Particulate matter pollution and risk of outpatient visits for psychological diseases in Nanjing, China

Environ Res. 2021 Feb;193:110601. doi: 10.1016/j.envres.2020.110601. Epub 2020 Dec 8.


Exposure to air pollution has been associated with increased risk for a range of adverse mental health conditions. Less is known about whether air pollution is also associated with increases in the utilization of mental health services, especially outpatient mental health service utilization. This study aimed to examine the association between the number of daily outpatient visits at the psychological disease departments of two major hospitals (PSYC) and daily average concentrations of PM2.5 and PM10 in a heavily polluted city in China, Nanjing, from 2013/7/1 to 2019/2/28, using generalized additive models with a quasi-Poisson regression. Results showed that each 10 μg/m3 increase in PM2.5 concentration on lag0 day was associated with a 0.40% increase (95% CI: 0.07-0.72) in PSYC visits, and each 10 μg/m3 increase in PM10 concentration on the same day a 0.31% increase (95% CI: 0.09-0.54) in PSYC visits. Exposure-response curves suggested linear relationships between PM concentration and daily PSYC outpatient visits, without evidence of a threshold. Associations remained positive, but were non-significant, with adjustment for co-pollutants, SO2, NO2 and CO. Significantly larger effects were found for older and male participants, vs. their counterparts. These findings add to the growing literature linking air pollution to mental health service utilization, demonstrating the critical need for both air pollution mitigation measures and increased capacity of the mental health system in China.

Keywords: Air pollution; Mental disorders; Outpatient visits; Particulate matter; Time series.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Air Pollutants* / analysis
  • Air Pollution* / adverse effects
  • Air Pollution* / analysis
  • China / epidemiology
  • Cities
  • Humans
  • Male
  • Outpatients
  • Particulate Matter / analysis


  • Air Pollutants
  • Particulate Matter