No discussion of data on health outcomes related to the environment is complete without consideration of data on psychological health outcomes. For purposes of this report, psychological health does not include neurological disorders such as autism and learning disabilities, i.e., those which have a largely physiological basis, and are considered separately above. While neurological conditions are included in some the information sources on psychological health, our focus here is upon data outcomes with an emotional or perceptual basis linked to one’s environment. This may include depression, stress, anxiety, and outcomes and behaviors linked to one’s state of psychological well-being. However, one should not discount that fact that psychological factors such as stress are, in turn, linked to physiological conditions such as suppressed immune response[352] and heart disease.[353]
Environmental factors can influence mental health in numerous ways. For example, the features of a person’s perception of their environment may affect their attitudes and behaviors. As discussed later under the Built Environment section, several studies by Kuo et al. illustrate that the presence of trees and green spaces can influence children’s school performance, crime rates, and violent behavior.[354] Additionally, environmental factors may stimulate behaviors beneficial to mental health either directly or indirectly—for example, a nearby trail may encourage a person to engage in physical activity, which may in turn lessen depression and stress levels.
As with physical health, several different types of outcome data for mental health exist. Although the aggregate levels at which many of them are readily and publicly available are not geographically detailed enough for serious environmental health research, we list a few of them below. This will at least provide some starting points for obtaining more detailed data if necessary.
These data sets may be very fragmented due to different funding streams and administrative oversight for services. For example, public agency datasets will exclude individuals whose treatment is not partially or entirely covered by public funds, e.g., those pay out-of-pocket for private treatment. Laws originally set up to protect individual privacy can make it difficult for bureaus overseeing different types of services to the same individual to share information with one another.[355] Also, many individuals from low-income backgrounds have poorer access to care, either due to lack of health insurance or other coverage, difficulty obtaining transportation access to health care providers, a lack of time to spend waiting in exceptionally crowded facilities (e.g., hospital waiting rooms in underserved areas), schedule constraints due to job and family (e.g., a single mother working two jobs that offer little or no sick/vacation leave), or lack of education regarding the importance of preventive treatment. Thus, their mental health conditions may never even show up in service utilization data.
The Pennsylvania Health Care Cost Containment Council (PHC4) dataset described above contains information on individuals involuntarily admitted for emergency treatment “necessary to protect the life or health, or both, of the individual or to control behavior by the individual which is likely to result in physical injury to others.” [356], [357] The Allegheny County Department of Human Services (DHS) maintains various datasets internally, but privacy and confidentially concerns must be addressed before such data can be shared more openly. Additionally, limited treatment data, aggregated for large areas, are available online. Within the U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Office of Applied Studies website provides data including state and county-level statistics on substance abuse treatment admissions, and metropolitan area statistics for drug-related emergency room visits and drug-related deaths.[358]
A child’s environment may impact such psychological
health factors as their ability to pay attention in school and self-discipline,
which in turn may be reflected in their performance on standardized educational
tests[359]
and behaviors such as school attendance rate. School-district level data
for the entire state is available through Standard and Poor’s School Evaluation
website.[360]
These include data on standardized test passing rates, attendance rates,
dropout rates and disciplinary sanctions, along with various other school
district characteristics (e.g., spending per student and percent economically
disadvantaged) that also impact these data—and must thus be controlled for in
any statistical study. Some of these data are also available through the
Pennsylvania Department of Education’s website,[361] and accompanying school-level
demographics can be obtained through the Pittsburgh Public School Data Atlas at
the
Section 618 of the Individuals with Disabilities
Education Act (IDEA) requires school districts to annually report data on
enrollment numbers for children receiving special education services to the
U.S. Department of Education. These include data on children ages birth
through 2, and 3 though 21+.[363]
Although it includes primarily neurological disorders, which are addressed
above, it also includes some psychological conditions. The Pennsylvania
Department of Education’s “Penn Data Special Education Reporting System”
reports include numbers of enrolled children with conditions including mental
retardation, hearing impairments, speech or language impairments, visual
impairments, emotional disturbance, orthopedic impairments, specific learning
disabilities, deaf-blindness, multiple disabilities, autism, and developmental
delay.[364]
These reports include data summarized for each of
As discussed later under the Built Environment
section, one’s environment may elicit psychological and behavioral
responses—i.e., lack of exposure to green space may be linked to violence and
criminal behavior.[366], [367] In addition to the
Pittsburgh Police Department reports data listed in the Built Environment
section, some data are more easily accessible but on a larger geographic
scale. The FBI Uniform Crime Reports (UCR) include arrests and reported offenses
collected and reported by local police departments. Data are broken out
by different categories of crime, including violent versus non-violent
offenses. One should keep in mind that these do not reflect data such as
911 calls where police were dispatched, but no report was filed. Some
crime information at a sub-city level, including data on serious assaults and
homicides for
This may include self-reported perception of
psychological well-being, behaviors associated with psychological well-being,
and utilization of mental health services (e.g., “How often do you visit a
counselor for depression?”). Due to the cost and effort of gathering such
data, they are generally for a small proportion of people over a large
geographic area, or a somewhat larger proportion of people within a very
limited geographic area. The Behavioral Risk Factor Surveillance System
(BRFSS) mentioned earlier, which included an expanded example for
Psychological health data have a few general limitations. One is that a particular psychological illness or condition may or may not be reflective of an individual’s more global mental health or state of psychological well-being, or their perceived quality of life.[377] Frequently, we have only a small piece of the overall picture. Additionally, a person’s current condition may have been shaped by previous experiences in a completely different environment. A child attending school in one district may have been born and raised in a community with a completely different mix of environmental factors. Furthermore, whereas many physiological conditions can be represented by data on a simple binary basis (e.g., either a person has had cancer or they have not), many psychological conditions may be better represented on a continuous scale (e.g., sometimes sad, always sad) that may not be accurately represented in a data set. Having a diagnosed condition such as clinical depression from the DSM, or Diagnostic and Statistical Manual of Mental Disorders, would be the closest approximation of such binary data. Even so, mental disorders are difficult to quantify because their diagnosis often involves a certain symptom “threshold,” i.e., the individual must exhibit a certain number of symptoms over a certain period of time.[378] Also, diagnoses as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) change with each revision.
Finally, little data exist on some pertinent topics. For example, some evidence suggests that feelings of personal inadequacy are linked to materialistic behavior.[379] This might include, for example, purchasing a larger house and larger automobile in an attempt to compensate for feelings of inadequacy. Such materialistic behavior, in turn, may further deteriorate the environment and impact health, as described in the Consumer Demands and Polluting Activities section and elsewhere.[380] While there do not currently appear to be any comprehensive data sources on insecurity and feelings of self-worth, surveys collecting such data could be informative to the environmental health community.