Fine Particulate Matter From 2020 California Wildfires and Mental Health–Related Emergency Department Visits

Importance: A growing body of research suggests that exposure to fine particulate matter (PM_2.5; particle size 2.5 microns or smaller) may be associated with mental health outcomes. However, the potential impact of wildfire-specific PM_2.5 exposure on mental health remains underexplored.

Objective: To investigate whether wildfire-specific PM_2.5 exposure may be associated with emergency department (ED) visits for mental health conditions, including all-cause and for psychoactive substance use, nonmood psychotic disorders, anxiety, depression, and other mood-affective disorders during the extensive 2020 California wildfire season.

Design, Setting, and Participants: This cross-sectional study used data on ED visits from July to December 2020 obtained from the California Department of Health Care Access and Information (HCAI). Eligible participants were California residents who presented to an ED in California for mental health conditions without COVID-19. The data were analyzed between July 2020 and December 2020.

Exposure: Wildfire-specific PM_2.5 exposure (with up to 7-day lags) based on participants’ residential zip codes.

Main Outcomes and Measures: Daily ED visit counts for all-cause and disease-specific mental health conditions (F00-F99) identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes at zip code tabulation areas.

Results: Between July and December 2020, there were 86 609 ED visits for mental health conditions (median [IQR] patient age, 38 [27-54] years; 40 272 female [46.5%]; 10 657 Black [12.3%], 30 044 Hispanic [34.7%], 35 145 White [40.6%]). Visits included psychoactive substance use (23 966 [27.6%]), nonmood psychotic disorders (16 714 [19.3%]), anxiety (26 711 [30.8%]), depression (10 422 [12.0%]), and other mood-affective disorders (5338 [6.2%]). During peak wildfire months, the median (IQR) daily concentration of wildfire-specific PM_2.5 increased to 11.9 (3.9-32.5) μg/m³. A 10-μg/m³ increase in wildfire-specific PM_2.5 was associated with higher ED visits for all-cause mental conditions (cumulative relative risk [cRR] over lag 0-7 days, 1.08; 95% CI, 1.03-1.12), depression (cRR over lag 0-7 days, 1.15; 95% CI, 1.02-1.30), other mood-affective disorders (cRR over lag 0-7 days, 1.29; 95% CI, 1.09-1.54), and anxiety (cRR over lag 0-4 days, 1.06; 95% CI, 1.00-1.12). Subgroup analyses suggested that wildfire smoke was associated with disproportionately increased ED visits among female individuals (eg, depression: cRR over lag 0-4 days, 1.17; 95% CI, 1.03-1.32) and young people (other mood-affective disorders: cRR over lag 0-4 days, 1.46; 95% CI, 1.08-1.98). Effect modification by race was found, with non-Hispanic Black individuals having an increased risk of ED visits for other mood-affective disorders (cRR over lag 0-5 days, 2.35; 95% CI, 1.56-3.53) and Hispanic individuals an increased risk for visits for depression (cRR over lag 0-7 days, 1.30; 95% CI, 1.06-1.59).

Conclusions and Relevance: Wildfire smoke exposure was associated with significantly increased odds of subsequent ED visits for mental health conditions in this cross-sectional study, with varying lag times for different subconditions and demographic groups.