Teenage Psychosis Linked to Air Pollution for the First Time

A number of studies have demonstrated the negative health effects of air pollution on adults and children. A recent report from the Health Effects Institute¹ shows 90 percent of the world live in an area where pollution levels are higher than deemed safe by the World Health Organization (WHO).

The sheer magnitude of air pollution in quantity and in the effect it has on health contributes to making it the largest environmental cause of death in the world.² Air pollution known to trigger significant health damage is fine particulate matter (PM) measuring 2.5 micrograms in diameter (PM2.5). These tiny particles are capable of being absorbed through your lungs into your bloodstream.

Concentrations exceeding 10 micrograms per meter cubed (ug/m3) exist in 92 percent of the world and 54 percent live in areas where the particulate matter exceeds even the least stringent WHO air quality target of 35 ug/m3.³ One method of studying environmental effects on human health has been through an evaluation of twins. Dr. Tim Spector, professor of genetic epidemiology at King's College London, believes:⁴

"Twin studies are the only way of doing natural experiments in humans. By studying twins, you can learn a great deal about what makes us tick, what makes us different ..."

Recent analysis of a nationally representative cohort of data from young twins gathered from 1999 to 2008 demonstrates exposure to air pollution is associated with an increased risk of experiencing a psychotic episode.⁵

Twin Study Data Used to Evaluate Environmental Risk Factors on Behavior

The researchers used the data gathered from the Environmental-Risk (E-Risk) Longitudinal Twin Study and compared it against pollution data completed October 2017. The E-Risk study began in 1998 with the primary goal to understand children's disruptive behavior and determine if there was a specific environmental risk factor influencing the behavior.⁶

Twins were engaged to examine any interactions with genetic and individual factors. Researchers measured disruptive behavior such as opposition, misconduct, hyperactivity and inattentiveness. The study recruited twins at age 5 and started with a sample size of 2,232.⁷

Comprehensive home visits were conducted when the children were 5, 7, 10 and 12 years of age. At 18 the scientists had retained 93 percent of the group. The researchers believed it was important to gather a group of young participants to help determine the onset of behavioral problems and evaluate against a variety of environmental factors.

The team conducted several additional analyses on the data and found 71 percent of the adolescents in the study did not change residences between the ages of 12 and 18, keeping air pollution exposure consistent.⁸ They also included the degree to which the children's environments were urban, as an additional variable accounting for factors correlated with air pollution.

Psychotic Experiences May Be Linked to Air Pollution

At age 18 the participants were interviewed separately and privately by two different researchers. Almost 33 percent (632) reported they had experienced one psychotic episode from age 12 to 18, describing feelings like people were spying on them or hearing voices no one else heard.⁹

The researchers matched the responses to estimates of air pollution in their neighborhoods over a one-year period, finding that those living in an area with the highest levels of pollutant gases reported a higher percentage of psychotic experiences.

In those areas, 12 teenagers out of every 20 reported a psychotic type episode, while in areas with lower levels of nitrogen oxide gases, only 7 of 20 reported the same. The researchers then factored issues that might have contributed to these episodes, including a past family history of mental conditions, social deprivation or alcohol and drug use, but the findings remained the same.¹⁰

The lead researcher, postdoctoral fellow Joanne Newberry, said psychotic experiences among adolescents were more common in urban areas. She added while the study could not show causation, it did suggest pollution was a contributing factor.¹¹

According to Newberry, nitrogen oxides could account for about 60 percent of the association between psychotic episodes and urban living.¹² The first study finding a link between growing up in a city and a higher number of psychotic episodes was published in 1939 in the Journal of the American Medical Association.¹³

What Is Psychosis?

The word psychosis describes a number of conditions affecting the mind, during which you have some loss of contact with reality. During a psychotic episode, thoughts and perceptions may be disturbed and you may have difficulty differentiating between what's real and what isn't.¹⁴

Symptoms may include hallucinations, seeing or hearing things others don't see or hear, and inappropriate behavior. Delusions are another symptom of psychosis and are strong beliefs that are inconsistent with the individuals' culture. Researchers in the featured study found teenagers experienced hallucinations and had the feeling people were following them.¹⁵

Someone experiencing a psychotic episode may also suffer depression, sleep problems, social withdrawal and difficulty functioning. Psychosis is actually a symptom and not an illness. Nearly 100,000 young people experience these symptoms each year, and as many as 3 percent will have an episode at some point during their life.¹⁶

Researchers believe there are several triggers contributing to psychosis, including traumatic events, such as death, war or sexual assault. Individuals who have chronic substance use, such as amphetamines and LSD, have an increased vulnerability. A physical injury, such as a traumatic brain injury, stroke and some diseases related to dementia, may also trigger psychosis.¹⁷

In some instances, psychosis is a symptom of another condition, such as schizoaffective disorder, bipolar disorder, depression or schizophrenia. Diagnosis is made by a physician or psychologist and early treatment leads to the best outcomes.¹⁸

Indoor Air Pollution Contains Additional Pollutants

Your indoor air quality is important to your long-term health as most people spend up to 90 percent of their day indoors. According to the U.S. Environmental Protection Agency (EPA), the concentrations of some pollutants indoors may be up to five times higher than outdoors.¹⁹

The two primary sources of indoor air pollution are materials used in the construction of the building and everything in it — including your furniture — and any chemical products you bring into your home, such as aerosols and room deodorizers. Many of these sources contain volatile organic compounds (VOCs), which have both short- and long-term health effects.²⁰

Modern buildings are built with energy efficiency in mind and require proper ventilation to reduce the buildup of indoor air pollutants.²¹ One of the easiest ways to do this is to open your windows every day for cross-ventilation, even on cold days. Although outdoor air may not be pristine, cross-ventilation helps to reduce the buildup of indoor air pollutants.

Other contributing factors may come from outdoor air pollution brought into the house through air conditioning units. Technology is also available to monitor fine particulate matter in your home, track trends and even deliver the information straight to your mobile phone.

A science teacher testing a product in his classroom detected spikes in particulate matter corresponding to a generator on the school rooftop that shuttled the pollutants into the building through the air conditioning units.²²

Filters attached to air conditioning and heating units are not capable of completely eliminating PM2.5 pollutants from the air. The EPA recommends running your air conditioning system with the fresh air intake closed to reduce the amount of outdoor PM 2.5 brought into the home.²³ Those most susceptible to air pollution often spend more time indoors, such as the very young and very old.²⁴

Air Pollution Linked to Poor Health and Premature Death

In addition to the psychotic episodes experienced by teens living in urban areas, poor air quality is linked to a number of health conditions in children and adults, and contributes to premature death. Adults may suffer from poor sleep, cancer,²⁵ cardiovascular disease,²⁶ lung conditions²⁷ and cognitive decline.²⁸

A report from the WHO²⁹ analyzed studies from the past 10 years, and included input from dozens of experts, to reveal some of the top health risks air pollution poses to children. These health conditions continue to have a negative effect through childhood and into adulthood, including:

Adverse birth outcomes, including low birth weight, premature birth, stillbirth and infants born small for gestational age.

Infant mortality — As pollution levels increase, so does risk of infant mortality.

Neurodevelopment — Exposure to air pollution may lead to lower cognitive test outcomes, negatively affect children's mental and motor development and may influence the development of autism and attention deficit hyperactivity disorder.

Childhood obesity.

Lung function — Prenatal exposure to air pollution is associated with impaired lung development and lung function in childhood.

Acute lower respiratory infection, including pneumonia.

Asthma — Exposure to ambient air pollution increases the risk of asthma and exacerbates symptoms of childhood asthma.

Ear infection.

Childhood cancers, including retinoblastomas and leukemia.

Health problems in adulthood — Evidence suggests prenatal exposure to air pollution may increase the risk of chronic lung disease and cardiovascular disease later in life.

Your Diet Helps Protect Against Air Pollution

Fine particulate matter may enter your system and trigger chronic inflammation, which in turn increases your risk of a number of health problems. Since controlling your exposure to air pollution is challenging, one option is to fortify your diet with nutrients that may have a protective effect, including:³⁰

• Omega-3 fats — They are anti-inflammatory, and in a study of 29 middle-aged people, taking an animal-based omega-3 fat supplement reduced some of the adverse effects to heart health and lipid levels, including triglycerides, occurring with exposure to air pollution (olive oil did not have the same effect).³¹

• Broccoli sprouts — Broccoli-sprout extract prevented allergic response occurring with exposure to particles in diesel exhaust, suggesting it could have a protective effect on air pollution's role in allergic disease and asthma.³² A broccoli-sprout beverage enhanced detoxification of some airborne pollutants in residents of a highly polluted region in China.³³

• Vitamins C and E — In children suffering from asthma, antioxidants, including vitamins C and E, were shown to help buffer the impact of ozone exposure on the child's smaller airways.³⁴

• B vitamins — A small-scale human trial found high doses of vitamins B6, B9 and B12 in combination completely offset damage caused by very fine particulate matter in air pollution.³⁵

Four weeks of high-dose supplementation reduced genetic damage in 10 gene locations by 28 to 76 percent, protected mitochondrial DNA from the harmful effects of pollution, and helped repair some of the genetic damage.

Reducing Air Pollution Requires a Global Effort

In many areas, people have limited options to improve their air quality. The WHO notes³⁶ "reducing ambient air pollution requires wider action, as individual protective measures are not only insufficient, but are neither sustainable nor equitable." Solving the problem and protecting the health of future generations of children will instead take a global effort. According to WHO:³⁷

"To reduce and prevent exposure to both household air pollution and ambient air pollution, public policy is essential. Air pollutants do not recognize political borders but travel wherever the wind and prevailing weather patterns take them. Therefore, regional and international cooperative approaches are necessary to achieve meaningful reductions in children's exposure.

Individual efforts can add up to collective action that changes minds, changes policies and changes the quality of the air around us. Such actions would go far toward ensuring that children can breathe freely, without the terrible burdens imposed by air pollution."

In your own home, you may take several steps to keep your indoor air clean, including opening windows to let fresh air in and avoiding the use of known air pollutants like chemical cleaning products, air fresheners and scented candles.

If you live near a roadway or industry, seek to open your windows when outdoor pollutants are at the lowest levels. Purifying your home's air is also a wise step, but no one filter is able to remove all pollutants, so be sure to do your research on the different types of air filters to meet your specific needs.

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