Heatwave-related variations in psychiatric consultations and admissions: a time-series analysis

Background Heatwaves are becoming increasingly frequent and intense across Europe, posing significant risks to physical and mental health. Emerging evidence suggests that prolonged exposure to high temperatures may exacerbate psychiatric symptoms and increase the demand for acute mental health services. Objectives This study examined the relationship between extreme heat events and psychiatric service utilization in Bolzano, Italy, by analyzing emergency psychiatric consultations and acute psychiatric admissions across three non-consecutive years. Methods A retrospective observational analysis was conducted using daily psychiatric consultations in the Emergency Department (ED) and daily admissions to acute psychiatric wards from 2013, 2018, and 2023. Meteorological data were obtained from the provincial environmental agency. Time-series analyses employed ARIMA models, incorporating daily minimum and maximum temperatures, tropical nights, and a cumulative heatwave index (nₕotₕtwv). Model selection was based on BIC, and the effect of exogenous temperature variables was evaluated through changes in AIC. Residual diagnostics guided the inclusion of weekly seasonal dummy variables. Results Non-seasonal ARIMA models with day-of-week dummies provided the best fit for both consultations and admissions. Adding the cumulative heatwave variable (nₕotₕtwv) consistently improved model fit across all years, whereas minimum and maximum temperatures alone did not. Heatwave duration emerged as a more sensitive predictor of psychiatric service utilization than isolated temperature peaks. No evidence of yearly seasonality was found, and residual diagnostics supported the robustness of models including weekly dummy variables. Conclusion Heatwaves are associated with increased psychiatric consultations and hospital admissions in Bolzano, with cumulative heat exposure representing a critical determinant. These effects cannot be explained solely by seasonal patterns, suggesting an independent climatic influence. Given the projected rise in heatwave intensity and duration, mental health services should incorporate climate-responsive planning and early-warning strategies.