The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study

Objective To determine whether higher past exposure to particulate air pollution is associated with prevalent high symptoms of anxiety. Design Observational cohort study. Setting Nurses’ Health Study. Participants 71 271 women enrolled in the Nurses’ Health Study residing throughout the contiguous United States who had valid estimates on exposure to particulate matter for at least one exposure period of interest and data on anxiety symptoms. Main outcome measures Meaningfully high symptoms of anxiety, defined as a score of 6 points or greater on the phobic anxiety subscale of the Crown-Crisp index, administered in 2004. Results The 71 271 eligible women were aged between 57 and 85 years (mean 70 years) at the time of assessment of anxiety symptoms, with a prevalence of high anxiety symptoms of 15%. Exposure to particulate matter was characterized using estimated average exposure to particulate matter <2.5 μm in diameter (PM2.5) and 2.5 to 10 μm in diameter (PM2.5-10) in the one month, three months, six months, one year, and 15 years prior to assessment of anxiety symptoms, and residential distance to the nearest major road two years prior to assessment. Significantly increased odds of high anxiety symptoms were observed with higher exposure to PM2.5 for multiple averaging periods (for example, odds ratio per 10 µg/m3 increase in prior one month average PM2.5: 1.12, 95% confidence interval 1.06 to 1.19; in prior 12 month average PM2.5: 1.15, 1.06 to 1.26). Models including multiple exposure windows suggested short term averaging periods were more relevant than long term averaging periods. There was no association between anxiety and exposure to PM2.5-10. Residential proximity to major roads was not related to anxiety symptoms in a dose dependent manner. Conclusions Exposure to fine particulate matter (PM2.5) was associated with high symptoms of anxiety, with more recent exposures potentially more relevant than more distant exposures. Research evaluating whether reductions in exposure to ambient PM2.5 would reduce the population level burden of clinically relevant symptoms of anxiety is warranted.

[1]  S D Colome,et al.  Psychological reactions to air pollution. , 1988, Environmental research.

[2]  Stephanie I. Davis,et al.  Anxiety affecting parkinsonian outcome and motor efficiency in adults of an Ohio community with environmental airborne manganese exposure. , 2012, International journal of hygiene and environmental health.

[3]  C. Pope Review: Epidemiological Basis for Particulate Air Pollution Health Standards , 2000 .

[4]  B. Rowe,et al.  Air pollution and daily emergency department visits for depression. , 2009, International journal of occupational medicine and environmental health.

[5]  S. Sears,et al.  Psychopathology and Symptoms of Atrial Fibrillation: Implications for Therapy , 2012, Journal of cardiovascular electrophysiology.

[6]  Timo Mäkelä,et al.  SOURCES AND CHEMICAL COMPOSITION OF ATMOSPHERIC FINE AND COARSE PARTICLES IN THE HELSINKI AREA , 2001 .

[7]  L. Berkman,et al.  Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. , 1979, American journal of epidemiology.

[8]  Christopher J. Paciorek,et al.  Predicting Chronic Fine and Coarse Particulate Exposures Using Spatiotemporal Models for the Northeastern and Midwestern United States , 2008, Environmental health perspectives.

[9]  K. Schruers,et al.  Experimental pathophysiology of panic. , 1998, Journal of psychosomatic research.

[10]  C. O'connor,et al.  Phobic Anxiety and Increased Risk of Mortality in Coronary Heart Disease , 2010, Psychosomatic medicine.

[11]  T. Vos,et al.  Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010 , 2013, The Lancet.

[12]  G. Brenes Anxiety and Chronic Obstructive Pulmonary Disease: Prevalence, Impact, and Treatment , 2003, Psychosomatic medicine.

[13]  M. Fareed,et al.  Particulate matter concentration in ambient air and its effects on lung functions among residents in the National Capital Region, India , 2013, Environmental Monitoring and Assessment.

[14]  A. Peters,et al.  Particulate Matter Air Pollution and Cardiovascular Disease: An Update to the Scientific Statement From the American Heart Association , 2010, Circulation.

[15]  Changsoo Kim,et al.  Ambient particulate matter as a risk factor for suicide. , 2010, The American journal of psychiatry.

[16]  G. Colditz,et al.  Association between catechol-O-methyltransferase and phobic anxiety. , 2004, The American journal of psychiatry.

[17]  B. Rowe,et al.  Air Pollution and Emergency Department Visits for Suicide Attempts in Vancouver, Canada , 2010, Environmental health insights.

[18]  John E. Miller,et al.  Air pollutants and the admission rate of psychiatric patients. , 1979, The American journal of psychiatry.

[19]  M. Berk,et al.  Oxidative Stress in Psychiatric Disorders: Evidence Base and Therapeutic Implications , 2009 .

[20]  H. Völzke,et al.  Mental health problems, obstructive lung disease and lung function: findings from the general population. , 2011, Journal of psychosomatic research.

[21]  J. Schwartz,et al.  Acute exposure to air pollution triggers atrial fibrillation. , 2013, Journal of the American College of Cardiology.

[22]  S. Salim,et al.  Moderate treadmill exercise prevents oxidative stress-induced anxiety-like behavior in rats , 2010, Behavioural Brain Research.

[23]  M. Stein,et al.  Advances in the Management of Treatment-Resistant Anxiety Disorders , 2010 .

[24]  Z. Xia,et al.  Oxidative stress: A potential recipe for anxiety, hypertension and insulin resistance , 2010, Brain Research.

[25]  R. Kessler,et al.  The economic burden of anxiety disorders in the 1990s. , 1999, The Journal of clinical psychiatry.

[26]  Olga V. Demler,et al.  Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[27]  F. Dominici,et al.  Potential Confounding of Particulate Matter on the Short-Term Association between Ozone and Mortality in Multisite Time-Series Studies , 2007, Environmental health perspectives.

[28]  J. Januzzi,et al.  Association between C-reactive protein and generalized anxiety disorder in stable coronary heart disease patients. , 2008, European heart journal.

[29]  Ronald C Kessler,et al.  The global burden of mental disorders: An update from the WHO World Mental Health (WMH) Surveys* , 2009, Epidemiologia e Psichiatria Sociale.

[30]  L. Michelson,et al.  The Middlesex Hospital Questionnaire: A Validity Study with American Psychiatric Patients , 1981, British Journal of Psychiatry.

[31]  D. Panagiotakos,et al.  Anxiety in relation to inflammation and coagulation markers, among healthy adults: the ATTICA study. , 2006, Atherosclerosis.

[32]  R. Twombly STEERing Doctors to Environmental Health Awareness , 2002, Environmental health perspectives.

[33]  A. Yohannes,et al.  Depression and anxiety in chronic heart failure and chronic obstructive pulmonary disease: prevalence, relevance, clinical implications and management principles , 2010, International journal of geriatric psychiatry.

[34]  H. Engler,et al.  Acute amygdaloid response to systemic inflammation , 2011, Brain, Behavior, and Immunity.

[35]  Wayne Katon,et al.  Anxiety disorders and comorbid medical illness. , 2008, General hospital psychiatry.

[36]  Constantinos Sioutas,et al.  Exposure Assessment for Atmospheric Ultrafine Particles (UFPs) and Implications in Epidemiologic Research , 2005, Environmental health perspectives.

[37]  Joel Schwartz,et al.  Diabetes, Obesity, and Hypertension May Enhance Associations between Air Pollution and Markers of Systemic Inflammation , 2006, Environmental health perspectives.

[38]  Antonella Zanobetti,et al.  Air Pollution and Markers of Coagulation, Inflammation, and Endothelial Function: Associations and Epigene-environment Interactions in an Elderly Cohort , 2012, Epidemiology.

[39]  Anu Asnaani,et al.  Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. , 2011, Journal of psychiatric research.

[40]  M. Diociaiuti,et al.  The two PM(2.5) (fine) and PM(2.5-10) (coarse) fractions: evidence of different biological activity. , 2001, Environmental research.

[41]  R. Maronpot,et al.  DNA Damage in Nasal and Brain Tissues of Canines Exposed to Air Pollutants Is Associated with Evidence of Chronic Brain Inflammation and Neurodegeneration , 2003, Toxicologic pathology.

[42]  S Crown,et al.  A Short Clinical Diagnostic Self-rating Scale for Psychoneurotic Patients , 1966, British Journal of Psychiatry.

[43]  G. Evans,et al.  Air pollution and depressive symptomatology: Exploratory analyses of intervening psychosocial factors , 1984 .

[44]  David C Christiani,et al.  Urinary 8-hydroxy-2'-deoxyguanosine as a biomarker of oxidative DNA damage in workers exposed to fine particulates. , 2004, Environmental health perspectives.

[45]  J. Lépine,et al.  The epidemiology of anxiety disorders: prevalence and societal costs. , 2002, The Journal of clinical psychiatry.

[46]  S. V. van Eeden,et al.  Particulate matter air pollution exposure: role in the development and exacerbation of chronic obstructive pulmonary disease , 2009, International journal of chronic obstructive pulmonary disease.

[47]  C. Pisinger,et al.  Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review , 2004, Nordic journal of psychiatry.

[48]  M. Szyszkowicz Air pollution and emergency department visits for depression in Edmonton, Canada. , 2007, International journal of occupational medicine and environmental health.

[49]  David E Newby,et al.  Global association of air pollution and heart failure: a systematic review and meta-analysis , 2013, The Lancet.

[50]  F. Kelly,et al.  Oxidative stress: its role in air pollution and adverse health effects , 2003, Occupational and environmental medicine.

[51]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[52]  J. Rotton,et al.  Psychological costs of air pollution: Atmospheric conditions, seasonal trends, and psychiatric emergencies , 1984 .

[53]  Sanghyuk Bae,et al.  Air Pollution and Symptoms of Depression in Elderly Adults , 2012, Environmental health perspectives.

[54]  J. Briere,et al.  Summer in the city: urban weather conditions and psychiatric emergency-room visits. , 1983, Journal of abnormal psychology.

[55]  Steffen Loft,et al.  Personal PM2.5 exposure and markers of oxidative stress in blood. , 2002, Environmental health perspectives.

[56]  A. Nel,et al.  Particulate matter and atherosclerosis: role of particle size, composition and oxidative stress , 2009, Particle and Fibre Toxicology.

[57]  J. Kornhuber,et al.  The hypothesis of an impact of ozone on the occurrence of completed and attempted suicides. , 2009, Medical hypotheses.

[58]  W. Katon,et al.  The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. , 2007, General hospital psychiatry.

[59]  Loyda B. Mendez,et al.  Particulate matter in polluted air may increase biomarkers of inflammation in mouse brain. , 2005, Neurotoxicology.

[60]  Ling Sh,et al.  Particulate matter air pollution exposure: role in the development and exacerbation of chronic obstructive pulmonary disease , 2009 .

[61]  M. Green Air pollution and health , 1995 .

[62]  S. Salim,et al.  Depression, anxiety-like behavior and memory impairment are associated with increased oxidative stress and inflammation in a rat model of social stress , 2013, Brain Research.

[63]  J. Sunyer,et al.  Traffic-related air pollution correlates with adult-onset asthma among never-smokers , 2009, Thorax.

[64]  Louise Sharpe,et al.  Panic attacks and panic disorder in chronic obstructive pulmonary disease: a cognitive behavioral perspective. , 2010, Respiratory medicine.

[65]  P. Gosset,et al.  Activation of different pathways of apoptosis by air pollution particulate matter (PM2.5) in human epithelial lung cells (L132) in culture. , 2006, Toxicology.

[66]  D. Niemeier,et al.  Near-roadway air quality: synthesizing the findings from real-world data. , 2010, Environmental science & technology.

[67]  G. Lip,et al.  Illness perceptions, affective response, and health-related quality of life in patients with atrial fibrillation. , 2009, Journal of psychosomatic research.

[68]  A. Nel,et al.  Ultrafine particulate pollutants induce oxidative stress and mitochondrial damage. , 2002, Environmental health perspectives.

[69]  A. Faustini,et al.  Short-Term Effects of Air Pollution in a Cohort of Patients With Chronic Obstructive Pulmonary Disease , 2012, Epidemiology.

[70]  V. Meyer-Rochow,et al.  The association between anxiety and C-reactive protein (CRP) levels: Results from the Northern Finland 1966 Birth Cohort Study , 2011, European Psychiatry.

[71]  Annette Peters,et al.  Associations between Traffic Noise, Particulate Air Pollution, Hypertension, and Isolated Systolic Hypertension in Adults: The KORA Study , 2014, Environmental health perspectives.

[72]  J. Moreira,et al.  Oxidative stress in the hippocampus, anxiety-like behavior and decreased locomotory and exploratory activity of adult rats: effects of sub acute vitamin A supplementation at therapeutic doses. , 2007, Neurotoxicology.

[73]  Yifang Zhu,et al.  Concentration and Size Distribution of Ultrafine Particles Near a Major Highway , 2002, Journal of the Air & Waste Management Association.

[74]  R. Delfino,et al.  Epidemiologic evidence for asthma and exposure to air toxics: linkages between occupational, indoor, and community air pollution research. , 2001, Environmental health perspectives.

[75]  S. Salim,et al.  Inflammation in anxiety. , 2012, Advances in protein chemistry and structural biology.

[76]  M. Block,et al.  Particulate matter, oxidative stress and neurotoxicity. , 2008, Neurotoxicology.

[77]  G. Lip,et al.  Depression, anxiety, and quality of life in patients with atrial fibrillation. , 2007, Chest.

[78]  Duanping Liao,et al.  Spatio-temporal modeling of particulate air pollution in the conterminous United States using geographic and meteorological predictors , 2014, Environmental Health.

[79]  E. Rimm,et al.  Prospective study of phobic anxiety and risk of coronary heart disease in men. , 1994, Circulation.

[80]  J. Manson,et al.  Phobic Anxiety and Risk of Coronary Heart Disease and Sudden Cardiac Death Among Women , 2005, Circulation.

[81]  Elie Karam,et al.  Mental disorders among adults with asthma: results from the World Mental Health Survey. , 2007, General hospital psychiatry.

[82]  Eric E. Schadt,et al.  Glyoxalase 1 and glutathione reductase 1 regulate anxiety in mice , 2005, Nature.

[83]  E. Wagner,et al.  Preventing frail health. , 1992, Clinics in geriatric medicine.

[84]  P. Vokonas,et al.  Decreased heart rate variability in men with phobic anxiety (data from the Normative Aging Study). , 1995, The American journal of cardiology.

[85]  T. Meade,et al.  Phobic anxiety and ischaemic heart disease. , 1987, British medical journal.

[86]  Jean Krutmann,et al.  Long-term exposure to traffic-related particulate matter impairs cognitive function in the elderly. , 2009, Environmental research.

[87]  Francine Laden,et al.  Exposure measurement error in PM2.5 health effects studies: A pooled analysis of eight personal exposure validation studies , 2014, Environmental Health.

[88]  J. Schwartz,et al.  Increased Risk of Paroxysmal Atrial Fibrillation Episodes Associated with Acute Increases in Ambient Air Pollution , 2005, Environmental health perspectives.

[89]  Joel Schwartz,et al.  Spatio-temporal modeling of chronic PM10 exposure for the Nurses' Health Study. , 2008, Atmospheric environment.

[90]  J. Manson,et al.  The Nurses' Health Study: 20-year contribution to the understanding of health among women. , 1997, Journal of women's health.

[91]  K. Rexrode,et al.  High Phobic Anxiety Is Related to Lower Leukocyte Telomere Length in Women , 2012, PloS one.

[92]  P de Jonge,et al.  Anxiety disorders and inflammation in a large adult cohort , 2013, Translational Psychiatry.

[93]  D. Baldwin,et al.  A neuroimmunological perspective on anxiety disorders , 2012, Human psychopharmacology.

[94]  I. Kawachi,et al.  Prospective study of phobic anxiety and risk of Parkinson's disease , 2003, Movement disorders : official journal of the Movement Disorder Society.