Air pollution and mental health

Josephine Cock argues that psychologists should be more concerned about air pollution.

Most of us enjoy the glow of a cosy winter fire and the aroma of food cooking on a summer barbeque. But it’s well known now that they give off tiny particles and gases that can harm our health.1-4 In fact, wood smoke may be even more damaging than cigarettes.5 As this is a behavioural as well as a medical issue, why are psychologists not more concerned?6 Why do some of us shrug and say ‘Well, yes, air pollution is truly terrible in some cities abroad, but there’s no need to worry about it here, is there?’ Well, actually, there is. There is no safe level.7,8 It’s only a question of degree.9

According to a whole range of recent papers on cardiovascular health10-12, infant development13-16, cognitive decline,17-20 dementia and Parkinson’s disease,21-24 depression and suicide,25-28 neurology,29-32 and toxicology,33,34it would appear, that chronic exposure to fumes, whether from fires, farmyards, traffic, or artificially scented products, does us no good at all.35-40 So, why isn’t there more fuss? I haven’t seen any posters at my GP clinic telling me not to use artificially fragranced items or not to get a wood stove if my children or relatives have asthma, have you?41,42 And when there is a high air pollution episode, our government just tells us to stay indoors if we are ‘vulnerable’. We are not advised to stop making more pollution.43-46 My cardiorespiratory specialist always asks if I have biological allergies (no) and if I’ve smoked cigarettes (never) but not about the environment where I live or have lived.47

I know our government has recently placed restrictions on the sale of so-called wet wood and coal for fires and log burners, and has encouraged families to replace dirtier older stoves with new low-pollution Ecodesign wood stoves, but if the stoves are that bad, why not ban them altogether?48-52 I think it is because there would be outrage. People do not like having anything they cherish taken away from them. It’s been the same with diesel cars.53 When they first came on the market, they were called environmentally friendly as well as economic. When they were not.54 I suspect it is the same with the wood stoves and some of the so-called ‘natural’ lotions and potions we use in our bathrooms and kitchens.55-57 Who bothers to check out the ingredients? I do.

Perhaps what we need is a more noticeable national awareness campaign, so that we can feel we are genuinely doing something to clean up the air we breathe?58-60 We know about the Low Emissions Zones for traffic in our cities, but they seem to be getting mixed responses.61-63 Same with electric cars.64 The Mums for Lungs group in London are trying to wean us of the wood stoves, which I wholeheartedly agree with.65,66 But what about those families in rural areas who have no other real option for warmth in winter? They would argue that fuel poverty prevents them from purchasing expensive heat pumps and solar panels.67,68 And more insulation is costly too.

Before we can cut back on air pollution, and find new ways to live, do we need to educate ourselves, and our children, on the sources and nature of that pollution? I doubt it is on the school agenda, but I could be wrong.69,70 After all, children are learning about the importance of preserving our environment. That’s one ‘good’ thing coming out of the climate crisis – it has alerted us to the other problems that need fixing, whether through social change or new technology.71-73

So, what role can psychologists play in raising awareness on the harm air pollution does?74,75 If you are a counsellor or therapist, and someone comes to you with depression or stress, do you ask if they are living or working in a place where the air quality might be making them ill?76,77 I did an internet search and came up with a long list of references to scientific studies saying that air pollution can damage mental health and cognition.78-86 It may even be involved in dementia.87 It has been shown to stunt the growth of young lungs and damage babies’ hearts, so why not their brains too?88-93 It is known that particulates can cross the blood-brain barrier.94-98

If we do not know the risks, or if we choose to ignore them, we cannot deal with the fallout.98-100 And who pays the costs? We know we do, if we end up wheezing and tottering our way through a tiring and possibly demented old age, or if we see our precious children being urgently rushed to A&E with a pollution related life-threatening asthma attack.101-103 And what about the cost to the NHS and the number of useful years of life lost to painful illnesses, caused, or exacerbated, by air pollution?104-108 Would it be appropriate for The Psychologist to run a new survey on what its readers think, and what they want to do, about air pollution, in all its many guises.109,110

Professor Sir Stephen Holgate at Southampton University and Dr Gary Fuller at Imperial College have suggested we should have a new Royal Commission on Air Quality.111,112 In 2018, the Rt. Honr. Michael Gove (then Secretary of State for Environment, Food and Rural Affairs) said, ‘(it is) our goal that by 2025, we will halve the number of people living in locations where concentrations of particulate matter are above the WHO guideline limit of 10 ug/m3’.113 But can this be achieved? Dirty old diesels are still permitted on our roads, even though it is true that the NO2 level in UK has dropped, and we should celebrate that fact at least. But what about fumes from construction sites and dockyards?114,115 And fine particulates from domestic combustion and farming?116,117

In 2018, Mr Gove also told us, ‘The importance of raising awareness of the dangers of air pollution is evident in a research report, also published today, which shows just 1 in 5 respondents felt they knew a lot about its effects. The report also showed a lack of awareness of the wide range of sources of air pollution with most naming transport as the main cause. But transport emissions are only one part of the problem. From farming to cleaning solvents there are a large range of other day to day practices, processes and products that produce harmful emissions. Of particular concern is burning wood and coal to heat a home which contributes 38% of UK emissions of damaging particulate matter. Cleaner fuels and stoves produce less smoke, less soot and more heat. In future only the cleanest domestic fuels will be available for sale.’ Indeed, the reduction in domestic coal burning has greatly reduced the overall level of PM2.5 here in the UK, which is to be commended, and ‘wet’ wood is (very largely) no longer for sale at shops and garages. However, at the national level, PM2.5 pollution from domestic wood burning continues and the percentage contribution from that source has gone steeply up not down in recent years.118-122 And not many know that.

Dirty old(er) stoves are set to puff away indefinitely as they have not been banned and the new, less-polluting stoves will deteriorate over time. Even a highly efficient, extra-hot burning, stove can be turned into a serious polluter if tainted wood or rubbish is burnt in it.123,124 So, yes, it is cosy to sit by the fire on a cold night but at what cost?125Even if I can’t smell, or taste, the unhealthy smoke, perhaps my neighbours can? And is it harming their health as well as ours?126-128

I don’t want to be a spoilsport or a scaremonger, but perhaps I should ask my GP, or therapist, if smoke is truly harmful? And are electric cars, heat pumps, solar panels, biomass pellets, and non-scented, non-plastic, organic products the right way forward? And shouldn’t there be an air quality meter at every school and hospital across the land by now? If we really want to know how bad - or how good - our air is, shouldn’t we be measuring it more widely and checking the levels daily? Or would that make us all neurotic? 

Perhaps, by discussing air pollution sources and their effects on the brain, biology and behaviour, psychologists can help reach the wider community, and push for more collective action.129-136 The air we breathe matters enormously, and scientific evidence on brain injury from air pollution is coming in fast.137-145

Josephine Cock, PhD CPsychol AFBPsS (retired)






4.         Shehab, M.A. et al. (2021). The contribution of cooking appliances and residential traffic proximity to aerosol personal exposure. J Environ Health Sci Eng, 19, 1, 307-318.






10.       Bourdrel, T. (2017). Cardiovascular effects of air pollution. Archives of Cardiovascular Diseases, 110, 1, 634-642.

11.       Staffogia, M. et al. (2022). Long-term exposure to low ambient air pollution concentrations and mortality among 28 million people: results from seven large European cohorts within the ELAPSE project. Lancet Planet Health, 6, 1, e9-e18. doi: 10.1016/S2542-5196(21)00277-1.

12.       Miller, M. & Newby, D.E. (2020). Air pollution and cardiovascular disease: car sick. Cardiovascular Research, 116, 2, 279–294.

13.       Ghazi, T. et al. (2021). Prenatal air pollution exposure and placental DNA methylation changes: implications on foetal development and future disease susceptibility. Cells, 10, 11, 3025. doi:10.3390/cells10113025

14.       Markevych, I. et al. (2021). NeuroSmog: determining the impact of air pollution on the developing brain: project protocol. Int J Environ Res Public Health, 19, 1, 310. doi:10.3390/ijerph19010310

15.       Volk, H.E. et al. (2020). Maternal immune response and air pollution exposure during pregnancy: insights from the Early Markers for Autism (EMA) study. J Neurodev Disord, 12, 1, 42.

16.       Latham, R. et al. (2021). Childhood exposure to ambient air pollution and predicting individual risk of depression onset in UK adolescents, Journal of Psychiatric Research.

17.       Iaccarino, L. et al. (2021). Association between ambient air pollution and amyloid positron emission tomography positivity in older adults with cognitive impairment. JAMA Neurol 78, 197-207.

18.       Gao, X. et al. (2021). Short-term air pollution, cognitive performance, and nonsteroidal anti-inflammatory drug use in the Veterans Affairs Normative Aging Study. Nature Aging.

19.       Kulick, E.R. et al. (2020). Long-term exposure to air pollution and trajectories of cognitive decline among older adults. Neurology, 94, e1782–e1792.

20.       Power, M.C. et al. (2016). Exposure to air pollution as a potential contributor to cognitive function, cognitive decline, brain imaging, and dementia: a systematic review of epidemiologic research. Neurotoxicology 56, 235–253.

21.       Carey, I.M. (2018). Are noise and air pollution related to the incidence of dementia? A cohort study in London, England. British Medical Journal Epidemiology Research, 8, 9.

22.       Fu, P. & Yung, K.K.L. (2020). Air pollution and Alzheimer’s disease: a systematic review and meta-analysis. Journal of Alzheimer's Disease, 77, 2, 701-714. Doi:10.3233/JAD-200483

23.       Salami, F. et al. (2020). Associations between long-term exposure to ambient air pollution and Parkinson's disease prevalence: A cross-sectional study. Neurochem Int, 133, 104615. doi: 10.1016/j.neuint.2019.104615

24.       Wang. X. et al. (2022). Association of improved air quality with lower dementia risk in older women. PNAS, 119, 2, e2107833119.

25.       Braithwaite, I. et al. (2019). Air pollution (particulate matter) exposure and associations with depression, anxiety, bipolar, psychosis and suicide risk: A systematic review and meta-analysis. Environ Health Perspect, 127, 12, 126002.

26.       Borronia, E. et al. (2022). Air pollution exposure and depression: A comprehensive updated systematic review and meta-analysis. Environmental Pollution, 292, A, 18245.

27.       Davoudi, M. et al. (2021). Association of suicide with short-term exposure to air pollution at different lag times: a systematic review and meta-analysis. Science of The Total Environment, 771, 144882. 10.1016/j.scitotenv.2020.144882

28.       Liu, Q. et al. (2021). Association between particulate matter air pollution and risk of depression and suicide: a systematic review and meta-analysis. Environmental Science and Pollution Research.

29.       Younan, D. et al. (2020). Particulate matter and episodic memory decline mediated by early neuroanatomic biomarkers of Alzheimer’s disease. Brain, 143, 1, 289-302. pmid:31746986

30.       de Prado Bert, P. et al. (2018). The effects of air pollution on the brain: a review of studies Interfacing environmental epidemiology and neuroimaging. Curr Environ Health Rep, 5, 3, 351-364.

31.       Karceski, S. (2020). Air pollution & brain health. Neurology, 94, 17.

32.       Schikowski, T. et al. (2020). The role of air pollution in cognitive impairment and decline. Neurochem Int, 136, 104708.

33.       Potter, N. et al. (2021). Particulate matter and associated metals: a link with neurotoxicity and mental health, Atmosphere, 10.3390/atmos12040425, 12, 4, 425.

34.       Calderón-Garcidueñas, L. et al. (2020). Quadruple abnormal protein aggregates in brainstem pathology and exogenous metal-rich magnetic nanoparticles (and engineered Ti-rich nanorods). The substantia nigrae is a very early target in young urbanites and the gastrointestinal tract a key brainstem portal. Environmental Research, 91, 110139.






40.       Smith, J.D. et al. (2020). PM2.5 on the London Underground. Environment International, 134, 105188.






46.       Noël, C. et al. (2021). Qualitative research about public health risk perceptions on ambient air pollution: a review study. SSM Popul Health, 15, 100879. doi:10.1016/j.ssmph.2021.100879

47.       Wang, M. et al. (2019). Association between long-term exposure to ambient air pollution and change in quantitatively assessed emphysema and lung function. JAMA, 322, 6, 546–556. doi:10.1001/jama.2019.10255










57.       Coggon et al. (2021). Volatile chemical product emissions enhance ozone and modulate urban chemistry. Proceedings of the National Academy of Sciences, 118, 32, e2026653118. doi:0.1073/pnas.2026653118.














71.       Kinney, P.L. (2020). From air pollution to the climate crisis: leaving the comfort zone. Daedalus, 149, 4, 108–117. doi:





76.       Braithwaite, S. et al. (2019). Air pollution (particulate matter) exposure & associations with depression, anxiety, bipolar, psychosis & suicide risk: a systematic review and meta-analysis. Environmental Health Perspectives, 127, 12.

77.       Response to: The health effects of fine particulate air pollution. BMJ, 2019, 367.

78.       La Nauze, A. & Severnini, E.R. (2021). Air pollution and adult cognition: evidence from brain training. National Bureau of Economic Research, Working Paper 28785. doi 10.3386/w28785

79.       Bakolis, I. et al. (2020). Mental health consequences of urban air pollution: prospective population-based longitudinal survey. Social Psychiatry and Psychiatric Epidemiology.

80.       Gladka, A. et al. (2018). Impact of air pollution on depression and suicide. International Journal of Occupational Medicine and Environmental Health, 31, 6, 711-772. doi:10.13075/ijomeh.1896.01277

81.       Hao, G. et al. (2021). Associations of PM2.5 and road traffic noise with mental health: evidence from UK Biobank. Environmental Research.

82.       Marazziti, D. et al. (2021). Climate change, environment pollution, COVID-19 pandemic, and mental health. Sci Total Environ, 773, 145182. doi:10.1016/j.scitotenv.2021.145182

83.       Mok, P. et al. (2021). Exposure to ambient air pollution during childhood and subsequent risk of self-harm: a national cohort study. Preventive Medicine, 152, 106502. 10.1016/j.ypmed.2021.106502

84.       Newbury, J. et al. (2021). Association between air pollution exposure and mental health service use among individuals with first presentations of psychotic and mood disorders: Retrospective cohort study. The British Journal of Psychiatry, 1-8. doi:10.1192/bjp.2021.119

85.       Ventriglio, A. et al. (2020). Environmental pollution and mental health: a narrative review of literature. CNS Spectrums, 26, 1, 51-61. 10.1017/S1092852920001303.

86.       Zhao, T. et al. (2020). Depression and anxiety with exposure to ozone and particulate matter: An epidemiological claims data analysis. International Journal of Hygiene and Environmental Health, 228. 113562. 10.1016/j.ijheh.2020.113562








94.       Brockmeyer, S.& D'Angiulli, A. (2016). How air pollution alters brain development: the role of neuroinflammation. Transl Neurosci, 7, 1, 24-30. doi:10.1515/tnsci-2016-0005

95.       Shou, Y. et al. (2019). A review of the possible associations between ambient PM2.5 exposures & the development of Alzheimer's disease. Ecotoxicol Environ Saf, 174, 344-352. doi:10.1016/j.ecoenv.2019.02.086. PMID: 30849654.

96.       Pascual, F. (2021). Breaching the barrier: nanoscale particulate matter and measures of brain health. Environ Health Perspect, 129, 2, 124003. doi:10.1289/EHP10319. PMID 34962425. PMC8713652.

97.       Randolph, A.C. et al. (2019). Blood-brain barrier dysfunction after smoke inhalation injury. Shock, 51, 5, 634-649. doi: 10.1097/SHK.0000000000001196. PMID: 29905673











108.     Southerland, V.A. et al. (2022). Global urban temporal trends in fine particulate matter (PM2.5) and attributable health burdens: estimates from global datasets. Lancet Planet Health, S2542-5196(21)00350-8. doi:10.1016/S2542-5196(21)00350-8. PMID 34998505.
















124.     Lopez-Aparicio, S. (2021). Status of wood log burning in Norway and overview of emissions: is it time to put out the fire in wood burners? Innoasis Science Talks Online, Norwegian Institute for Air Research.











135.     Ramírez, A.S. et al. (2019). Public awareness of air pollution and health threats: challenges and opportunities for communication strategies to improve environmental health literacy. J Health Commun, 24, 1, 75-83. doi:10.1080/10810730.2019.1574320. PMID 30730281. PMC6688599

136.     Aleluia Reis, A. et al. (2022). Internalising health-economic impacts of air pollution into climate policy: a global modelling study. The Lancet Planetary Health, 6, e40-e48.


138.     Weitekamp, C.A. et al. (2021). Effects of air pollution exposure on social behavior: a synthesis and call for research. Environ Health, 20, 1,72. doi: 10.1186/s12940-021-00761-8. PMID: 34187479; PMCID: PMC8243425

139.     Thomson, E.M. (2019). Air pollution, stress, and allostatic load: linking systemic and central nervous system impacts. J Alzheimers Dis, 69, 3, 597-614. doi: 10.3233/JAD-190015. PMID: 31127781. PMCID: PMC6598002

140.     Lu, J.G. (2020). Air pollution: a systematic review of its psychological, economic, and social effects. Curr Opin Psychol, 32, 32:52-65. doi:10.1016/j.copsyc.2019.06.024. PMID: 31557706

141.     Olaniyan, T. et al. (2022). Ambient air pollution and the risk of acute myocardial infarction and stroke: A national cohort study. Environmental Research. In press.

142.     Mesnil, M. et al. (2020). Brain disorders and chemical pollutants: a gap junction link? Biomolecules, 11, 1, 51. doi: 10.3390/biom11010051. PMID: 33396565 PMCID: PMC7824109 DOI: 10.3390/biom11010051

143.     Costa, L.G. et al. (2020). Effects of air pollution on the nervous system and its possible role in neurodevelopmental and neurodegenerative disorders. Pharmacol Ther, 210, 107523. doi: 10.1016/j.pharmthera.2020.107523. PMID: 32165138 PMCID. PMC7245732. 

144.     Brokamp. C. et al. (2019). Paediatric psychiatric emergency department utilization and fine particulate matter: a case-crossover study. Environmental Health Perspectives, 127, 9.


BPS Members can discuss this article

Already a member? Or Create an account

Not a member? Find out about becoming a member or subscriber