India is currently battling a vicious second wave of COVID-19 pandemic which has caused trauma and loss on an unprecedented scale. Almost every person you know has either had a health scare due to COVID-19 themselves, or had to see a loved one go through it. While most have recovered from the ordeal, so many have lost their dear ones to the disease. Heartbreaking stories, pictures and videos of tragedies unfolding around the nations, the loneliness brought on by social isolation, the financial issues caused by impact on livelihood and high cost of treatment, all these factors combined have severely affected our mental health in these last few months.

So while the number of cases continues to move up and down the scale, we know for sure that India is well on its way to another pandemic, an invisible kind, the one that revolves around our mental health. Now more than ever, it is crucial that we sit up and take notice of the mental health crisis that is unfolding around us- within our homes, workspaces, residential complexes, streets and digital communities.

However, there are certain factors that make this mental health crisis brought on by COVID-19 worse. Air pollution being one.

*Trigger Warning: This article may contain information and details that could be triggering for certain individuals.

Air Pollution and Mental Health

When we talk about air pollution, we often limit the discussion around how it impacts our physical well-being, however, it also impacts our mental wellness. Infact, our understanding of mental health itself is limited. We see how emotional triggers impact it, but how many of us realise that our environment, living conditions etc can also have a big role to play?

For instance, imagine living in a metro city, where skies are choked with plumes of smoke and the AQI index is often dipping into the severe range. Now imagine living in a city where you are surrounded by greenery, where AQI plummets into the moderate rate on the worst days, while remaining “good” most of the time. Even if you are locked inside your home due to COVID-19, which scenario would you prefer here? Doesn’t looking at clear skies, green pastures and breathing in fresh air instantly lighten your mood? Wouldn’t living at such a place make the limitations of lockdown more bearable?

And there’s scientific proof too, if you do feel that air quality holds the potential to positively and negatively impact your mood. A study conducted on 25 mainland Chinese provinces from 2003 to 2015 to examine the effects of annual Particulate Matter 2.5 concentrations on the average level of happiness found that High PM2.5 concentrations are negatively related to the level of happiness. The study found that high concentration of PM2.5, a chief pollutant in haze pollution, can not only increase an individuals’ negative emotions, it can also decrease their positive feelings about their quality of life.

Impact Of Air Pollution On Mental Health in Adults During COVID-19

For us adults, there is simply no escape from negativity that surrounds us due to COVID-19. We have to address our worst fears, chalk out emergency plans, and also have to be there for loved ones who may be experiencing personal tragedies. Adults also are susceptible to higher exposure of both COVID-19 and air pollution, as we have to step out to run errands, work in closed indoor spaces for longer durations and tend to prioritise health of elderly and younger members of the household over our own.

Here are some mental health problems that adults are susceptible to, due to air pollution:

Bipolar disorder : This disorder is marked by severe swings in mood, behaviour, energy levels and sleeping patterns. The swings range from manic highs- marked by high levels of energy, reduced need for sleep and increased motivation, and depressive lows- marked by lack of motivation, low levels of energy and even suicidal thoughts in some cases. The episodes could last for days or months at a stretch.

A study conducted on two independent and large data sets in Denmark and the United States proposed that pollutants affect the human brain via neuroinflammatory pathways that have also been shown to cause depression-like phenotypes in animal studies. In the study conducted in the US, the regions with the worst air quality were associated with an approximately 29% increase in the apparent rate of bipolar disorder. On the other hand, counties with the highest number of pleasant weather days were associated with an estimated 21.8% decrease in the rate of bipolar disorder.

Suicidal thoughts : Seeing COVID-19 related tragedies and trauma unfold around you can severely impact a person’s mental health, to an extent that they may also end up harbouring suicidal thoughts. Just in May this year it was reported that researchers at the Swansea University, Cardiff University, and the NHS in Wales conducted a study in 12000 people, which found that stressors like social isolation, domestic abuse, relationship problems, redundancy, and financial problems had a strong link to suicidal thoughts and behaviour.

While many of these stressors are difficult to avoid for people, what makes matters worse is the addition of air pollution and its negative impact to the equation.

A 2010 study conducted in Vancouver, Canada confirmed significant associations among carbon monoxide (CO), nitrogen dioxide (NO(2)), sulphur dioxide (SO(2)), and particulate matter (PM(10)) levels for all suicide attempts in the cold period, based on emergency department visits.

Depression and anxiety : A study conducted in the city of Barcelona found an increased risk of psychiatric history of anxiety and depression disorders (occurring between 2009 and 2014) with increasing air pollution in the city. Increased exposure to Nitrous Oxide gas was correlated to increased risk of antidepressant usage.

These mental health issues have also been on rise amidst COVID-19 due to the sheer scale at which the pandemic has affected our healths, lifestyles and livelihood. Lack of information, overexposure to incorrect information, constant conversations about the disease and its harms with friends, family and peers often end up making matters worse for us.

Impact Of Air Pollution On Mental Health in Children During COVID-19

It is not just adults, both air pollution and COVID-19 have a negative impact on the mental health of children too. While parents may be trying to shield children from “bad” news, change in lifestyle such as reduced playground time, limited to no time spent with friends does impact children’s mental health. Children these days have to watch their parents clean up the house and sanitise it on a war footing. A cough or mild temperature is enough to stress everyone in the house. Children also have to be mindful of every surface they touch, how much they sanitise and when. While for us adults these changes may be minor inconveniences, considering the larger cost one may have to pay if infected with COVID-19, for children, these adjustments will have an impact on their mental health in the longer run- something that we are sadly not even thinking about right now, and air pollution can only make matters worse.

For instance, exposure to traffic-related air pollution (TRAP) has been linked to childhood anxiety symptoms. Also, a study conducted by Columbia university found that children of women with higher monitored prenatal exposure to Polycyclic aromatic hydrocarbons or PAH had more symptoms of Anxious/Depressed and Attention Problems at 6–7 years than did children with lower prenatal PAH exposure.

What can we do?

Given the clear correlation between worsening of air quality and negative impact on mental health of adults and children, it is imperative now more than ever to manage our air pollution exposure on a war footing. Here are some measures we can take to lessen the impact of air pollution on our mental well-being:

1. Keep a constant check on your mental wellbeing and that of your loved ones. If you observe/ or are observed to have behavioural changes, do not play them down. Reach out to a therapist/ counsellor to the soonest and seek professional help.

2. As stated that the environment plays an important role in our mental well-being, make a checklist of obvious stressors that you feel may be impacting your mental health and think of measures you can take to cut them down. For instance, reduce news time, or time spent on social media to reduce intake of negative news. You can also set aside a no screen-time window for every member of the household, during which everyone can spend one on one time with each other.

3. Remember that mental health is a two way street too. Just as much it is important to focus on your mental health, pay attention to that of those around you as well. Your colleagues, maids, vegetable vendors, milk man etc they are all going through the same ordeal as you. Just as we expect empathy from others, we need to incorporate that virtue in our own conduct too, in order to remove negativity surrounding us and those connected to us.

4. Start monitoring air quality indoors and outdoors in case you are experiencing mental health issues. We often talk about outdoor air quality, but indoor pollution can often be worse than outdoor air pollution. Considering the fact that we are spending more time indoors these days, we need to pay equal attention to indoor air quality. Check out our article on tips to manage indoor air pollution here.

5. Consider moving to places with lower AQI, at least during months when it worsens. Due to COVID-19 a lot of us are already working from home, and thus can escape our city dwellings for quieter, cleaner and better towns and cities, where air pollution is comparatively lesser.

6. Control indoor air pollution caused by smoking.

7. Use of indoor houseplants, purifiers to boost indoor air quality at your house or work space.

8. Use of face masks for immediate relief: Due to COVID-19 we have all taken to wearing masks whenever we are stepping out of our house. However, normal cloth or surgical masks are not fit to protect you from air pollution. On the other hand an N95 mask will serve both purposes for you, offering you protection from the coronavirus and air pollution as well. So whenever you have to step outside your house, make sure you check the air quality outside and mask up accordingly.

Managing health of your employees

A study suggests that workplace measures may promote and maintain the mental health and work performance of employees during the COVID-19 epidemic. So here are some measures that employers can take to safeguard mental health of their employees:

1. A very important aspect of good mental health is positive conversations and a work culture that is mental health friendly. The current situation demands that business, employers and even employees show empathy towards each other so that we can all cope better. Take the time to ask and make it comfortable for your employees to share their mental health situation and be open to give them some time-off or breaks to help them cope with the situation as needed.

2. Businesses where employees are still required to report to work should take it upon themselves to ensure that their employees are at the least possible mental health risk from indoor air pollution.

3. Constant monitoring of air quality should be carried out at offices. Check out this article to learn how poor air quality may be affecting your business and what measures can you take to rectify it.

4. Even companies that are allowing work from home during the current situation can take it upon themselves to encourage employees to boost indoor air quality at their homes.

While a global vaccination drive promises to eradicate the pandemic, no one knows how long it will take to make this world a COVID-19 free place. In this period of uncertainty, we need to commit to caring for our mental health and that of our loved ones.

The most important thing we can do, apart from taking help from professionals, is to talk, and more importantly, listen. Listen to your own mind, when it tells you that something doesn’t feel right. Listen to your loved ones if they complain about how worsening AQI is making it difficult for them to cope with the stress of COVID-19. Talk to your employers, employees and friends about the impact of air pollution and COVID-19 on mental health and why it needs to be addressed urgently. Raising awareness about the cause is the only way we can avoid slipping into another pandemic, as we struggle to conquer one.

What other measures do you think we need to take, to preserve our mental health during COVID-19?