness of climate change even among those who have not personally experienced catastrophic weather. Up to 60% of young people worldwide endorse climate distress. Yet, systematic investigation into climate distress, including epidemiologic estimates of prevalence as well as examination of associations with downstream health outcomes, is limited by the lack of a consistent operational definition and a brief validated measure.

Methods: We completed 1) content analysis of existing measures of climate distress and related literature in Fall-Winter 2023, 2) a series of meetings (n=5) in Spring 2024 with key informants (n=24) from public health jurisdictions in Washington, Oregon, and California, 3) focus groups with stakeholders (e.g., clinicians, community partners, academic researchers). A scoping review of existing measures (e.g., “climate distress”, “eco-anxiety”, “climate change AND mental health”) was performed. Items from existing measures were collated and independently coded by two coders to summarize key components of the construct. We focused meetings on reaching consensus to propose a short measure of climate distress for statewide health surveys. Intermediate findings informed the creation of an interview guide. In Fall 2024, focus groups will be conducted, transcribed and coded inductively to identify emergent themes for a survey measure and operational definition.

Results: Content analysis identified several key components of climate change: psychological distress about climate change not due to adverse weather events, functional limitations such as poor sleep or inability to concentrate, climate emotions (e.g., anger, grief, hopelessness), and underlying beliefs about climate change. Meetings resulted in a three-question proposal for the Washington State Healthy Youth Survey which addresses climate change belief, climate change stress, and functional impairment. Discussion of use cases (including dashboard development, program priority setting and evaluation, research, school curriculum development and funding proposals) informed decisions about brief measure items. Final analyses and results, including focus group data, are anticipated to be completed in Fall 2024 and by AMS will include suggestions for a refined operational definition and survey measure.

Discussion: Intermediate results highlight that multiple components comprise the construct of climate distress. As a novel construct at the intersection of climate change and health, definitions are evolving, and transdisciplinary perspectives are needed. We will present a final recommendation on a brief measure and operational definition of climate distress for large epidemiological surveys with critical ability to support investigations into links with other exposures, protective measures, and health outcomes.