On our last podcast, Mad in the Family covered the effect of climate change and extreme weather events on children’s and mothers’ mental health. This one continues the conversation on environmental links to emotional distress: emerging research showing that pollution in the air and water can affect our minds and emotions, and that children are especially vulnerable, both while they are young and later in life.

Kristina Marusic is a Pittsburgh-based investigative reporter for Environmental Health News, an award-winning, non-partisan organization dedicated to driving science into public discussion and policy. Last fall, EHN collaborated with Allegheny Front on a five-part series, “Pollution’s Mental Toll: How Air, Water, and Climate Pollution Shape Our Mental Health.” They found that residents throughout western Pennsylvania were likely suffering changes to their brains due to pollution in the surrounding environment, even at levels below federal limits.

Prior to joining EHN in 2018, Kristina covered issues related to environmental and social justice as a freelancer for a wide range of digital media outlets including The Washington Post, Slate, Vice, Women’s Health, and MTV News, among others. Her reporting on environmental health for Public Source won first place in the Keystone Society of Professional Journalists’ Spotlight contest in 2017. Kristina holds an MFA in Non-Fiction Writing from the University of San Francisco and a bachelor’s degree in Creative Writing from Hofstra University. She is the co-founder and chair of the Pittsburgh chapter of the Association of LGBT Journalists.

The following transcript has been edited for length and clarityListen to the audio of the interview here:

Miranda Spencer: What emerging scientific research or events led EHN to start covering this connection between air and water pollution and mental health?

Kristina Marusic: I was working on a big collaborative project involving lots of media outlets that were covering mental health broadly. That made me wonder what sort of connections existed between environmental health and mental health. And when I started looking into it, I found that this is a relatively new area of study, but that the few studies that do exist were finding really compelling evidence that pollution impacts mental health in some really important ways.

As you mentioned, I wasn’t surprised to learn that being worried about pollution or climate change can contribute to anxiety or depression. But I was very surprised to learn that pollution can also cause physical changes to our brains that can impact our mental health.

Spencer: Let’s talk about air pollution. What were some of the main findings from your series last fall on the effects on emissions from fossil fuel production and other industries on mental health, especially in children?

Marusic: I talked to the authors of three recent studies on air pollution and mental health. The first study out of the U.K. was really unique because it followed kids who’d been exposed to air pollution for 20 years, which is quite a long study. They found that the more air pollution people were exposed to as children, the more likely they were to develop symptoms of “mental illness” when they turned 18, which is when symptoms tend to first show up for lots of people.

And they did a good job of controlling for other factors by adjusting their findings to account for things like family psychiatric history, socioeconomic deprivation, social disconnection, and dangerousness in people’s neighborhoods. And that study was also unique because it looked at symptoms of mental illness rather than specific diagnoses. So, they used surveys to look at things like anxiety, depression, eating disorders, substance use, post-traumatic stress.

And Aaron Rubin—the lead author of that study who I talked to—said something I thought was so smart and so interesting. He said they did that because the idea that there’s a specific disorder people get, with an on or off switch, is really outdated. Mental illness is not binary. We’re not simply either depressed or not depressed. But we all walk around with symptoms of mental distress that we find more or less burdensome depending on what’s going on in our lives and our ability to regulate that distress.

That was the newest study. But it was also relatively small. They only looked at about 2,030 people for that study. I also wanted to look at some of the bigger studies that exist. The second study I looked at was published in 2019 and it looked at mental health data from 151 million people in the United States and 1.4 million people in Denmark. That study found that long periods of increased air pollution in urban areas were linked to a 16% increase in cases of bipolar disorder and a 6% increase in depression diagnosis. This one was looking at formal diagnoses from a physician.

Spencer: So, mood symptoms?

Marusic: Right. Those researchers had more detailed data for the Denmark group than the American group. The link between air pollution and mental illness for that group was even stronger. Among those 1.4 million people in Denmark, air pollution exposure was linked to a 31% increase in bipolar disorder, a 104% increase in schizophrenia, a 210% increase in personality disorder and a 68% increase in major depression. Those are significant increases with exposure to air pollution.

Spencer: And the third study?

Marusic: Those first two studies both looked at the long-term effects of air pollution on mental health. I also spoke with the author of the first study to ever look at the mental health effects of short-term exposure to air pollution in children. Rather than following kids who were exposed or adults who were exposed over a long period of time, they looked at five years of emergency room data for more than 6,800 kids and teens who visited Cincinnati Children’s Hospital for psychiatric distress. That included things like anxiety, depression, bipolar disorder, suicidality, personality disorders and schizophrenia.

They found that kids who were exposed to high amounts of air pollution or higher amounts of air pollution—not necessarily exorbitant amounts—were significantly more likely to end up in the emergency room for a mental health problem a few days later than children with lower exposures.

Spencer: It sounds like there’s something neurotoxic going on here.

Marusic: Yeah. Scientists are still trying to figure out exactly what happens in brains that are exposed to air pollution that impacts our mental health, but a lot of researchers think it’s related to the inflammation that air pollution causes. Chronic inflammation in the brain can damage neurons that are involved in our autonomic nervous system, the way regulatory responses can impact our mental health.

In animal studies, they’ve found that exposure to air pollution creates persistent inflammation in the animal’s brain and that can cause symptoms that mimic depression or bipolar disease.

Spencer: I gathered there was also a disparate impact found on communities of color and low-income communities?

Marusic: That’s true. We know that communities of color and low-income communities tend to have worse air pollution in general overall. They’re just more likely to have those exposures. But in that study that looked at kids who went to the emergency room in Cincinnati, they also looked at the overlapping effects of air pollution exposure and poverty. They found that kids from neighborhoods experiencing high levels of poverty were most likely to experience a mental illness crisis following spikes in air pollution.

The author I spoke with said that could be because poverty and crime cause stress, which also causes inflammation in our bodies. He hypothesized that that could be overlapping with the inflammation caused by air pollution to worsen the effects.

Spencer: That makes sense. A few months ago, your colleague, Grace van Deelen reported on scientific findings that ground-level ozone can negatively affect the mental health of teenagers. What is ozone, and how does it seem to affect young people’s brains and behavior?

Marusic: Ozone is a chemical byproduct that gets released when certain pollutants are exposed to sunlight. Those pollutants come from things like car exhaust, power plants, and industrial manufacturing. But they can also come from the fumes that are released from paints, and solvents, and glues. And in the study that Grace wrote about, researchers at the University of Denver and Stanford University looked at mental health symptoms in 213 adolescents who were between the ages of nine and 13 in communities with various levels of ozone pollution.

They found that the kids with higher levels of ozone exposure were more likely to have an increase in depressive symptoms over a four-year period. The symptoms they looked at were things like feeling sad or tearful, withdrawing socially, or losing interest in their daily activities. This is pretty significant because three out of every eight Americans live in counties with ozone levels that are rated F on a report-card type of scale by the American Lung Association.

Those are places with a high number of unhealthy ozone days. Right now, cities in the west and southwest have the highest levels of ozone pollution, which is likely being driven in part by wildfires that are caused by climate change.

Spencer: Doubling back a little bit about the kids’ ER visits, I recall that you wrote that the pollution levels were within federal limits, but they were still causing effects.

Marusic: That’s right. In that particular study, all of the spikes in air pollution they looked at were still below federal air pollution thresholds. None of them actually broke clean air laws. But they still saw this effect of kids that were exposed to these spikes in air pollution being more likely to end up in the ER with symptoms of mental illness.

The author I talked to also pointed out that that study probably represents the tip of the iceberg, because it only captured symptoms severe enough to prompt an emergency room visit, right? It didn’t capture anyone who had a milder increase in their anxiety or depression, but not severe enough to prompt their parents to take them into the hospital. It’s part of this growing body of research in the last couple of years indicating that air pollution is really harmful to human health in various ways at levels that are well below current legal limits.

Spencer: Let’s look at water pollution—specifically lead. I believe there is no level of lead in drinking water that health agencies consider safe. How does lead and other water pollution affect kids’ mental health?

Marusic: Scientists are a lot clearer on exactly how lead impacts the brain than they are about air pollution because they’ve been studying it for a lot longer at this point. Lead exposure impacts a protein receptor in the brain that’s known as the NMDA receptor. That stands for N-methyldextroaspartic acid receptor. The NMDA receptor is critically important for brain development, learning, and cognitive function. But improper functioning of that receptor is also seen in the brains of people with certain mental illnesses. In particular, schizophrenia tends to involve dysfunction of the NMDA receptor.

Spencer: Anything that affects a brain chemical process obviously is going to have some kind of effect on us. So, that makes sense.

Marusic: Right. It’s really interesting how [the researcher] explained this. That NMDA receptor influences the development of inhibitory neurons that help keep the brain balanced. And when it’s damaged by lead exposure, it doesn’t create enough of those.

He said that in a healthy brain, you have excitatory and inhibitory neurons in kind of equal numbers to keep things balanced. If that’s interrupted, and you have too many excitatory neurons, and not enough inhibitory neurons, then the balance is off, and that can manifest as mental illness.

Spencer: I’ve heard that lead in water or lead that kids intake can lead to aggression, learning difficulties, and so on. That’s very well documented.

Marusic: That’s right. A lot of the early research on lead exposure in kids focused on cognitive ability and learning. Some of the recent research has started following kids who were exposed to lead for longer periods of time. They’re finding now that being exposed to lead as a kid can actually impact your mental health in middle age in ways that might not even show up until much later in life.

Spencer: Very interesting. There’s a role for environmental pollution in triggering mental health problems. But it often happens in the larger context. Could you talk about that bigger picture a little more?

Marusic: I think the kind of big, important takeaway is that communities that have high levels of childhood lead exposure are also likely to experience other issues that can disproportionately impact mental health. That can include things like poverty, racism, violence, and also other harmful environmental exposures like air pollution. If you’re in a community with lead in the water, it’s also likely that you’re experiencing higher levels of air pollution.

Research has shown that regardless of income level in the United States, Black children are two-to-three times as likely as White and Hispanic children to experience lead poisoning. And that is a lingering effect of racist practices like redlining, which restricted Black communities to neighborhoods that were considered less desirable by their White neighbors and a clear result of environmental injustice. Similarly, research has shown that Black Americans are exposed to more air pollution than any of their other counterparts regardless of income level. That, again, is kind of a lingering effect of these systemic inequalities.

Spencer: Sounds like a perfect storm. These systemic problems would seem to require government action at some level. What can parents and families do to protect their kids’ brains and bodies from these pollutants, aside from moving, if they can?

Marusic: That’s an important question. I would say that one thing people can do is do what they can to help move along some of those regulatory and government-level changes that we really need to protect everyone. One way to do that is to reach out to your local, state and federal lawmakers to tell them that these issues are important to you and urge them to enact policies that promote clean air and safe drinking water and letting them know that that’s important not only for our physical health but also to protect our mental health.

Another good way to do that is following advocacy groups that do work related to clean air and clean water, especially that are local to you. If you follow those groups on social media, it makes it easier to stay in the loop about new proposed laws, so that you can take action when it’s most important.

As part of the series, we also included a page of resources about taking care of your mental health and getting involved in advocacy related to clean air and water. But at a more individual level, families can consider buying indoor/outdoor air monitors. There are some that are made for home use that have gotten cheaper and more accurate in the last couple of years; Purple air monitors are one brand that’s pretty widely available. Avoid spending a lot of time outdoors, or doing strenuous exercise outdoors, if you’re having a bad air day in your local area.

Indoor air pollution is also a problem. Americans spend 90% of their time indoors. Unfortunately, when there’s air pollution outdoors, it can get trapped in our homes too. People can consider buying an air filter for inside the house. Those can be expensive, but there’s a way to do a cheaper DIY version by attaching a HIPAA filter to a box fan and we can do that for under 40 bucks. There are instructions available for how to do that online and that can go a really long way to help clean your indoor air.

In terms of water, you can use a good water filter that removes lead—basic Brita filters or other kinds of widely available water filters. Mostly all are good at getting lead out. But there’s another filter that removes a lot of additional contaminants called the Zero filter that’s one of the better ones available for residential use.

Most states and cities have lead-safe home programs that can help you test for lead paint and remove it from your house safely if it turns out you have lead paint in your home.

Spencer: Should people who live in polluted areas have their kids’ blood tested to find lead, to get ahead of it to understand what the exposures are, or is the damage already done?

Marusic: When it comes to lead, most U.S. cities require some sort of lead testing for toddlers. I think even outside of cities, most pediatricians take a look at that in the first couple of years of a kid’s life. If your pediatrician is not looking at blood lead levels, it’s definitely a good idea to ask them between ages one and three when you’re having blood work done anyway. Just ask them to do a lead screening.

Spencer: Could you tell us quickly about the community-based mental healthcare models being developed in the Pittsburgh area?

Marusic: Especially after the pandemic, we’ve seen a number of community groups form. Some of them are based on a group-therapy model and some are more just for connection and solidarity, and being able to talk about concerns related to some of these issues, which can go a long way to making people feel less alienated and more empowered to figure out how to take action.

Spencer: Can you think of any other resources families might look to, to get help with pollution issues that can affect their kids’ mental health?

Marusic: It’s important to note all of these studies sound a little scary. But when it comes to individual exposures, the changes were all fairly moderate. Where this becomes a significant issue is when you’re looking at a whole population exposed to air pollution.

The change in one person being exposed to air pollution is not going to make someone who is perfectly healthy suddenly have extreme mental illness. It’s more about the fact that if we’re exposing millions of kids to air pollution, then the cumulative impact becomes significant. That’s something we should be worried about as a society, making sure we have regulations in place in the United States that keep everyone safe all at once, so we’re not putting the burden on individual parents, right? To buy the right filter, and carefully monitor the air, and have to be so, so vigilant about trying to protect their kids.

Spencer: Has any positive change happened since these articles came out?

Marusic: Yeah. A big part of my series was focused on Pittsburgh, which is where I live. The air quality is exceptionally bad here, particularly due to industrial polluters. We have some big legacy industries here that tend to pretty flagrantly violate our Clean Air laws. After the series came out, I heard from a lot of residents who were concerned about impacts to their mental health and wanted to know what they could do to take action. We definitely saw a lot of people reaching out to some of our key lawmakers here in the region to tell them about the links between air pollution and mental health, and “Make sure that they know that this is a concern and this is on people’s radar.”

Those things, changing laws, tend to take time. These things can take years. But thanks to years of this kind of advocacy work here, we’ve seen our local health department—which oversees air quality in the area—step up with its enforcement of clean air regulations in recent months and issue some really big fines to some of those big industrial polluters, which feels like progress.

Spencer: Are you working on any new stories about the links between environmental pollution and child or adult mental health?

Marusic: I’m always keeping an eye out for new studies on this and I’m hoping to do a follow-up story on the series sometime in the fall. But I’m also always open to story ideas. If any of your listeners have them, I’d be happy to hear from them.



Environmental Health News



MIA Reports are supported, in part, by a grant from the Open Society Foundations




  1. Mental health, by whatever name we call it, has always existed and always will! In the case of emotional, cognitive, and behavioral issues triggered by pollution, industry and government (not psychiatrists) have the major role–and responsibility–here. Namely, to ensure everyone has clean air and water.

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    • “In the case of emotional, cognitive, and behavioral issues triggered by pollution, industry and government (not psychiatrists) have the major role–and responsibility–here. Namely, to ensure everyone has clean air and water.”

      All sensible persons agree with this statement. Many of them will then jump into their car for a short crisp zippy pop to the local store. Upon returning they will accept a delivery for an item they could have picked up, for a little extra, at a local store while they were out. That weekend it’ll become very hot and they’ll turn the sprinklers on the lawn for 6 hours. Afterwards spraying the borders with bio-poisons. Almost all of the clothes they wear will contain oil derivatives. Every day their personal lifetime disposable plastic mountain will reach a new record peak. And there will always be ten reasons not to change,

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  2. Clean air and water yes. But the idea of mental health has not always existed, at least not in the present form. And at this juncture with psychotherapy, recovery programs, and psychiatry and drugs, the very idea of mental health is a menace. And so is “behavioral issues”.

    Psychologists and Psychotherapists and Behavioral Therapists are not the answer to Psychiatrists.

    In times past they used to talk about demonic possession. Foucault explains that today talk about mental illness is really just the same thing.

    So if you say that bad air and bad water cause mental illness, then that reinforces the idea that some other people may have mental illness and so they are not legitimate.


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  3. Darling Ones,

    I am in the asylum. I am penning this as a patient in the psychiatric hospital.

    I requested a sojourn here. Nobody pushed me. I was not treated like an infant but a grown up. My room here is private with an en suite. The bed is comfortable. The armchair the same. The huge window looks out onto a green wistful park. Mature trees shimmer in the breezes. Everything feels pleasantly far away from the collective mayhem of the city. Tranquility is the atmosphere. The nurses are respectful and considerate and affectionate. The psychiatrists did not fleece me or coerce me or dismissed for my suggestions. Every interview feels as egalitarian as a group gathering in a teepee or a yurt. There is a true sense of “we”. As in “we” are all going to help this distress somehow improve. I have not been told that drugs will cure everything. It was me who chose to go back on them. I know fully how little drugs can achieve and I know how excruciating the side effects and withdrawals are and I know the long term picture. But this should illuminate to my detractors just how abyssmal my schizophrenia gets. It is far worse than the worst akathesia. I willingly go back on medication reknowned at causing akasthesia and many other torments because my very real schizophrenia is currently utterly more unendurable than being iatrogenically messed up. That should make people pause and wonder at how I live with what is worse than akasthesia. Much much much worse.

    But as far as the hospital goes, I just popped in to the comments to give my update, to any incognito fans out there hovering at discrete La Grange points.

    I am feeling great relief at being on medication and being back in this dignified, caring hospital. The staff are short staffed and weary and yet they are always centering the individual in front of them. Some psychiatric patients are not easy to deal with. The aggression.
    I have been offered activities that I shall engage with as I feel these should help me ponder my schizophrenia illness.

    This article by Kristina and Miranda is lovely. I have been writing of pollution since 2000. A long time. There does need to be a reawakening to the sensuous world, of air and water and fire and earth. All the elements and natural forms. There needs to be a reocnition of Earth as “lover”. You cannot care for what you feel no love for.
    But love is not vengeance. My concern is that in future the powerfully evocative sense of “loss” of the “lover” that is Earth, will not be kindled to rediscover the “lover” but will just be used as an excuse to enact revenge and in doing so cause umpteen wars that will DESTROY the “lover”.

    How we approach “missing” pristine Earth really matters TO THE EARTH who does NOT want her creatures wiped out in a holocaust. For this reason we must simmer down and restrain our anger and divert it to positive endeavours like conservartion not retaliation. There will be no end of it…..no end…

    (Please nobody reply to my comment).

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    • I do want to be just a wittle bit mischievous in response to certain bits at the start of the article and playfully say that “if” pollution causes “brain inflammation” to “the brain” such that its “synapses and neurons” and other “brain chemicals” becomes deranged enough to produce mental illness of schizophrenia then it astonishes me why some people cannot believe that my schizophrenia “is” caused by a chemical imbalance severe enough to make me almost overdose last week.

      It sometimes feels as if I am not allowed to say what causes my schizophrenia but everyone else can say theirs is caused by chaos and clouds.

      Please respect that I am not at all saying anyone who has ever been diagnosed with errant brain chemicals has that schizophrenia diagnosis. And I am not saying it cannot be caused by multitudinous things. We simply do not know enough to say that candy floss does not cause hallucinations. But I think we should look upon it as being like two populations who are like two different siblings who live in the same bleak house. One sibling symbolizes those who feel they have a brain disease or illness or inflammation whereas the other sibling symbolizes those who feel they never had the slightest thing wrong with themselves.

      What feels TRUE for one sibling may not feel TRUE for the other sibling.

      It is rather farcical to insist they be like identical twins. Agreeable puppets nodding in sequence and finishing each others sentences for each other. It is creepy and unrealistic to demand such uniformity of belief, be the demand from either sibling.

      I seek no reply to this comment. Blessings.

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    • Diaphanous, if I understand you correctly you are now in a psychiatric hostpital. I am sorry to hear that. But on the other hand if you feel that you need to be in a safe and supervised place, then you should have that, that should be available.

      Some have called for Soteria Houses


      They would be safe places, but without the mental health presumptions and without the drugging.

      I would not promote this because it still amounts to promoting the ideas of mental health and recovery, but we still should have these, and homeless shelters, for those who feel that they need them.


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      • Tick one.

        Tick one.

        Vegetable curry.
        Macarroni cheese.

        Tick three.

        All are invited to join me for dinner. My hospital three course meal is the best medicine. I am not wanting to always “side” with any one paradigm.

        People are fed up of institutions. But consider a movie theatre. It is an institution. A nice institution. The trouble with all institutions is that they do not cater to individual fussy little requirements. A cinema cannot have but one chair in it. A perfect ergonomically comfortable chair. Nor can the instituton of the movie theatre LOVE us as individuals. Therefore ALL institutions are compromises and doomed to rankle our frail idiosycrasies. Being disappointed in there not being a special velvet chair makes us ENTITLED demanders who BLAME the other for msking us uncomfortable. Dashing our expectation. Institutions are found in Stone Henge, Knossis, Pompeii, and global shrines to institutions long gone but preserved for romantic nostalgia. Tourism is itself an institution that is already flocking to the mothballed asylum institution of dereliction of duty, to be amazed, as if partaking in a historical movie in a movie theatre, with only one chair.

        I am waffling. But I want to say humans do seem to keep building institutions from the rubble of demolished institutions. An institution is just order in chaos, but just as the human needs heros, it also needs pomp and ceremony found in institutions. Chartres cathedral is an old institution. Lovingly polished by window cleaners. All institutions can be the dignifying of humanity, like ambulance crews or Hoover Dam flood rescuers. We want human institutions on balance, but the individual must come first.

        Psychiatry is an institution. All institutons can turn rotton through incursions of bullies over time. They commandeer the shared vision and corrupt it. But that does not mean institutions are wrong or to blame. Bullying is like a dust that sweeps through any institution. A pyroclastic billowing bewildering apocalyptic force of menace. It can even occur in a movie theatre, when you are told you deserve no chair at all.

        (I appreciate your kindness Joshua)

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  4. Miranda Spencer, I appreciate your interview. I would like to see some research on how the climate changes such as increased warmth, storms, etc. affect not only “mental health” but all health. I would say, yes, there are issues with the concept of “mental health” in that when we speak of “mental health” we are usually speaking of “emotional health.” Many times, we don not even discuss “cognitive health” which is very important. And, yes, in all issues of health, not just the “mental health fields” but all “health fields” everything is “medicalized.” So, it seems like there is no way anymore to not be sick or going to be sick with something. Additionally, every single phase of life has become a “sickness” of some sort. But this is pervasive now everywhere, helped along by “mass media,” “social media” and others. The use of drugs and the expectation of the use of drugs as “remedies” for everything is also an issue for both the providers and the “patients.” I am concerned in regards to these drugs is that they are made of synthetics and seek to replicate the normal, natural activiities of the brain and the body. Additionally, there is the consideration that the drugs have entered the soil, the water table, and the air. Thus, they could be considered pollution and might very well be affecting the population (all ages included) in adverse ways we might not have even thought of in previous years. The other problem is when we close our minds to the point we can not entertain even the slightest notion that outside forces may even affect our emotions and or our minds and brains. “Nit-picking” constantly against even the concepts of psychology, mental health, etc. will only reinforce the negative side of psychology, etc. Not only that if the desire is to advocate against psychiatry, etc. psychiatry, etc. in it worst version only becomes stronger. It is better to keep an open mind and learn and love and work together to the best of our unique, individual abilities to solve the issues of the day. Thank you.

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    • What a great response. Measured. Balanced. Restrained. Healing. Reflective. Courteous. Diplomatic.

      You are a giant among equals.

      I always used to laugh when my angels said that of me. I first thought it a compliment but then thought how can I be a giant among equals if all equals must be equally the same small height.

      Ah but then I realized that in a spiritual sense we are all giants. So we are each an individual giant among equally giant giants.

      So now it is a compliment.

      To be a giant often means being modest and humble in not wanting to out-equal anyone by being more giant than all of them. The most spiritual are the most invisible and inconsequential and puny. The giants do not look like giants. The giants look like sheep. It takes courage to brave seeming like you have no opinions but your own.

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      • Now there will be an article pop up on the front page on how psychiatry causes iatrogenic height variability and stunting…think I have not noticed that trend. I say stuff…up crops a hypothesis like a combine harvester to mow my tender seedlings.

        Call me paranoid.

        Angels say it is…

        “like a game”.

        Sorry but angels have better things to do today.

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