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Environ Health. 2018 Jan 10;17(1):4. doi: 10.1186/s12940-017-0348-8.

The association between daily concentrations of air pollution and visits to a psychiatric emergency unit: a case-crossover study.

Author information

Occupational and Environmental Medicine, Lund University, Medicon Village, Byggnad 402A, Scheelevägen 2, 223 63, Lund, Sweden.
Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden.
Psykiatri Affektiva, Sahlgrenska University Hospital, Gothenburg, Sweden.
CELAM - Centre for Ethics, Law and Mental Health, Sahlgrenska University Hospital, Gothenburg, Sweden.
Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
Environment and Natural Resources, University of Iceland, Reykjavík, Iceland.
Occupational and Environmental Medicine, Gothenburg University, Gothenburg, Sweden.



Air pollution is one of the leading causes of mortality and morbidity worldwide. Experimental studies, and a few epidemiological studies, suggest that air pollution may cause acute exacerbation of psychiatric disorders, and even increase the rate of suicide attempts, but epidemiological studies on air pollution in association with psychiatric disorders are still few. Our aim was to investigate associations between daily fluctuations in air pollution concentrations and the daily number of visits to a psychiatric emergency unit.


Data from Sahlgrenska University Hospital, Gothenburg, Sweden, on the daily number of visits to the Psychiatric emergency unit were combined with daily data on monitored concentrations of respirable particulate matter(PM10), ozone(O3), nitrogen dioxides(NO2) and temperature between 1st July 2012 and 31st December 2016. We used a case-crossover design to analyze data with conditional Poisson regression models allowing for over-dispersion. We stratified data on season.


Visits increased with increasing PM10 levels during the warmer season (April to September) in both single-pollutant and two-pollutant models. For example, an increase of 3.6% (95% Confidence Interval, CI, 0.4-7.0%) was observed with a 10 μg/m3 increase in PM10 adjusted for NO2. In the three-pollutant models (adjusting for NO2 and O3 simultaneously) the increase was 3.3% (95% CI, -0.2-6.9). There were no clear associations between the outcome and NO2, O3, or PM10 during the colder season (October to March).


Ambient air particle concentrations were associated with the number of visits to the Psychiatric emergency unit in the warm season. The results were only borderline statistically significant in the fully adjusted (three-pollutant) models in this small study. The observation could be interpreted as indicative of air pollution as either exacerbating an underlying psychiatric disorder, or increasing mental distress, even in areas with comparatively low levels of air pollution. In combination with the severe impact of psychiatric disorders and mental distress on society and individuals, our results are a strong warrant for future research in this area.


Acute effects of air pollution; Air pollution; Environmental epidemiology; Mental distress; Particles; Psychiatric disorders

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