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Learn more: PMC Disclaimer | PMC Copyright Notice J Clim Chang Health . 2026 Apr 3;27:100650. doi: 10.1016/j.joclim.2026.100650 Search in PMC Search in PubMed View in NLM Catalog Add to search Climate worry and daily life impacts among a sample of Canadian youth accessing integrated youth services Zachary Daly Zachary Daly a School of Nursing, T201-2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada b Wellstream: The Canadian Centre for Innovation in Child and Youth Mental Health and Substance Use, T308-2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada c Human Early Learning Partnership (HELP), Suite 440, 2206 East Mall, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Find articles by Zachary Daly a, b, c , Emily K Jenkins Emily K Jenkins a School of Nursing, T201-2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada b Wellstream: The Canadian Centre for Innovation in Child and Youth Mental Health and Substance Use, T308-2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada c Human Early Learning Partnership (HELP), Suite 440, 2206 East Mall, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada Find articles by Emily K Jenkins a, b, c , Sarah Adair Sarah Adair d Foundry, 915-1045 Howe Street, Vancouver, British Columbia, Canada Find articles by Sarah Adair d , A Fuchsia Howard A Fuchsia Howard a School of Nursing, T201-2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada e Women's Health Research Institute, 4500 Oak St, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada f Fraser Health Authority, 13750 96th Avenue, Surrey, British Columbia, Canada Find articles by A Fuchsia Howard a, e, f , Skye Barbic Skye Barbic d Foundry, 915-1045 Howe Street, Vancouver, British Columbia, Canada g Department of Occupational Science & Occupational Therapy, T325-2211 Wesbrook Mall, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada h Centre for Advancing Health Outcomes, 588-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6 Find articles by Skye Barbic d, g, h, ⁎ Author information Article notes Copyright and License information a School of Nursing, T201-2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada b Wellstream: The Canadian Centre for Innovation in Child and Youth Mental Health and Substance Use, T308-2211 Wesbrook Mall, University of British Columbia, Vancouver, British Columbia, Canada c Human Early Learning Partnership (HELP), Suite 440, 2206 East Mall, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada d Foundry, 915-1045 Howe Street, Vancouver, British Columbia, Canada e Women's Health Research Institute, 4500 Oak St, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada f Fraser Health Authority, 13750 96th Avenue, Surrey, British Columbia, Canada g Department of Occupational Science & Occupational Therapy, T325-2211 Wesbrook Mall, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada h Centre for Advancing Health Outcomes, 588-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6 ⁎ Corresponding author at: T325-2211 Wesbrook Mall, Vancouver, British Columbia, V6T 2A1, Canada. [email protected] Received 2025 Aug 13; Accepted 2026 Jan 13; Collection date 2026 Jan-Feb. © 2026 The Authors This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). PMC Copyright notice PMCID: PMC13089125 PMID: 42005570 Abstract Introduction Despite calls for service providers to support youth in navigating the mental health impacts of climate change, data from clinical contexts remain limited. Our research explores climate worry among youth accessing integrated youth services (IYS) in British Columbia, Canada. Methods Youth aged 16-24 years (n=393) were recruited from the waiting rooms of four IYS centres. Participants completed a survey to capture sociodemographic characteristics and assess mental health, including single items on level of climate change worry and whether feelings about climate change negatively impacted their daily lives. Results Overall, 40.9% of participants were very or extremely worried about climate change and 28.0% of participants reported that their feelings about climate change resulted in negative impacts on their daily life. Gender diverse youth and older youth were more likely to report negative daily life impacts due to their feelings about climate change. Moreover, while climate worry was inconsistently associated with measures of mental health, reporting that climate change was negatively impacting daily life was associated with higher scores of depressive symptoms, psychological distress, and worsened functioning across multiple domains. Conclusion This study is among the first to examine the relationship between climate change and youth mental health in a clinical sample. From these results, it is clear that a substantial subset of youth accessing clinical services are identifying that their feelings about climate change are negatively impacting their daily lives. Based on these results, service providers should be attuned to the impacts of climate change on youth mental health. Keywords: Climate distress, Mental health, Climate change, Climate anxiety, Youth, Integrated youth services 1. Introduction Climate change and its effects have been linked to a growing number of adverse consequences for human health [ [1] , [2] , [3] ]. One health consequence that is receiving increasing attention is the negative impacts of climate change on mental health, particularly among youth [ [4] , [5] , [6] ]. These mental health impacts can be either direct or indirect [ 6 , 7 ]. The former refers to impacts resulting from experiences of climate change-induced disasters, such as wildfires, floods, and storms, as well as witnessing more gradual changes, such disruptions to local ecosystems. The latter refers to impacts resulting from the more existential concerns arising from overall awareness of climate change and its impacts [ 6 , 7 ]. As a whole, these impacts have been found to exacerbate or trigger mental health concerns, including anxiety, depression, and post-traumatic stress disorder [ 6 , 8 , 9 ]. Alongside these mental health concerns, climate change has been found to contribute to various challenging emotional responses, including but not limited to fear, anxiety, anger, despair, and grief [ [10] , [11] , [12] , [13] , [14] ]. Various terms have been suggested to describe these responses, including climate anxiety, eco-anxiety, and climate worry, as well as more specialized terms such as solastalgia, ecological grief, Anthropocene horror, and eco-despair [ 6 , 10 , [15] , [16] , [17] ]. Given this profusion of terminology, climate distress has been used as an umbrella term to refer to these impacts collectively [ 18 , 19 ]. Of note, challenging emotions related to climate change are not inherently pathological [ 11 , 13 , [20] , [21] , [22] ]. Indeed, such reactions can be thought of as rational responses to the state of the world. Some scholars have suggested that they can even be adaptive [ 10 ], with positive relationships to pro-environmental behaviours [ 14 , 23 ]. However, research also suggests that, for some youth, experiences of climate distress are associated with mental ill-health [ 24 ], with youth considered at increased risk of these negative mental health consequences [ 25 ], owing to their stage of brain development [ 25 ], higher exposure to distressing media [ 26 ], and differing temporal orientation [ 27 ]. Furthermore, research has identified that certain youth are more likely to experience climate distress, with girls and gender diverse youth often identified as having higher levels of climate distress [ 12 , 28 ]. Recognizing these risks, there is a growing body of literature exploring the mental health impacts of various forms of climate distress, including climate worry, on youth, mostly at a population-level [ 18 , 24 ]. The overall pattern is that various forms of climate distress are associated with worsened youth mental health [ 18 , 24 ], including climate worry [ [29] , [30] , [31] ]. However, data on the mental health impacts of climate change among youth accessing clinical services remain limited [ 32 ]. This is concerning given that the studies that are available indicate this issue is leading to clinical presentations [ 33 , 34 ]. While it has been suggested that climate-change related emotional responses may reach the level of clinical significance when an individual is unable to able to cope with them on their own [ 24 ] or when there are impacts to daily functioning [ 35 ], there remain gaps in understandings about when clinical intervention might be warranted [ 32 ]. Given these knowledge gaps, the purpose of this paper is to understand how climate worry and daily life impacts due to emotions about climate change present in a sample of youth aged 16-24 years accessing health and social services in British Columbia (BC), Canada. The primary aim is to determine to what extent climate worry and negative daily life impacts due to emotions about climate change in a clinical sample are associated with measures of mental health and functioning. A secondary aim is to identify youth characteristics that may increase the likelihood of experiencing emotions about climate change that negatively impact their daily life. 2. Methods This study presents findings on the mental health impacts of climate change for youth who accessed clinical services at Foundry, an integrated youth services (IYS) initiative in BC, Canada, between March 2023 and April 2024. Foundry consists of a network of community-based centres, and a virtual service, that co-locates low-barrier mental health, substance use, physical/sexual health, peer support, and social services [ 36 , 37 ]. BC has experienced several climate events in recent years, such as a Heat Dome in 2021, which killed 619 people [ 38 ]. Furthermore, the interior region of BC experiences frequent, destructive wildfires [ 39 ], which result in air quality advisories across many areas of the province [ 40 , 41 ]. As part of a larger study examining youth health and functioning, youth aged 16-24 years were recruited from the waiting rooms of four Foundry centres; three centres are located in the Lower Mainland region of BC, and one is located in the Northern region of the province. Youth who were waiting to receive clinical services were approached by a member of the study team and informed about the opportunity to participate in the study. Ethical approval was attained from the University of British Columbia Behavioural Research Ethics Board (H20-03100). Informed consent was obtained from all participants. The consent form included information about the study, potential risks, how the data would be used, and who the youth could contact with further questions or concerns. Youth were informed that their data would be kept confidential and not shared with their healthcare team. Youth were provided with a tablet computer to complete the survey. Participants were compensated for their time with a $10 cash honorarium and entered into a gift card draw. They were also provided with information on locally available mental health resources. 2.1. Measures Sociodemographic questions characterized the sample according to a range of personal characteristics, including age, gender, housing status, and education. Mental Health was assessed using a variety of measures, including a single-item measure of overall mental health: “In general, would you say your mental health is…” with response options of “Excellent”, “Very good”, “Good”, “Fair” and “Poor”. This item has seen widespread use in the Canadian context [ 42 , 43 ]. Given prior documented associations between climate worry and depression [ 30 ], the Patient Health Questionnaire-8 (PHQ-8) [ 44 ] was also included, which measures depressive symptoms over the prior two weeks. The PHQ-8 has been used with youth samples [ 45 ], and was selected for this study as it omits an item on suicidal or self-injurious thoughts, while still being a valid measure of depressive symptoms [ 44 ]. For the PHQ-8, cut-offs were used to categorize participants as having no significant depressive symptoms (scores <5), mild depressive symptoms (scores ≥5 and <10), moderate depressive symptoms (scores ≥10 and <15), moderately severe depressive symptoms (scores ≥15 and < 20), or severe depressive symptoms (scores ≥20) [ 44 ]. The Cronbach’s-alpha for the PHQ-8 in this sample was 0.89. Additionally, the 10-item version of the Kessler Psychological Distress Scale (K10) was used to measure psychological distress over the previous 30 days [ 46 ]. For the K10, cut-offs were used to categorize participants as having no/low psychological distress (scores ≤15), moderate psychological distress (scores >15 and ≤21), high psychological distress (scores >21 and ≤29), or very high psychological distress (scores ≥30) [ 47 ]. The Cronbach’s alpha for this scale was 0.93. Finally, to explore impacts on functioning, the 36-item World Health Organization Disability Assessment Schedule-2.0 (WHODAS) [ 48 ] was used to assess functioning over the previous 30 days across six sub-domains: cognition, mobility, self-care, getting along with others, life activities, and participation. This scale has been previously validated among Canadian youth experiencing mental health challenges [ 49 ]. WHODAS scores for each of the sub-domains were calculated using the Simple Scoring Method [ 48 ], in which values for individual items are summed and divided by the number of items in the sub-domain. This scoring method is considered suited to clinical contexts [ 48 ] and process results in scores ranging from 1 to 5, with higher scores indicating greater difficulties with everyday functioning. The Cronbach’s alphas for the six sub-scales of the WHODAS were 0.86, 0.86, 0.75, 0.84, 0.94, and 0.93, respectively. To assess climate worry and daily life impacts due to feelings about climate change, we used two separate items drawn from a prior 10-country survey of youth [ 11 ]; these items have also been used in research in Brazil [ 50 ] and with Canadian youth [ 13 ]. One item explored climate worry through the question: “I am worried that climate change threatens people and the planet”, with the response options including: “Not worried”, “A little worried”, “Moderately worried”, “Very worried”, “Extremely worried”, and “Prefer not to say”. Similar single-item measures of climate worry have been used in prior studies [ [29] , [30] , [31] ]. The other climate item assessed daily life impacts due to climate distress more generally: “My feelings about climate change negatively affect my daily life (at least one of the following is negatively affected: Eating, concentrating, work, school, sleeping, spending time in nature, playing, having fun, relationships)”, with the response options, “yes”, “no”, and “prefer not to answer”. 2.2. Analysis Bivariate relationships between ordinal variables were examined using Goodman and Kruskal's gamma. Mann Whitney-U tests were conducted to compare median scores on the PHQ-8, K10, and WHODAS sub-scales for those who did and did not report any level of climate worry, those who did and did not report extreme climate worry, and those who did and did not report negative daily life impacts due to feelings about climate change. Given that prior research has found differences among youth based on age [ 18 , 51 ], age was dichotomized to compare older (19-24 years) and younger (16-18) youth. Chi-square tests were used to examine differences in the prevalence of reporting negative daily life impacts across sociodemographic characteristics; post-hoc comparisons using a Bonferroni correction were conducted as needed. All analyses were completed using SPSS 29.0 [ 52 ]. A p-value less than 0.05 was considered statistically significant and pairwise deletion was used to address missing data. 3. Results 3.1. Sociodemographic characteristics A total of 393 youth participated in the survey. The mean age of participants was 20.4 years (standard deviation 2.58), and 48.1% identified as women. The majority of participants were living in market housing, although 9.9% were homeless or living in a shelter. Sociodemographic characteristics are presented in Table 1 . Table 1. Sociodemographic characteristics of the sample. Age n % 16-18 101 25.7 19-24 292 74.3 Gender identity * n % Woman 189 48.1 Gender diverse 108 27.5 Man 93 23.7 Missing 3 0.8 Ethnicity ⁎⁎ n % White/Caucasian (European) 177 45.0 First Nations/Métis/Inuit 73 18.6 East Asian (Chinese, Japanese, Korean) 64 16.3 Southeast Asian (Filipino, Indonesian, Thai) 35 8.9 Other (mixed ethnicity) 34 8.7 Hispanic/Latino (Chilean, Columbian, Mexican) 27 6.9 Middle Eastern/North African (Armenian, Egyptian, Iranian, Lebanese, Moroccan) 26 6.6 South Asian (Bangladeshi, Indian, Pakistani, Nepalese) 21 5.3 Black (Kenyan, Nigerian, Somali) 11 2.8 Caribbean (Haitian, Jamaican) 7 1.8 Prefer not to answer 8 2.0 Housing n % Market rental (apartment with roommates, family home) 234 59.5 Homeless/shelter 39 9.9 Shared housing (where more than 5 people share a bathroom) 35 8. 9 Supportive housing (group home, support staff in the building) 27 6.9 Missing 58 14.8 Highest level of completed education n % Less than high school 98 24.9 High school graduate 142 36.1 Some college 101 25.7 Undergraduate or graduate degree 52 13.2 Open in a new tab ⁎ : Participants were asked “How would you describe your gender identity? (check all that apply)”, and were provided the following response options: female, male, non-binary, Two-Spirit, Trans female, Trans male, not sure/questioning, I don’t identify with any of these options, and Prefer not to answer. Participants who selected only male were categorized as man and participants who selected only female were categorized as woman. Participants who chose other options, or combinations of options, were considered gender diverse. ⁎⁎ : Participants were asked: “Which ethnicity do you identify with? (check all that apply)”. 3.2. Mental health characteristics Table 2 presents mental health characteristics of the sample. There was a high degree of mental health concern among participants, with over half screening positive for very high psychological distress. Over one in five were categorized as experiencing severe depressive symptoms. Table 2. Mental health, and climate distress characteristics of the sample. M ental health characteristics Self-reported health n % Excellent 29 7.4 Very good 77 19.6 Good 156 39.7 Fair 100 25.4 Poor 31 7.9 Self-reported mental health n % Excellent 12 3.1 Very good 38 9.7 Good 83 21.1 Fair 146 37.2 Poor 114 29.0 Depressive symptoms (PHQ8) n % No significant depressive symptoms 29 7.4 Mild depressive symptoms 68 17.3 Moderate significant depressive symptoms 74 18.8 Moderately severe depressive symptoms 83 21.1 Severe depressive symptoms 91 23.2 Missing/unable to calculate 48 12.2 Psychological distress (K10) n % None to low psychological distress 19 4.8 Moderate psychological distress 38 9.7 High psychological distress 80 20.4 Very high psychological distress 210 53.4 Missing/unable to calculate 46 11.7 WHODAS sub-domain scores Median Interquartile range Cognition (n=345) 2.33 1.17 Mobility (n=351) 1.60 1.20 Self-care (n=341) 1.75 1.25 Getting along with others (n=287) 2.20 1.60 Life activities (n=331) 2.50 1.38 Participation (n=293) 2.38 1.50 Climate distress characteristics I am worried that climate change threatens people and the planet n % Not worried 29 7.4 A little worried 60 15.3 Moderately worried 133 33.8 Very worried 85 21.6 Extremely worried 76 19.3 Prefer not to say 9 2.3 Skipped question 1 0.3 My feelings about climate change negatively affect my daily life (at least one of the following is negatively affected: Eating, concentrating, work, school, sleeping, spending time in nature, playing, having fun, relationships) n % No 247 62.8 Yes 110 28.0 Prefer not to answer 34 8.7 Skipped question 2 0.5 Open in a new tab 3.3. Climate worry and daily life impacts due to emotions about climate change As shown in Table 2 , a total of 40.9% of participants reported being very or extremely worried about climate change, and 28.0% reported experiencing negative impacts on their daily lives due to their feelings about climate change. There was a strong positive relationship between level of climate worry and negative impacts to daily life due to feelings about climate change (G=0.53, p<0.001) ( Figure 1 ). Notably, even among participants who reported no climate worry, 11.5% indicated that their feelings about climate change had a negative impact on their daily life. Among those who endorsed extreme climate worry, 34.3% reported that their feelings were not impacting their daily life. Figure 1. Open in a new tab Relationship between climate worry and reporting that feelings about climate change negatively impact daily life. 3.4. Climate worry, daily life impacts due to emotions about climate change, and wellbeing There was a weak negative relationship between climate worry and self-reported mental health (G=-0.19, p<0.001). However, there was no relationship between climate worry and depressive symptoms (G=0.06 p=0.32) or between climate worry and psychological distress (G=0.13, p=0.07). There was a moderate negative relationship between reporting negative daily impacts due to feelings about climate change and self-reported mental health (G=-0.22, p=0.01), as well as moderate positive relationships between reporting negative daily impacts due to feelings about climate change and both depressive symptoms (G=0.21, p=0.02) and psychological distress (G=0.35, p<0.001). As shown in Table 3 , the difference in median scores between those reporting any level of climate worry and those who reported not being worried was not statistically significant for the PHQ-8, K10, or any of the WHODAS subdomains. Compared to those who did not report extreme climate worry, individuals who did report extreme climate worry had higher median scores for the Cognition, Self-care, and Getting along subdomains of the WHODAS. Those who reported negative daily life impacts had higher median scores for the PHQ-8 and K10, as well as five of the sub-domains of the WHODAS, with the life activities sub-domain the only exception. Table 3. Comparison of median scores on the PHQ-8, K10, and WHODAS sub-scales by climate distress responses * . Comparison 1 Comparison 2 Comparison 3 Scale or sub-scale Any climate worry ⁎⁎ No climate worry Extreme climate worry Not extreme climate worry ⁎⁎⁎ Daily life impacts No daily life impacts Median Median p-value Median Median p-value Median Median p-value PHQ-8 15.00 14.00 0.26 16.00 14.00 0.06 16.00 14.00 0.007 K10 32.00 33.00 0.85 34.00 32.00 0.08 35.00 30.00 <0.001 WHODAS: cognition 2.33 2.33 0.99 2.83 2.33 0.01 2.83 2.17 <0.001 WHODAS: mobility 1.60 1.70 0.73 1.90 1.60 0.36 2.00 1.60 0.01 WHODAS: self-care 1.75 1.75 0.80 2.13 1.75 0.01 2.00 1.75 0.004 WHODAS: getting along with others 2.20 2.00 0.61 2.40 2.00 0.03 2.40 2.00 0.008 WHODAS: life activities 2.38 2.56 0.72 2.81 2.38 0.19 2.75 2.38 0. 31 WHODAS: participation 2.38 2.88 0.17 2.63 2.38 0.08 2.75 2.25 <0.001 Open in a new tab ⁎ : Mann Whitney-U tests used to compare median scores, p-values <0.05 are bolded. ⁎⁎ : Those who reported being “A little worried”, “Moderately worried”, “Very worried”, or “Extremely worried”. ⁎⁎⁎ : Those who reported being "Not worried”, “A little worried”, “Moderately worried”, or “Very worried”. K10: Kessler Psychological Distress Scale, PHQ-8: Patient Health Questionnaire-8, WHODAS: World Health Organization Disability Assessment Schedule-2.0 3.5. Sociodemographic variables and negative daily life impacts The relative prevalence of reporting that feelings about climate change negatively affect daily life by various sociodemographic variables is presented in Table 4 . Those who were gender diverse had a higher prevalence of negative daily life impacts than those who identified as men or as women. Furthermore, individuals aged 19-24 years were more likely to report negative life impacts compared to those who were younger. Table 4. Prevalence of reporting that feelings about climate change negatively affect daily life by sociodemographic characteristics. My feelings about climate change negatively affect my daily life n % p-value * Gender identity ⁎⁎ Woman (n=177) 44 24.9 a <0.001 Gender diverse (n=98) 45 45.9 b Man (n=80) 20 25.0 a Education level Not completed high school (n=86) 20 23.3 0.08 Complete high school or more (n=271) 90 33.2 Housing situation Market rental (apartment with roommates, family home) (n=217) 63 29.0 0.51 Homeless/shelter (n=35) 13 37.1 Shared housing (where more than 5 people share a bathroom) (n=32) 12 37.5 Supportive housing (group home, support staff in the building) (n=22) 5 22.7 Age 16-18 (n=92) 20 21.7 0.03 19-24 (n=265) 90 34.0 Open in a new tab ⁎ : Determined via Chi-square. Superscript letters for the gender variable indicate which categories differ at the p<0.05 level, based on post-hoc analysis, using a Bonferroni correction. ⁎⁎ : Participants were asked “How would you describe your gender identity? (check all that apply)”, and were provided the following options: female, male, non-binary, Two-Spirit, Trans female, Trans male, not sure/questioning, I don’t identify with any of these options, and Prefer not to answer. Participants who selected only male were categorized as man and participants who selected only female were categorized as woman. Participants who chose other options, or combinations of options, were considered gender diverse. 4. Discussion Despite calls to better support youth experiencing mental health concerns related to climate change [ 22 , 53 ], there is limited available data from clinical contexts to provide evidence-based guidance. This paper, based on surveys of youth accessing services at one of four IYS centres in BC, presents some of the first quantitative data on climate worry and daily life impacts due to climate-related emotional responses among a clinical sample of youth. Nearly all of the youth in this study reported experiencing climate worry to some degree, many at a high level. Further, over a quarter reported that their feelings about climate change were negatively impacting their daily lives. This appears lower than what has been reported in community-based population surveys of youth in Canada [ 13 ], although the reasons for this discrepancy are unclear. While there are limited clinical data to make comparisons, research conducted at a youth outpatient mental health practice in the United States found a high level of mental health concern related to climate change, with approximately two-thirds of participants reporting anxiety due to hearing about climate change, with symptoms including worry, anxiety about the future, and difficulty sleeping [ 54 ]. In the present study, there was a strong positive relationship between level of climate worry and reporting that one’s feelings about climate change negatively impact daily life. However, the associations between climate worry and measures of mental health and functioning were inconsistent, with only a weak relationship with self-reported mental health, and unsignificant associations with depressive symptoms and psychological distress. These findings support the notion that climate distress may not be inherently pathological [ 11 , 20 , 21 ], but contrast with other research documenting significant relationships between climate worry and depression [ 30 , 31 ]. What seems important, from a clinical perspective, is reporting impacts on daily life as a result of negative climate emotions. Youth who reported that their emotions about climate change negatively impacted their daily life had higher median scores on the PHQ-8, K10, and on five of the six sub-domains of the WHODAS. Given the associations with worsened wellbeing across multiple domains, reporting such impacts likely indicates the need for further assessment. This is in line with the view that impacts to daily functioning warrant clinical attention [ 35 ]. However, while there have been suggestions that clinicians screen for the impact of climate change on youth mental health [ 33 ], none of the existing scales have been created for this purpose [ 18 ]. Among youth who did not report any worry about climate change, a small number still indicated experiencing negative impacts to their daily lives because of their feelings about climate change. This suggests that worry is not the only emotional response to climate change associated with mental health concerns. Youth whose climate distress manifests in other feelings, such as grief, risk being “missed” if questions focus on worry alone. Open-ended questions may thus be of use during clinical assessment [ 18 ]. Conversely, even among those who reported being extremely worried about climate change, one in three did not endorse negative daily life impacts. This suggests that youth can potentially cope with even high levels of climate worry, supporting the notion that strong emotions in response to climate change do not necessarily manifest in a clinically significant manner. While there have been numerous studies into how youth cope with the emotions brought on by climate change [ [55] , [56] , [57] ], to our knowledge, none are focused on clinical contexts. Our findings further show that the prevalence of reporting daily life impacts due to climate change varies by sociodemographic characteristics. Specifically, youth who are gender diverse are more likely to report negative daily life impacts due to climate change. This finding is consistent with prior population-level research in Canada [ 12 , 14 , 28 ] and elsewhere [ 58 ]. While the underlying reasons are not clear, it is important to note that gender diverse youth experience a number of mental health inequities [ 47 , 59 ]. Findings indicating that older youth are more likely to experience negative impacts to daily functioning as a result of climate change-related emotions also align with population-level research into age and climate distress [ 18 ]. This study has important limitations. To start, the research is based on a convenience sample from a limited number of IYS centres in BC, Canada. As such, caution must be taken when generalizing to youth in other contexts or accessing different kinds of clinical services. This is particularly the case, given that none of the four centres in the study were located in rural areas; prior research has indicated that there may be differences in youth climate distress across urban and rural areas [ 12 ]. Another limitation is that of missing data. The question on housing status was only added partway through data collection, resulting in a relatively high amount of missingness and reducing statistical power. Furthermore, it was not possible to calculate PHQ-8, K10, or WHODAS scores for all youth. The fact that entire scales were often skipped, along with all subsequent questions, suggests that some youth may have been leaving surveys incomplete after being called to appointments. One exception is an item on the WHODAS related to sexual activity. This item had a higher degree of missingness than others, suggesting that youth may have been choosing not to respond to this question. This issue of missingness may be related to another limitation of the study, which was the relatively long length of the survey. Finally, there is the issue of causation. Indeed, the difficulty of disentangling causal pathways between various forms of climate distress and more general mental health concerns has been identified as a widespread issue [ 5 ]. While climate change may be driving mental health concerns in some youth, it is also possible that existing mental health challenges predispose some youth to climate distress, or that causal pathways are bidirectional [ 26 ]. However, regardless of the causal direction, the clinical implications are clear: if a youth reports that their emotions about climate change are negatively impacting their life, further follow-up is needed to guide related supports. These findings suggest several areas for future research. For example, there is a need for research exploring how youth who report extreme climate worry, but no impact to their daily lives, differ from those who identify extreme worry alongside daily life impacts. Such differences could reveal protective factors and potential interventions. Further research is also needed to better understand the underlying pathways connecting climate distress and socio-demographic characteristics, such as gender. More broadly, given the limited data, it would be helpful to examine this issue in other, varied clinical contexts. 5. Conclusion This study is among the first to examine climate change and mental health among youth accessing clinical services. Many of the youth were very or extremely worried about climate change, and a notable subset identified that their feelings about climate change were negatively impacting their daily lives, suggesting a need for clinical support. These results underscore the urgent need for service providers to be attuned to the impacts of climate change on youth mental health, and for further research to refine assessment methods for these impacts, determine protective factors, and understand what forms of support youth find most helpful. Data availability statement The datasets generated and/or analysed during the current study are not publicly available due to privacy but are available from the corresponding author on reasonable request. CRediT authorship contribution statement Zachary Daly: Writing – original draft, Methodology, Formal analysis, Data curation, Conceptualization. Emily K. Jenkins: Writing – original draft, Supervision, Methodology, Conceptualization. Sarah Adair: Writing – review & editing, Project administration, Investigation, Data curation. A. Fuchsia Howard: Writing – review & editing. Skye Barbic: Writing – review & editing, Supervision, Project administration, Methodology, Conceptualization. Declaration of competing interest Zachary Daly serves on the board of Canadian Association of Nurses for the Environment (CANE) and has accepted speaking fees from the Canadian Association of Physicians for the Environment (CAPE). Neither organization had any role in the collection of data, the writing of the manuscript, or the decision to submit for publication. Other authors declare that they have no competing or potential conflicts of interest. Acknowledgments ZD is supported by a Canada Graduate Scholarships Doctoral Award (CGS D) from the Canadian Institutes of Health Research (CIHR). EJ holds a Tier II Canada Research Chair in Population Health Approaches to Mental Health and Substance Use. AFH holds a Scholar Award from Michael Smith Health Research BC. SB holds a Tier II Canada Research Chair in Integrated Youth Services. No funding source had any role in the writing of the manuscript, or the decision to submit it for publication. We would like to thank Xiaoxu Ding, Cassia Warren, and Taite Biggs for assistance with data collection. Thank you to the members of the Climate Youth Advisory Committee: Anurada U. Amarasekera, Preet Bains, & Alisha Thapar. We also acknowledge the assistance and support of staff at Foundry Vancouver-Granville, Foundry Prince George, Foundry Richmond, and Foundry North Shore. Contributor Information Zachary Daly, Email: [email protected]. Emily K. Jenkins, Email: [email protected]. Sarah Adair, Email: [email protected]. A. Fuchsia Howard, Email: [email protected]. Skye Barbic, Email: [email protected]. References 1. Berry P., Schnitter R. Government of Canada; OttawaCanada: 2022 Feb 09. Health of Canadians in a changing climate: advancing our knowledge for action. https://geoscan.nrcan.gc.ca/starweb/geoscan/servlet.starweb?path=geoscan/fulle.web&search1=R=329522 Internet]cited 2023 Jan 31]. Available from: [ Google Scholar ] 2. Romanello M., Walawender M., Hsu S.C., Moskeland A., Palmeiro-Silva Y., Scamman D., et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet. 2024;404(10465):1847–1896. doi: 10.1016/S0140-6736(24)01822-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 3. Rocque R.J., Beaudoin C., Ndjaboue R., Cameron L., Poirier-Bergeron L., Poulin-Rheault R.A., et al. Health effects of climate change: an overview of systematic reviews. BMJ Open. 2021 June 1;11(6) doi: 10.1136/bmjopen-2020-046333. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 4. Massazza A., Teyton A., Charlson F., Benmarhnia T., Augustinavicius JL. Quantitative methods for climate change and mental health research: current trends and future directions. Lancet Planet Health. 2022;6(7):e613–e627. doi: 10.1016/S2542-5196(22)00120-6. [ DOI ] [ PubMed ] [ Google Scholar ] 5. Hwong A.R., Wang M., Khan H., Chagwedera D.N., Grzenda A., Doty B., et al. Climate change and mental health research methods, gaps, and priorities: a scoping review. Lancet Planet Health. 2022;6(3):e281–e291. doi: 10.1016/S2542-5196(22)00012-2. [ DOI ] [ PubMed ] [ Google Scholar ] 6. Lawrance E.L., Thompson R., Newberry Le, Vay J., Page L., Jennings N. The impact of climate change on mental health and emotional wellbeing: A narrative review of current evidence, and its implications. Int Rev Psychiatry. 2022;34(5):443–498. doi: 10.1080/09540261.2022.2128725. [ DOI ] [ PubMed ] [ Google Scholar ] 7. Godden N.J., Farrant B.M., Yallup Farrant J., Heyink E., Carot Collins E., Burgemeister B., et al. Climate change, activism, and supporting the mental health of children and young people: perspectives from Western Australia. J Paediatr Child Health. 2021;57(11):1759–1764. doi: 10.1111/jpc.15649. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 8. Cosh S.M., Ryan R., Fallander K., Robinson K., Tognela J., Tully P.J., et al. The relationship between climate change and mental health: a systematic review of the association between eco-anxiety, psychological distress, and symptoms of major affective disorders. BMC Psychiatry. 2024;24(1):833. doi: 10.1186/s12888-024-06274-1. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 9. Boivin M., Gousse-Lessard A.S., Hamann Legris N. Towards a unified conceptual framework of eco-anxiety: mapping eco-anxiety through a scoping review. Cogent Ment Health. 2025;4(1) doi: 10.1080/28324765.2025.2490524. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 10. Pihkala P. Anxiety and the ecological crisis: an analysis of eco-Anxiety and climate anxiety. Sustainability. 2020;12(19):7836. [ Google Scholar ] 11. Hickman C., Marks E., Pihkala P., Clayton S., Lewandowski R.E., Mayall E.E., et al. Climate anxiety in children and young people and their beliefs about government responses to climate change: a global survey. Lancet Planet Health. 2021;5(12):e863–e873. doi: 10.1016/S2542-5196(21)00278-3. [ DOI ] [ PubMed ] [ Google Scholar ] 12. Aylward B., Cunsolo A., Clayton S., Minor K., Cooper M., Chatwood S., et al. Examining the mental health impacts of climate change on young people in Canada: a national cross-sectional survey. Lancet Planet Health. 2024;8:S3. doi: 10.1016/S2542-5196(24)00068-8. [ DOI ] [ PubMed ] [ Google Scholar ] 13. Galway L.P., Field E. Climate emotions and anxiety among young people in Canada: A national survey and call to action. J Clim Change Health. 2023;9 [ Google Scholar ] 14. Maggi S., Benomar C., Quick M., Corvello M., Kingsbury M., Kohen D. Climate emotions, pro-environmental behaviours, and activism among Canadian youth. J Ment Health Clim Change. 2023 https://zenodo.org/doi/10.5281/zenodo.10443325 Internet]cited 2024 Feb 20]; Available from: [ Google Scholar ] 15. Verplanken B., Marks E., Dobromir A.I. On the nature of eco-anxiety: how constructive or unconstructive is habitual worry about global warming? J Environ Psychol. 2020 Dec;72 [ Google Scholar ] 16. Clark T. Ecological grief and Anthropocene horror. Am Imago. 2020;77(1):61–80. [ Google Scholar ] 17. Galway L.P., Beery T., Jones-Casey K., Tasala K. Mapping the solastalgia literature: A scoping review study. Int J Environ Res Public Health. 2019;16(15):2662. doi: 10.3390/ijerph16152662. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 18. Wortzel J.D., Denga V.S., Angrish J., Dooley L., Manjón I., Shabdar S., et al. Pediatric climate distress: A scoping review and clinical resource. J Clim Change Health. 2024 doi: 10.1016/j.joclim.2024.100349. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 19. Koder J., Dunk J., Rhodes P. Climate Distress: A review of current psychological research and practice. Sustainability. 2023;15(10):8115. [ Google Scholar ] 20. Hickman C. We need to (find a way to) talk about … eco-anxiety. J Soc Work Pract. 2020;34(4):411–424. [ Google Scholar ] 21. Bhullar N., Davis M., Kumar R., Nunn P., Rickwood D. Climate anxiety does not need a diagnosis of a mental health disorder. Lancet Planet Health. 2022;6(5):e383. doi: 10.1016/S2542-5196(22)00072-9. [ DOI ] [ PubMed ] [ Google Scholar ] 22. Diffey J., Wright S., Uchendu J.O., Masithi S., Olude A., Juma D.O., et al. Not about us without us” – the feelings and hopes of climate-concerned young people around the world. Int Rev Psychiatry. 2022;34(5):499–509. doi: 10.1080/09540261.2022.2126297. [ DOI ] [ PubMed ] [ Google Scholar ] 23. Ogunbode C.A., Doran R., Hanss D., Ojala M., Salmela-Aro K., van den Broek K.L., et al. Climate anxiety, wellbeing and pro-environmental action: correlates of negative emotional responses to climate change in 32 countries. J Environ Psychol. 2022;84 [ Google Scholar ] 24. Ramadan R., Randell A., Lavoie S., Gao C.X., Manrique P.C., Anderson R., et al. Empirical evidence for climate concerns, negative emotions and climate-related mental ill-health in young people: A scoping review. Early Interv Psychiatry. 2023:1–27. doi: 10.1111/eip.13374. [ DOI ] [ PubMed ] [ Google Scholar ] 25. Vergunst F., Berry HL. Climate change and children’s mental health: A developmental perspective. Clin Psychol Sci J Assoc Psychol Sci. 2022;10(4):767–785. doi: 10.1177/21677026211040787. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 26. Crandon T.J., Scott J.G., Charlson F.J., Thomas HJ. A social–ecological perspective on climate anxiety in children and adolescents. Nat Clim Change. 2022;12(2):123–131. [ Google Scholar ] 27. Nadarajah K., David J.C., Brun L., Bordel S., Moyon L., Le Foll D., et al. We are running out of time”: temporal orientation and information seeking as explanatory factors of climate anxiety among young people. Psych. 2022;4(3):560–573. [ Google Scholar ] 28. Man L.L.Y., Rotenberg M., Andari S., Wells S., Hamilton H.A., Boak A., et al. Eco-depression and eco-anxiety among youth: a sex and gender analysis. Can J Psychiatry. 2024 Oct 1 doi: 10.1177/07067437241287153. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 29. Rizeq J., Ojala M. Climate worry and hope have different associations with well-being and Climate-friendly behaviors across young people from Sweden and Qatar. Ecopsychology. 2025 Mar;17(1):68–78. [ Google Scholar ] 30. Sciberras E., Fernando JW. Climate change-related worry among Australian adolescents: an eight-year longitudinal study. Child Adolesc Ment Health. 2022;27(1):22–29. doi: 10.1111/camh.12521. [ DOI ] [ PubMed ] [ Google Scholar ] 31. Vergunst F., Prentice C.M., Orri M., Berry H.L., Paquin V., Vitaro F., et al. Association of youth climate change worry with present and past mental health symptoms: a longitudinal population-based study. Clim Change. 2024;177(10):153. [ Google Scholar ] 32. Daly Z., Slemon A., Richardson C.G., Salway T., McAuliffe C., Gadermann A.M., et al. Associations between periods of COVID-19 quarantine and mental health in Canada. Psychiatry Res. 2021;295 doi: 10.1016/j.psychres.2020.113631. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 33. Williams M.O., Samuel V.M., Whitmarsh L., Poortinga W., Jenkins C., Constable C. There’s no helpline’: how mental health services can support young people with climate distress. Cogent Ment Health. 2024;3(1):1–21. doi: 10.1080/28324765.2024.2409815. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 34. Royal College of Psychiatrists . Royal College of PsychiatristsRoyal College of Psychiatrists; LondonUnited Kingdom: 2020 Nov 10. The climate crisis is taking a toll on the mental health of children and young people. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2020/11/20/the-climate-crisis-is-taking-a-toll-on-the-mental-health-of-children-and-young-people Internet]cited 2025 Nov 27]. Available from: [ Google Scholar ] 35. Lawrance E.L., Jennings N., Kioupi V., Thompson R., Diffey J., Vercammen A. Psychological responses, mental health, and sense of agency for the dual challenges of climate change and the COVID-19 pandemic in young people in the UK: an online survey study. Lancet Planet Health. 2022 Sept 1;6(9):e726–e738. doi: 10.1016/S2542-5196(22)00172-3. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 36. Barbic S., Mallia E., Wuerth K., Ow N., Marchand K., Ben-David S., et al. Implementing Foundry: A cohort study describing the regional and virtual expansion of a youth integrated service in British Columbia, Canada. Early Interv Psychiatry. 2024;18(10):877–887. doi: 10.1111/eip.13538. [ DOI ] [ PubMed ] [ Google Scholar ] 37. Wuerth K., Tee K., Mathias S., Foundry Barbic S. the British Columbia Integrated Youth Services Initiative: sharing lessons from a decade of innovation. Healthc Q Tor Ont. 2025 May;28(1):22–29. doi: 10.12927/hcq.2025.27634. [ DOI ] [ PubMed ] [ Google Scholar ] 38. British Columbia Coroners Service . British Columbia Coroners Service; 2022. Extreme Heat and Human Mortality: A Review of Heat-Related Deaths in B.C. in Summer 2021. [ Google Scholar ] 39. Parisien M.A., Barber Q.E., Bourbonnais M.L., Daniels L.D., Flannigan M.D., Gray R.W., et al. Abrupt, climate-induced increase in wildfires in British Columbia since the mid-2000s. Commun Earth Environ. 2023 Sept 5;4(1):309. [ Google Scholar ] 40. Jones S.A., Lins J., Abay H., Pham K., Dittrich R. Wildfire smoke, environmental justice, and young children in urban Pacific Northwest communities. Urban Clim. 2023;50 [ Google Scholar ] 41. Cleland S.E., Paul N., Coker E.S., Henderson SB. The Co-occurrence of wildfire smoke and extreme heat events in British Columbia, 2010–2022: evaluating spatiotemporal trends and inequities in exposure burden. ACS EST Air. 2025;2(3):319–330. [ Google Scholar ] 42. Statistics Canada . Statistics Canada. Government of Canada; OttawaCanada: 2025 Nov 10. Quality of life indicator: self-rated mental health. https://www160.statcan.gc.ca/health-sante/mental-health-sante-mentale-eng.htm Internet] cited 2025 Nov 27]. Available from: [ Google Scholar ] 43. Statistics Canada . Staistics Canada. Government of Canada; OttawaCanada: 2025 Jul 15. Canadian Health Survey on Children and Youth - 2025. https://www23.statcan.gc.ca/imdb/p3Instr.pl?Function=assembleInstr&lang=en&Item_Id=1574659 Internet] cited 2025 Nov 13]. Available from: [ Google Scholar ] 44. Kroenke K., Strine T.W., Spitzer R.L., Williams J.B.W., Berry J.T., Mokdad AH. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114(1–3):163–173. doi: 10.1016/j.jad.2008.06.026. [ DOI ] [ PubMed ] [ Google Scholar ] 45. Hodgson C.G., Bonifay W., Yang W., Herman KC. Establishing the measurement precision of the patient health questionnaire in an adolescent sample. J Affect Disord. 2023;342:76–84. doi: 10.1016/j.jad.2023.09.013. [ DOI ] [ PubMed ] [ Google Scholar ] 46. Kessler R.C., Andrews G., Colpe L.J., Hiripi E., Mroczek D.K., Normand S.L.T., et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002;32(6):959–976. doi: 10.1017/s0033291702006074. [ DOI ] [ PubMed ] [ Google Scholar ] 47. Pattison R., Puyat J.H., Giesbrecht A., Zenone M., Mathias S., Barbic S. Examining mental health differences between transgender, Gender nonconforming, and cisgender young people in British Columbia. Front Psychiatry. 2021 Sept 29 doi: 10.3389/fpsyt.2021.720681. https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.720681/full Internet]cited 2024 Dec 18];12. Available from: [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 48. Ustun T.B., Kostanjesek N., Chatterji S., Rehm J. World Health Organization; Geneva, Switzerland: 2010. Measuring health and disability : manual for WHO Disability Assessment Schedule (WHODAS 2.0) https://iris.who.int/handle/10665/43974 Internet]cited 2024 June 3] p. 88. Available from: [ Google Scholar ] 49. McDonald E.J., Bedard C., Kirkpatrick S.I., Perlman C.M., Ferro MA. Psychometric properties and informant agreement of the WHODAS 2.0 in youth with mental disorder. J Can Acad Child Adolesc Psychiatry. 2023;32(1):38–49. [ PMC free article ] [ PubMed ] [ Google Scholar ] 50. Nieves M., Jansen K. Worry related to climate change in Brazilian adults. Trends Psychiatry Psychother. 2025;47 doi: 10.47626/2237-6089-2024-0905. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 51. Martin G., Cosma A., Roswell T., Anderson M., Treble M., Leslie K., et al. Measuring negative emotional responses to climate change among young people in survey research: A systematic review. Soc Sci Med. 2023;329 doi: 10.1016/j.socscimed.2023.116008. [ DOI ] [ PubMed ] [ Google Scholar ] 52. IBM Corporation . IBM Corp; Armonk, NY: 2023. IBM SPSS Statistics for Windows. [ Google Scholar ] 53. Hurley E.A., Dalglish S.L., Sacks E. Supporting young people with climate anxiety: mitigation, adaptation, and resilience. Lancet Planet Health. 2022;6(3):e190. doi: 10.1016/S2542-5196(22)00015-8. [ DOI ] [ PubMed ] [ Google Scholar ] 54. Kuang H., Root RA. Perception of climate change in adolescents and its psychiatric implications. J Am Acad Child Adolesc Psychiatry. 2019;58(10):S229. [ Google Scholar ] 55. Petrasek MacDonald J., Cunsolo Willox A., Ford J.D., Shiwak I., Wood M. Protective factors for mental health and well-being in a changing climate: perspectives from Inuit youth in Nunatsiavut, Labrador. Soc Sci Med. 2015;141:133–141. doi: 10.1016/j.socscimed.2015.07.017. [ DOI ] [ PubMed ] [ Google Scholar ] 56. Barraclough L. Dalhousie University; Halifax, Nova Scotia: 2022. Masters Thesis] [Internet] [ Google Scholar ] 57. Ojala M. Regulating worry, promoting hope: how do children, adolescents, and young adults cope with climate change? Int J Environ Sci Educ. 2012;7(4):537–561. [ Google Scholar ] 58. Teo S.M., Gao C.X., Brennan N., Fava N., Simmons M.B., Baker D., et al. Climate change concerns impact on young Australians’ psychological distress and outlook for the future. J Environ Psychol. 2024;93 [ Google Scholar ] 59. Forcier M., Wagner J., Holland S. Gender diverse youth: opportunities to identify and address systemic inequities. Pediatrics. 2021;147(6) doi: 10.1542/peds.2021-050278. [ DOI ] [ PubMed ] [ Google Scholar ] Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement The datasets generated and/or analysed during the current study are not publicly available due to privacy but are available from the corresponding author on reasonable request. 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