{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T11:22:52Z","timestamp":1768216972861,"version":"3.49.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Climate-related events such as droughts, extreme heat, and flooding intensify pressures on psychological well-being, particularly in vulnerable, low-resource, and conflict-affected settings. Iraq ranks as the world\u2019s fifth most climate-vulnerable country, and the Kurdistan Region has been increasingly affected by frequent and intense extreme weather events that threaten livelihoods and community stability. Despite rising exposure, the mental health impacts of climate change in the Kurdistan Region remain largely understudied. This study investigates the effects of climate change\u2013related stressors and extreme weather events on mental health through robust analytical methods, yielding the first rigorous empirical evidence from the region.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An analytical cross-sectional study was conducted with a sample of 618 participants aged \u226518\u202fyears, residing in urban and rural areas of three governorates in the Kurdistan Region of Iraq: Duhok, Erbil, and Sulaymaniyah. Data were collected using a questionnaire that integrated measures from several validated psychological scales, including the PHQ-8, GAD-7, K10, PCL-5, and CC-MMDS. The data were analyzed using independent t-tests and analysis of variance (ANOVA) for group comparisons, and multiple linear regression for associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final sample included N\u202f=\u202f608 adults aged 18\u201375\u202fyears (51.6% male, 48.4% female), recruited from Duhok (32.9%), Erbil (33.9%), and Sulaymaniyah (33.2%). Descriptive analysis identified heatwaves, droughts, and dust storms as the most frequently reported extreme weather events. Multiple linear regression analyses revealed that exposure to extreme weather events significantly predicted increased posttraumatic stress disorder symptom levels (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.23,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.008). Climate-related homelessness was also significantly associated with increased symptoms of depression (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.38,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.014), anxiety (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.42,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.007), psychological distress (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.32,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.042), and PTSD (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.39,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.010), after accounting for potential confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study found that individuals in the Kurdistan Region of Iraq who were exposed to climate-related stressors, such as extreme weather events and climate-induced homelessness, presented significantly poorer mental health outcomes compared to those without such exposure. These findings underscore the severe psychological impact of environmental changes and highlight the urgent need for targeted support within climate adaptation and disaster response strategies, especially for populations that are most directly affected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1719584","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:12:52Z","timestamp":1768205572000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exposure to climate-related stressors undermines mental health in the Kurdistan Region of Iraq: a cross-sectional study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jan Ilhan","family":"Kizilhan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumaia","family":"Al-Ghurbani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Uricher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zelal","family":"Ag","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibraheem Khalil","family":"Musa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bohar Suleiman","family":"Isa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"4486","DOI":"10.3390\/ijerph18094486","article-title":"Climate change and mental health: a scoping review","volume":"18","author":"Charlson","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1186\/s12889-016-3692-7","article-title":"Extreme weather events in developing countries and related injuries and mental health disorders - a systematic review","volume":"16","author":"Rataj","year":"2016","journal-title":"BMC Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"74","DOI":"10.3389\/fpsyt.2020.00074","article-title":"The impact of climate change on mental health: a systematic descriptive review","volume":"11","author":"Cianconi","year":"2020","journal-title":"Front Psych"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.copsyc.2019.06.023","article-title":"Global climate change and mental health","volume":"32","author":"Palinkas","year":"2020","journal-title":"Curr Opin Psychol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"106533","DOI":"10.1016\/j.envint.2021.106533","article-title":"Is there an association between hot weather and poor mental health outcomes? A systematic review and meta-analysis","volume":"153","author":"Liu","year":"2021","journal-title":"Environ Int"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1146\/annurev-publhealth-012420-105026","article-title":"Extreme weather and climate change: population health and health system implications","volume":"42","author":"Ebi","year":"2021","journal-title":"Annu Rev Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"108","DOI":"10.29063\/ajrh2024\/v28i8.11","article-title":"Investigating associations between climate change anxiety and mental health impact on vulnerable populations: a qualitative analysis","volume":"28","author":"Soomro","year":"2024","journal-title":"Afr J Reprod Health"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e118","DOI":"10.1017\/gmh.2024.65","article-title":"The effects of climate change on mental health and psychological well-being: impacts and priority actions","volume":"11","author":"Soomro","year":"2024","journal-title":"Cambrid Prisms Glob Ment Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1038\/s41591-023-02438-w","article-title":"Climate change and health: three grand challenges","volume":"29","author":"Campbell-Lendrum","year":"2023","journal-title":"Nat Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"235","DOI":"10.4236\/eng.2022.147021","article-title":"Climate change: droughts and increasing desertification in the Middle East, with special reference to Iraq","volume":"14","author":"Adamo","year":"2022","journal-title":"Engineering"},{"key":"ref11","volume-title":"Factsheet: The Impact of Climate Change on the Environment in IDP and Returnee Locations","year":"2022"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"13","DOI":"10.34257\/GJHSSBVOL22IS2PG13","article-title":"Consequences of the climate change in Iraq","volume":"22","author":"Sissakian","year":"2022","journal-title":"Glob J Human Soc Sci"},{"key":"ref13","year":"2024"},{"key":"ref14","first-page":"43","article-title":"Climate change: consequences on Iraq\u2019s environment","volume":"8","author":"Adamo","year":"2018","journal-title":"J Earth Sci Geotech Eng"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e277","DOI":"10.1017\/dmp.2024.267","article-title":"Investigating associations between climate change anxiety and children\u2019s mental health in Pakistan: impacts and priority actions","volume":"18","author":"Soomro","year":"2024","journal-title":"Disaster Med Public Health Prep"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1080\/09540261.2022.2128725","article-title":"The impact of climate change on mental health and emotional wellbeing: a narrative review of current evidence, and its implications","volume":"34","author":"Lawrance","year":"2022","journal-title":"Int Rev Psychiatry"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"117","DOI":"10.3238\/arztebl.m2022.0403","article-title":"The effects of climate change on mental health","volume":"120","author":"Walinski","year":"2023","journal-title":"Dtsch Arztebl Int"},{"key":"ref18","volume-title":"Climate Vulnerability Assessment in the Kurdistan Region of Iraq","year":"2024"},{"key":"ref19","doi-asserted-by":"crossref","DOI":"10.1007\/698_2024_1100","article-title":"Impact of climate change on Iraq: severe water scarcity and desertification","volume-title":"Climate Change and Environmental Degradation in the MENA Region","author":"Eltaif","year":"2024"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1192\/bji.2025.10068","article-title":"Prevalence of climate anxiety and its association with mental health: national cross-sectional study in Iraq","author":"Ahmed","year":"2025","journal-title":"BJPsych Int"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"23","DOI":"10.47310\/jpms2025140104","article-title":"Climate change anxiety symptoms in the Kurdistan region of Iraq","volume":"14","author":"Mohammed","year":"2025","journal-title":"J Pioneering Med Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"98","DOI":"10.4103\/intv.intv_40_21","article-title":"Assessment of perceptions of climate change and its causes and impacts on mental health and psychosocial wellbeing among a group of internally displaced persons in Iraq","volume":"20","author":"Marzouk","year":"2022","journal-title":"Intervention"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"29609","DOI":"10.3402\/gha.v9.29609","article-title":"Climate change and health in Bangladesh: a baseline cross-sectional survey","volume":"9","author":"Kabir","year":"2016","journal-title":"Glob Health Action"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jad.2008.06.026","article-title":"The PHQ-8 as a measure of current depression in the general population","volume":"114","author":"Kroenke","year":"2009","journal-title":"J Affect Disord"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1017\/S0033291719001314","article-title":"Equivalency of the diagnostic accuracy of the PHQ-8 and PHQ-9: a systematic review and individual participant data meta-analysis","volume":"50","author":"Wu","year":"2020","journal-title":"Psychol Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"107","DOI":"10.58723\/abdigermas.v3i3.453","article-title":"Construct validity of the Kessler psychological distress scale (K-10) instrument in the elderly with disabilities: Rasch model analysis","volume":"3","author":"Hilfi","year":"2025","journal-title":"Jurnal Ilmiah PengabdianMasyarakat Bidang Kesehatan (Abdigermas)"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1017\/s0033291702006074","article-title":"Short screening scales to monitor population prevalences and trends in non-specific psychological distress","volume":"32","author":"Kessler","year":"2002","journal-title":"Psychol Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1002\/mpr.288","article-title":"Psychometric properties of an interviewer-administered version of the Kessler psychological distress scale (K10) among Dutch, Moroccan and Turkish respondents","volume":"18","author":"Fassaert","year":"2009","journal-title":"Int J Methods Psychiatr Res"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/j.psychres.2016.03.014","article-title":"Investigation of abbreviated 4 and 8 item versions of the PTSD checklist 5","volume":"239","author":"Price","year":"2016","journal-title":"Psychiatry Res"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1037\/cps0000111","article-title":"The posttraumatic stress disorder (PTSD) checklist for DSM-5: a systematic review of existing psychometric evidence","volume":"30","author":"Forkus","year":"2023","journal-title":"Clin Psychol (New York)"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"100455","DOI":"10.1016\/j.joclim.2025.100455","article-title":"Corrigendum to \u201cdevelopment and validation of a climate change version of the man-made disaster-related distress scale (CC-MMDS)\u201d [J climate change health 20 (2024) 100356]","volume":"23","author":"Beckord","year":"2025","journal-title":"J Clim Change Health"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"100356","DOI":"10.1016\/j.joclim.2024.100356","article-title":"Development and validation of a climate change version of the man-made disaster-related distress scale (CC-MMDS)","volume":"20","author":"Beckord","year":"2024","journal-title":"J Clim Change Health"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"105724","DOI":"10.1016\/j.actpsy.2025.105724","article-title":"Climate change anxiety and its effect on emotional and functional health: regional analysis","volume":"260","author":"Qader","year":"2025","journal-title":"Acta Psychol"},{"key":"ref35","volume-title":"R: A Language and Environment for Statistical Computing","year":"2024"},{"key":"ref36","volume-title":"Pwr: Basic functions for power analysis","author":"Champely","year":""},{"key":"ref37","volume-title":"Psych: Procedures for Psychological, Psychometric, and Personality Research","author":"Revelle","year":"2024"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1093\/epirev\/mxi003","article-title":"The epidemiology of post-traumatic stress disorder after disasters","volume":"27","author":"Galea","year":"2005","journal-title":"Epidemiol Rev"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/9654753","article-title":"Climate change impact: the experience of the coastal areas of Bangladesh affected by cyclones Sidr and Aila","volume":"2016","author":"Kabir","year":"2016","journal-title":"J Environ Public Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1038\/s41558-018-0102-4","article-title":"The case for systems thinking about climate change and mental health","volume":"8","author":"Berry","year":"2018","journal-title":"Nat Clim Chang"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1418361","DOI":"10.3389\/fpsyg.2024.1418361","article-title":"Exploring factors affecting psychological resilience of farmers living in drought-affected regions in Iran: a qualitative study","volume":"15","author":"Tahernejad","year":"2024","journal-title":"Front Psychol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"100960","DOI":"10.1016\/j.envdev.2023.100960","article-title":"Drought impact on peri-urban farmers\u2019 mental health in semi-arid Ghana: the moderating role of personal social capital","volume":"49","author":"Abunyewah","year":"2024","journal-title":"Environ Dev"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1007\/s00508-024-02419-0","article-title":"Heat vulnerability: health impacts of heat on older people in urban and rural areas in Europe","volume":"136","author":"Fastl","year":"2024","journal-title":"Wien Klin Wochenschr"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1016\/S0140-6736(21)01208-3","article-title":"Hot weather and heat extremes: health risks","volume":"398","author":"Ebi","year":"2021","journal-title":"Lancet"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1177\/17579139231224690","article-title":"Heatwaves and homelessness","volume":"144","author":"Leggat","year":"2024","journal-title":"Perspect Public Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"11786302211018390","DOI":"10.1177\/11786302211018390","article-title":"Global Health impacts of dust storms: a systematic review","volume":"15","author":"Aghababaeian","year":"2021","journal-title":"Environ Health Insights"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1038\/nclimate1754","article-title":"The relationship between personal experience and belief in the reality of global warming","volume":"3","author":"Myers","year":"2013","journal-title":"Nat Clim Chang"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"106274","DOI":"10.1016\/j.nedt.2024.106274","article-title":"Is awareness of climate change a predictor of eco-anxiety? Research within the scope of nursing students","volume":"140","author":"Baykara Mat","year":"2024","journal-title":"Nurse Educ Today"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"101904","DOI":"10.1016\/j.jenvp.2022.101904","article-title":"Fear for the future: eco-anxiety and health implications, a systematic review","volume":"84","author":"Boluda-Verd\u00fa","year":"2022","journal-title":"J Environ Psychol"},{"key":"ref50","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/978-3-030-21344-2_19","article-title":"Assessing the impacts of climate change on natural resources in Erbil area, the Iraqi Kurdistan using geo-information and Landsat data","volume-title":"Environmental Remote Sensing and GIS in Iraq","author":"Khayyat","year":"2020"},{"key":"ref51","year":""},{"key":"ref52","year":""},{"key":"ref53","volume-title":"Migration governance indicators local profile 2025 \u2013 Kurdistan region of Iraq","year":"2025"},{"key":"ref54","volume-title":"Population of the Kurdistan region reaches 6.5 million; Erbil surpasses Sulaymaniyah and Halabja combined","year":"2025"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"e63739","DOI":"10.7759\/cureus.63739","article-title":"Assessment of anxiety, stress, and depression among COVID-19 survivors after 40 months in the Kurdistan region of Iraq: an online cross-sectional study","volume":"16","author":"Hamad","year":"2024","journal-title":"Cureus"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1038\/s44184-024-00054-1","article-title":"Mental health and psychosocial interventions in the context of climate change: a scoping review","volume":"3","author":"Xue","year":"2024","journal-title":"Npj Ment Health Res"},{"key":"ref57","doi-asserted-by":"publisher","DOI":"10.18103\/mra.v13i7.6772","article-title":"Healing after genocide: a cross-sectional study on emotion-focused coping and psychosocial recovery among Yazidi survivors","volume":"13","author":"Kizilhan","year":"2025","journal-title":"Med Res Arch"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1719584\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:12:55Z","timestamp":1768205575000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1719584\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":57,"alternative-id":["10.3389\/fpubh.2025.1719584"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1719584","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1719584"}}