{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T06:20:13Z","timestamp":1793946013606,"version":"4.8.0"},"reference-count":103,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biology"],"abstract":"<jats:p>Heat exposure is an increasingly important climate-related determinant of mental health, yet the biological mechanisms linking heat to psychiatric outcomes remain insufficiently integrated. This narrative review synthesizes evidence from climate medicine, thermoregulation, neuroscience, psychoneuroimmunology, sleep research, psychopharmacology, epidemiology, and psychiatry to examine how acute and chronic heat exposure may influence mental health. Heat acts as a multi-system biological stressor by challenging thermoregulation, increasing autonomic and cardiovascular strain, disrupting hydration, impairing sleep and circadian rhythms, activating stress-response systems, and contributing to neuroinflammation, oxidative stress, mitochondrial dysfunction, blood\u2013brain barrier disruption, and neurotransmitter alterations. These pathways may interact with psychotropic medication exposure and impaired behavioral thermoregulation, particularly among people with severe mental illness, older adults, individuals receiving lithium, people with cognitive impairment, substance use disorders, outdoor workers, and those living in poorly cooled environments. Heat-related psychiatric vulnerability is therefore transdiagnostic but heterogeneous, with relevance to distress, depression, anxiety, mood instability, psychosis, substance-related crises, cognitive dysfunction, delirium, and suicide-related outcomes. The review also distinguishes pathways supported by stronger human evidence from mechanisms supported mainly by experimental, preclinical, severe-spectrum, or indirect evidence. It proposes an integrative biological model and an evidence-informed translational agenda focused on exposure assessment, biomarkers, sleep and circadian monitoring, medication safety, risk prediction, physiological adaptation, heat-mitigation strategies, heat-health action plans, and implementation-oriented evaluation.<\/jats:p>","DOI":"10.3390\/biology15141165","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:23:14Z","timestamp":1784193794000},"page":"1165","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Heat, Brain, and Mental Health: Biological Mechanisms Underlying Climate-Related Psychiatric Outcomes"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3277-7036","authenticated-orcid":false,"given":"Julio","family":"Torales","sequence":"first","affiliation":[{"name":"Grupo de Investigaci\u00f3n sobre Epidemiolog\u00eda de los Trastornos Mentales, Psicopatolog\u00eda y Neurociencias, Facultad de Ciencias M\u00e9dicas, Universidad Nacional de Asunci\u00f3n, San Lorenzo 111421, Paraguay"},{"name":"Vicerrector\u00eda de Investigaci\u00f3n y Postgrado, Universidad de Los Lagos, Osorno 5290000, Chile"},{"name":"Facultad de Ciencias de la Salud, Universidad Sudamericana, Pedro Juan Caballero 130114, Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6843-7685","authenticated-orcid":false,"given":"Iv\u00e1n","family":"Barrios","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad Sudamericana, Pedro Juan Caballero 130114, Paraguay"},{"name":"C\u00e1tedra de Bioestad\u00edstica, Filial Santa Rosa del Aguaray, Facultad de Ciencias M\u00e9dicas, Universidad Nacional de Asunci\u00f3n, Santa Rosa del Aguaray 021801, Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8257-0183","authenticated-orcid":false,"given":"Marcelo","family":"O\u2019Higgins","sequence":"additional","affiliation":[{"name":"Grupo de Investigaci\u00f3n sobre Epidemiolog\u00eda de los Trastornos Mentales, Psicopatolog\u00eda y Neurociencias, Facultad de Ciencias M\u00e9dicas, Universidad Nacional de Asunci\u00f3n, San Lorenzo 111421, Paraguay"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom\u00e1s","family":"Caycho-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Facultad de Psicolog\u00eda, Universidad Cient\u00edfica del Sur, Lima 15067, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3934-7007","authenticated-orcid":false,"given":"Antonio","family":"Ventriglio","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9621-2291","authenticated-orcid":false,"given":"Jo\u00e3o Mauricio","family":"Castaldelli-Maia","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of S\u00e3o Paulo, S\u00e3o Paulo 05403903, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref_1","unstructured":"P\u00f6rtner, H.-O., Roberts, D.C., Tignor, M., Poloczanska, E.S., Mintenbeck, K., Alegr\u00eda, A., Craig, M., Langsdorf, S., L\u00f6schke, S., and M\u00f6ller, V. (2023). Climate Change 2022: Impacts, Adaptation and Vulnerability: Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change, Cambridge University Press."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2804","DOI":"10.1016\/S0140-6736(25)01919-1","article-title":"The 2025 report of the Lancet Countdown on health and climate change: Climate change action offers a lifeline","volume":"406","author":"Romanello","year":"2025","journal-title":"Lancet"},{"key":"ref_3","unstructured":"World Health Organization (2022). Mental Health and Climate Change: Policy Brief, World Health Organization."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s00038-009-0112-0","article-title":"Climate change and mental health: A causal pathways framework","volume":"55","author":"Berry","year":"2010","journal-title":"Int. J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","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":"ref_6","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.puhe.2018.06.008","article-title":"Associations between high ambient temperatures and heat waves with mental health outcomes: A systematic review","volume":"161","author":"Thompson","year":"2018","journal-title":"Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e580","DOI":"10.1016\/S2542-5196(23)00104-3","article-title":"Ambient temperature and mental health: A systematic review and meta-analysis","volume":"7","author":"Thompson","year":"2023","journal-title":"Lancet Planet. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"10953","DOI":"10.1073\/pnas.1801528115","article-title":"Empirical evidence of mental health risks posed by climate change","volume":"115","author":"Obradovich","year":"2018","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1038\/s41558-018-0222-x","article-title":"Higher temperatures increase suicide rates in the United States and Mexico","volume":"8","author":"Burke","year":"2018","journal-title":"Nat. Clim. Change"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1038\/s44184-026-00190-w","article-title":"Associations of heat exposure with mental health and suicide in children and adolescents: A systematic review and meta-analysis","volume":"5","author":"Lai","year":"2026","journal-title":"npj Ment. Health Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1152\/physrev.00047.2021","article-title":"Human temperature regulation under heat stress in health, disease, and injury","volume":"102","author":"Cramer","year":"2022","journal-title":"Physiol. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1146\/annurev-physiol-020518-114546","article-title":"Central mechanisms for thermoregulation","volume":"81","author":"Morrison","year":"2019","journal-title":"Annu. Rev. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"R1207","DOI":"10.1152\/ajpregu.00109.2011","article-title":"Central circuitries for body temperature regulation and fever","volume":"301","author":"Nakamura","year":"2011","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/jnc.13607","article-title":"Neuroinflammation: The devil is in the details","volume":"139","author":"DiSabato","year":"2016","journal-title":"J. Neurochem."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/nri.2015.5","article-title":"The role of inflammation in depression: From evolutionary imperative to modern treatment target","volume":"16","author":"Miller","year":"2016","journal-title":"Nat. Rev. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8416763","DOI":"10.1155\/2017\/8416763","article-title":"Oxidative stress: Harms and benefits for human health","volume":"2017","author":"Pizzino","year":"2017","journal-title":"Oxid. Med. Cell. Longev."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Yoneda, K., Hosomi, S., Ito, H., Togami, Y., Oda, S., Matsumoto, H., Shimazaki, J., Ogura, H., and Oda, J. (2024). How can heatstroke damage the brain? A mini review. Front. Neurosci., 18.","DOI":"10.3389\/fnins.2024.1437216"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Takata, F., Nakagawa, S., Matsumoto, J., and Dohgu, S. (2021). Blood\u2013brain barrier dysfunction amplifies the development of neuroinflammation: Understanding of cellular events in brain microvascular endothelial cells for prevention and treatment of BBB dysfunction. Front. Cell. Neurosci., 15.","DOI":"10.3389\/fncel.2021.661838"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1016\/j.oneear.2022.04.008","article-title":"Rising temperatures erode human sleep globally","volume":"5","author":"Minor","year":"2022","journal-title":"One Earth"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"101915","DOI":"10.1016\/j.smrv.2024.101915","article-title":"A systematic review of ambient heat and sleep in a warming climate","volume":"75","author":"Chevance","year":"2024","journal-title":"Sleep Med. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"115678","DOI":"10.1016\/j.psychres.2023.115678","article-title":"Mental illness and increased vulnerability to negative health effects from extreme heat events: A systematic review","volume":"332","author":"Meadows","year":"2024","journal-title":"Psychiatry Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"4658","DOI":"10.1017\/S0033291724002824","article-title":"The role of psychotropics on the associations between extreme temperature and heat-related outcomes among people with mental health conditions: Population-based study","volume":"54","author":"Wong","year":"2024","journal-title":"Psychol. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E915","DOI":"10.1503\/cmaj.250636","article-title":"Psychotropic prescriptions in the context of extreme heat","volume":"197","author":"Xue","year":"2025","journal-title":"CMAJ"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1471-1842.2009.00848.x","article-title":"A typology of reviews: An analysis of 14 review types and associated methodologies","volume":"26","author":"Grant","year":"2009","journal-title":"Health Inf. Libr. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1179\/2047480615Z.000000000329","article-title":"Writing narrative style literature reviews","volume":"24","author":"Ferrari","year":"2015","journal-title":"Med. Writ."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"R37","DOI":"10.1152\/ajpregu.00668.2006","article-title":"Thermoregulation: Some concepts have changed. Functional architecture of the thermoregulatory system","volume":"292","author":"Romanovsky","year":"2007","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S157","DOI":"10.1086\/317521","article-title":"Role of the preoptic-anterior hypothalamus in thermoregulation and fever","volume":"31","author":"Boulant","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1113\/expphysiol.2011.058701","article-title":"Human thermoregulation and the cardiovascular system","volume":"97","year":"2012","journal-title":"Exp. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/j.2040-4603.2015.tb00604.x","article-title":"Human cardiovascular responses to passive heat stress","volume":"5","author":"Crandall","year":"2015","journal-title":"Compr. Physiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2543","DOI":"10.1038\/s41467-025-57868-6","article-title":"Meta-analysis of heat-induced changes in cardiac function from over 400 laboratory-based heat exposure studies","volume":"16","author":"Meade","year":"2025","journal-title":"Nat. Commun."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/s13054-016-1376-4","article-title":"The neurological and cognitive consequences of hyperthermia","volume":"20","author":"Walter","year":"2016","journal-title":"Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Baindara, P., Jana, A., Dinata, R., and Mandal, S.M. (2025). Heatstroke-induced inflammatory response and therapeutic biomarkers. Biomedicines, 13.","DOI":"10.3390\/biomedicines13020261"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Li, P., Wang, G., Zhang, X.-L., He, G.-L., Luo, X., Yang, J., Luo, Z., Shen, T.-T., and Yang, X.-S. (2019). MicroRNA-155 promotes heat stress-induced inflammation via targeting liver X receptor \u03b1 in microglia. Front. Cell. Neurosci., 13.","DOI":"10.3389\/fncel.2019.00012"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1038\/nrn2297","article-title":"From inflammation to sickness and depression: When the immune system subjugates the brain","volume":"9","author":"Dantzer","year":"2008","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.neuron.2020.06.002","article-title":"The bidirectional relationship of depression and inflammation: Double trouble","volume":"107","author":"Beurel","year":"2020","journal-title":"Neuron"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"513","DOI":"10.3109\/02656736.2014.971446","article-title":"Reactive oxygen species, heat stress and oxidative-induced mitochondrial damage. A review","volume":"30","author":"Slimen","year":"2014","journal-title":"Int. J. Hyperth."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.neubiorev.2014.05.007","article-title":"Oxidative & nitrosative stress in depression: Why so much stress?","volume":"45","author":"Moylan","year":"2014","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.pnpbp.2010.05.004","article-title":"A review on the oxidative and nitrosative stress pathways in major depression and their possible contribution to the neurodegenerative processes in that illness","volume":"35","author":"Maes","year":"2011","journal-title":"Prog. Neuropsychopharmacol. Biol. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s40560-025-00832-9","article-title":"Heat stress-induced mitochondrial damage and its impact on leukocyte function","volume":"13","author":"Iba","year":"2025","journal-title":"J. Intensive Care"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/j.neuroscience.2009.04.004","article-title":"Permeability of the blood\u2013brain barrier depends on brain temperature","volume":"161","author":"Kiyatkin","year":"2009","journal-title":"Neuroscience"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Yamaguchi, T., Shimizu, K., Kokubu, Y., Nishijima, M., Takeda, S., Ogura, H., and Kawabata, K. (2019). Effect of heat stress on blood\u2013brain barrier integrity in iPS cell-derived microvascular endothelial cell models. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0222113"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1146\/annurev.physiol.67.040403.120816","article-title":"Endocrinology of the stress response","volume":"67","author":"Charmandari","year":"2005","journal-title":"Annu. Rev. Physiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1749-6632.1998.tb09546.x","article-title":"Stress, adaptation, and disease: Allostasis and allostatic load","volume":"840","author":"McEwen","year":"1998","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1001\/archinte.1993.00410180039004","article-title":"Stress and the individual: Mechanisms leading to disease","volume":"153","author":"McEwen","year":"1993","journal-title":"Arch. Intern. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.neubiorev.2009.10.002","article-title":"Allostatic load biomarkers of chronic stress and impact on health and cognition","volume":"35","author":"Juster","year":"2010","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1880-6805-31-14","article-title":"Effects of thermal environment on sleep and circadian rhythm","volume":"31","author":"Mizuno","year":"2012","journal-title":"J. Physiol. Anthropol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Harding, E.C., Franks, N.P., and Wisden, W. (2019). The temperature dependence of sleep. Front. Neurosci., 13.","DOI":"10.3389\/fnins.2019.00336"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/S2215-0366(20)30136-X","article-title":"Sleep disturbance and psychiatric disorders","volume":"7","author":"Freeman","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"101597","DOI":"10.1016\/j.smrv.2022.101597","article-title":"Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis","volume":"62","author":"Hertenstein","year":"2022","journal-title":"Sleep Med. Rev."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1176\/appi.ajp.2008.08010098","article-title":"Sleep and circadian rhythms in bipolar disorder: Seeking synchrony, harmony, and regulation","volume":"165","author":"Harvey","year":"2008","journal-title":"Am. J. Psychiatry"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1111\/pcn.12688","article-title":"Circadian rhythm in bipolar disorder: A review of the literature","volume":"72","author":"Takaesu","year":"2018","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"L\u00f5hmus, M. (2018). Possible biological mechanisms linking mental health and heat\u2014A contemplative review. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15071515"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"881","DOI":"10.2165\/00007256-200636100-00006","article-title":"Central fatigue: The serotonin hypothesis and beyond","volume":"36","author":"Meeusen","year":"2006","journal-title":"Sports Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/j.1600-0838.2010.01205.x","article-title":"Central fatigue and neurotransmitters, can thermoregulation be manipulated?","volume":"20","author":"Meeusen","year":"2010","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ijpsycho.2005.10.002","article-title":"Heat stress, plasma concentrations of adrenaline, noradrenaline, 5-hydroxytryptamine and cortisol, mood state and cognitive performance","volume":"61","author":"McMorris","year":"2006","journal-title":"Int. J. Psychophysiol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.eurpsy.2007.03.007","article-title":"Psychotropic drugs use and risk of heat-related hospitalisation","volume":"22","author":"Goumy","year":"2007","journal-title":"Eur. Psychiatry"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1111\/jcpt.12294","article-title":"Medicines can affect thermoregulation and accentuate the risk of dehydration and heat-related illness during hot weather","volume":"40","author":"Westaway","year":"2015","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"102886","DOI":"10.1016\/j.eclinm.2024.102886","article-title":"The effect of prescription and over-the-counter medications on core temperature in adults during heat stress: A systematic review and meta-analysis","volume":"77","author":"Hospers","year":"2024","journal-title":"EClinicalMedicine"},{"key":"ref_59","first-page":"e27278","article-title":"Drug-induced hyperthermia review","volume":"14","author":"Horseman","year":"2022","journal-title":"Cureus"},{"key":"ref_60","unstructured":"Torales, J., Arce, A., Moreno, M., Britez Cantero, J., Adorno, V., Melgarejo, O., Medina, A., Rodr\u00edguez, H., Maggi, C., and Villalba, J. (2019). Farmacolog\u00eda en Psiquiatr\u00eda, EFACIM. [1st ed.]."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1177\/0004867419889160","article-title":"Seasonal and temperature effect on serum lithium concentrations","volume":"54","author":"Cheng","year":"2020","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1001\/jamapsychiatry.2021.4369","article-title":"Association between ambient heat and risk of emergency department visits for mental health among US adults, 2010 to 2019","volume":"79","author":"Sun","year":"2022","journal-title":"JAMA Psychiatry"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"102240","DOI":"10.1016\/j.jhealeco.2019.102240","article-title":"Temperature and mental health: Evidence from the spectrum of mental health outcomes","volume":"68","author":"Mullins","year":"2019","journal-title":"J. Health Econ."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1017\/S2045796023000161","article-title":"Temperature and mental health-related emergency department and hospital encounters among children, adolescents and young adults","volume":"32","author":"Niu","year":"2023","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1093\/aje\/kwx295","article-title":"Examining the association between apparent temperature and mental health-related emergency room visits in California","volume":"187","author":"Basu","year":"2018","journal-title":"Am. J. Epidemiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s00127-012-0542-5","article-title":"A positive relationship between ambient temperature and bipolar disorder identified using a national cohort of psychiatric inpatients","volume":"48","author":"Sung","year":"2013","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"13582","DOI":"10.1038\/s41598-025-98247-x","article-title":"Extreme ambient temperature and emergency healthcare service utilization due to substance use disorders: A systematic review and meta-analysis","volume":"15","author":"Jhang","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Heo, S., Lee, W., and Bell, M.L. (2021). Suicide and associations with air pollution and ambient temperature: A systematic review and meta-analysis. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18147699"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Chen, D.D., Tu, J.H., Ling, K.N., Jin, X.H., and Huang, H.Y. (2025). Climate change and suicide epidemiology: A systematic review and meta-analysis of gender variations in global trends and environmental factors. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1463676"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"100446","DOI":"10.1016\/j.joclim.2025.100446","article-title":"Impacts of extreme heat on mental health: Systematic review and qualitative investigation of the underpinning mechanisms","volume":"22","author":"Baecker","year":"2025","journal-title":"J. Clim. Change Health"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"117385","DOI":"10.1016\/j.jenvman.2023.117385","article-title":"Heatwave and mental health","volume":"332","author":"Zhang","year":"2023","journal-title":"J. Environ. Manag."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1177\/00207640251336725","article-title":"Association between ambient temperature and emergency psychiatric consultations: A case-crossover study in a South American emergency setting (2021\u20132023)","volume":"71","author":"Torales","year":"2025","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"104859","DOI":"10.1016\/j.ajp.2026.104859","article-title":"Climate change and mental health: A multinational study of climate-anxiety, coping, and psychosocial responses","volume":"117","author":"Torales","year":"2026","journal-title":"Asian J. Psychiatry"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Torales, J., Ventriglio, A., Castaldelli-Maia, J.M., Liebrenz, M., Barrios, I., and O\u2019Higgins, M. (Int. Rev. Psychiatry, 2026). Climate change as a threat multiplier: Conflict pathways, inequities, and mental health impacts, Int. Rev. Psychiatry, Epub ahead of printing.","DOI":"10.1080\/09540261.2026.2620547"},{"key":"ref_75","doi-asserted-by":"crossref","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":"ref_76","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1146\/annurev.publhealth.29.020907.090843","article-title":"Heat stress and public health: A critical review","volume":"29","author":"Kovats","year":"2008","journal-title":"Annu. Rev. Public Health"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s40471-014-0014-4","article-title":"Racial and socioeconomic disparities in heat-related health effects and their mechanisms: A review","volume":"1","author":"Gronlund","year":"2014","journal-title":"Curr. Epidemiol. Rep."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1038\/s41558-021-01058-x","article-title":"The burden of heat-related mortality attributable to recent human-induced climate change","volume":"11","author":"Scovronick","year":"2021","journal-title":"Nat. Clim. Change"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"2224","DOI":"10.1002\/sim.3940","article-title":"Distributed lag non-linear models","volume":"29","author":"Gasparrini","year":"2010","journal-title":"Stat. Med."},{"key":"ref_80","unstructured":"World Health Organization (2023). Operational Framework for Building Climate Resilient and Low Carbon Health Systems, World Health Organization."},{"key":"ref_81","unstructured":"McGregor, G.R., Bessemoulin, P., Ebi, K., and Menne, B. (2015). Heatwaves and Health: Guidance on Warning-System Development, World Health Organization."},{"key":"ref_82","unstructured":"World Health Organization Regional Office for Europe (2026). Heat\u2013Health Action Plans: Guidance, World Health Organization Regional Office for Europe. [2nd ed.]."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"n2061","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"55","DOI":"10.7326\/M14-0697","article-title":"Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): The TRIPOD Statement","volume":"162","author":"Collins","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_85","unstructured":"World Health Organization (2026). Heat and Health, World Health Organization."},{"key":"ref_86","unstructured":"Global Heat Health Information Network, United Nations Office for Disaster Risk Reduction, and World Meteorological Organization (2025). An Assessment of Heat Action Plans: Global Standards, Good Practices and Partnerships, World Meteorological Organization."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.1001\/archinte.167.20.ira70009","article-title":"Prognostic factors in heat wave-related deaths: A meta-analysis","volume":"167","author":"Bouchama","year":"2007","journal-title":"Arch. Intern. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.envres.2018.05.021","article-title":"Vulnerability to heatwaves and implications for public health interventions: A scoping review","volume":"166","author":"Mayrhuber","year":"2018","journal-title":"Environ. Res."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1111\/j.1468-1331.2009.02581.x","article-title":"Heat-related side-effects of neurological and non-neurological medication may increase heatwave fatalities","volume":"16","author":"Lutz","year":"2009","journal-title":"Eur. J. Neurol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s40572-025-00486-7","article-title":"A critical gap in addressing mental health in heat-health action plans worldwide","volume":"12","author":"Spriggs","year":"2025","journal-title":"Curr. Environ. Health Rep."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1175\/BAMS-85-8-1067","article-title":"Heat watch\/warning systems save lives: Estimated costs and benefits for Philadelphia 1995\u20131998","volume":"85","author":"Ebi","year":"2004","journal-title":"Bull. Am. Meteorol. Soc."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s00038-013-0465-2","article-title":"Evaluating the effectiveness of heat warning systems: Systematic review of epidemiological evidence","volume":"58","author":"Toloo","year":"2013","journal-title":"Int. J. Public Health"},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Boeckmann, M., and Rohn, I. (2014). Is planned adaptation to heat reducing heat-related mortality and illness? A systematic review. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-1112"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/S0140-6736(09)61711-6","article-title":"Health effects of hot weather: From awareness of risk factors to effective health protection","volume":"375","author":"Hajat","year":"2010","journal-title":"Lancet"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S0140-6736(21)01209-5","article-title":"Reducing the health effects of hot weather and heat extremes: From personal cooling strategies to green cities","volume":"398","author":"Jay","year":"2021","journal-title":"Lancet"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e521","DOI":"10.1016\/S2542-5196(18)30237-7","article-title":"Workers\u2019 health and productivity under occupational heat strain: A systematic review and meta-analysis","volume":"2","author":"Flouris","year":"2018","journal-title":"Lancet Planet. Health"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1080\/23328940.2024.2361223","article-title":"Indoor overheating: A review of vulnerabilities, causes, and strategies to prevent adverse human health outcomes during extreme heat events","volume":"11","author":"Kenny","year":"2024","journal-title":"Temperature"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"4623","DOI":"10.3390\/ijerph8124623","article-title":"Heatwave early warning systems and adaptation advice to reduce human health consequences of heatwaves","volume":"8","author":"Lowe","year":"2011","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Casanueva, A., Burgstall, A., Kotlarski, S., Messeri, A., Morabito, M., Flouris, A.D., Nybo, L., Spirig, C., and Schwierz, C. (2019). Overview of existing heat-health warning systems in Europe. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16152657"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Adm. Policy Ment. Health"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s40211-025-00537-3","article-title":"Climate change and its impact on mental health","volume":"40","author":"Bhugra","year":"2026","journal-title":"Neuropsychiatrie"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the public health impact of health promotion interventions: The RE-AIM framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am. J. Public Health"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","year":"2009","journal-title":"Implement. Sci."}],"container-title":["Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-7737\/15\/14\/1165\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:41:47Z","timestamp":1784194907000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-7737\/15\/14\/1165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":103,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["biology15141165"],"URL":"https:\/\/doi.org\/10.3390\/biology15141165","relation":{},"ISSN":["2079-7737"],"issn-type":[{"value":"2079-7737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]}}}