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Significant association between increased risk of emergency department visits for psychiatric disorders and air pollutants in South Korea

Journal of Exposure Science & Environmental Epidemiology volume 33, pages 490–499 (2023)Cite this article

Abstract

Background

The association between air pollutants and psychiatric disorders has been investigated in many countries. However, results for the association between air pollutants and emergency room (ER) visits for psychiatric disorders are inconsistent. Further, systematic large-scale studies relating to the same are lacking, especially in South Korea.

Objective

We aimed to investigate the acute and short-term cumulative effect of air pollutants on ER visits for psychiatric disorders in South Korea.

Methods

The data on nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) and ER visits due to nine representative psychiatric disorders were collected from eight major cities in South Korea for three years. We estimated the relative risk (RR) at lag 0 and a cumulative 11-day RR by increasing a 10-unit for PM and 0.01-unit for NO2 using the Distributed Lag Nonlinear Model.

Results

During the study period, a total of 79,092 ER visits for psychiatric disorders were identified and tested for association with NO2, PM2.5, and PM10. The RR at lag 0 of depression per 0.01-unit increase in NO2 was the highest (3.127; 95% confidence interval [CI] 2.933 to 3.332) among the psychiatric disorders. The RRs at lag 0 of anxiety disorders per 10-unit increase in PM2.5 (1.709; 95% CI 1.424 to 2.053) and PM10 (2.168; 95% CI 1.957 to 2.403) were the highest among the psychiatric disorders.

Significance

Air pollutants increased ER visits for psychiatric disorders with the highest RR of depression due to NO2 and anxiety disorder due to PM2.5 and PM10. These results contribute evidence to the positive association between ambient exposure to air pollution and aggravation of psychiatric disorders, indicating air pollution may be a modifiable risk factor in mental health management.

Impact statement

We investigated the effect of air pollution on emergency room visits caused by major psychiatric disorders in prominent cities in South Korea. Using the Distributed Lag Nonlinear Model, an advanced analysis method, we calculated the acute effect and short-term cumulative effect. Air pollutants increased ER visits for psychiatric disorders with the highest relative risk of depression due to NO2 and anxiety disorder due to PM2.5 and PM10. These results reveal an association between ambient exposure to air pollution and aggravation of psychiatric disorders and suggest that air pollution may be a modifiable risk factor in mental health management.

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Fig. 1: The overall cumulative association between air pollutants and psychiatric disorders using the single-pollutant model.
Fig. 2: The lag-response association between the level of air pollutants and psychiatric disorders.
Fig. 3: Three-dimensional diagram of relative risk of the incidence of psychiatric disorders.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This research was supported by grants from the Gachon University Gil Medical Center (grant numbers 2019-11) and Research of Korea Centers for Disease Control and Prevention (grant number 2021ER120201). This work was also supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (NRF-2020R1A2C1007527 and NRF-2021R1A5A2030333). The sponsor of the study was not involved in study design, analysis and interpretation of data; writing of the report; or the decision to submit the study results for publication.

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Author notes

  1. These authors contributed equally: Jinwook Hong, Jae Myeong Kang.

Authors and Affiliations

  1. Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Republic of Korea

    Jinwook Hong & Jaehun Jung

  2. Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea

    Jinwook Hong & Jaehun Jung

  3. Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea

    Jae Myeong Kang, Seo-Eun Cho & Seung-Gul Kang

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Contributions

Conceptualization: JJ, SGK; Data curation: JH; Formal analysis: JH; Funding acquisition: JJ, SGK; Investigation: SEC; Methodology: JH, JMK, SEC; Project administration: JJ, SGK; Resources: SEC; Software: JH, JMK, SEC; Supervision: JH, JMK, SEC, JJ, SGK; Validation: JH, JMK; Visualization: JH; Roles/Writing—original draft: JH, JMK; Writing—review and editing: SEC, JJ, SGK.

Corresponding authors

Correspondence to Jaehun Jung or Seung-Gul Kang.

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The authors declare no competing interests.

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This study was approved by the Institutional Review Board of the Gil Medical Center (GCIRB2020-432). Participant consent was waived by the ethics committee because the data involved routinely collected medical data that was processed anonymously at all stages. The study methods were carried out based on the Declaration of Helsinki.

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Hong, J., Kang, J.M., Cho, SE. et al. Significant association between increased risk of emergency department visits for psychiatric disorders and air pollutants in South Korea. J Expo Sci Environ Epidemiol 33, 490–499 (2023). https://doi.org/10.1038/s41370-022-00504-y

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