Short-Term Exposure to Ambient Air Pollution and Onset of Severe Mental Disorders: A Case-Crossover Study in Northwestern China

Abstract BackgroundThe associations between short-term exposure to air pollution and severe mental disorders (SMDs) remain poorly understood, particularly in China and among potentially vulnerable subpopulations.MethodsWe conducted a time-stratified case-crossover study of 49,707 individuals diagnosed with SMDs in Gansu Province, China, from 2013 to 2020. Individual-level exposures to particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5), particulate matter ≤ 10 µm in aerodynamic diameter (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃) were estimated using high-resolution spatiotemporal data from the China High Air Pollutants dataset. We employed conditional logistic regression models to estimate associations between pollutant exposures and SMDs onset, controlling for temperature and humidity. Stratified analyses were performed to identify potentially vulnerable subpopulations.ResultsEach interquartile range increase in exposure to PM2.5 (23.1 µg/m³), CO (0.51 mg/m³), NO₂ (11.9 µg/m³), PM₁₀ (57.5 µg/m³), and SO₂ (19.1 µg/m³) was associated with increased odds of SMDs onset: 4.37% (95% CI: 2.28%-6.50%), 16.54% (95% CI: 12.26%-20.98%), 9.58% (95% CI: 6.30%-12.95%), 2.58% (95% CI: 1.34%-3.84%), and 30.65% (95% CI: 24.37%-37.25%), respectively. Exposure-response relationships displayed positive trends for all significant pollutants. Effect estimates were generally stronger among females, elderly individuals (≥ 65 years), and during warm seasons (May-October). Associations remained robust in two-pollutant models and various sensitivity analyses.ConclusionsShort-term exposure to multiple air pollutants is positively associated with SMDs onset, with differential vulnerability across population subgroups. These results suggest that air pollution may represent an important modifiable environmental risk factor for SMDs, particularly in regions with elevated pollution levels.