Taylor Blatchford | (TNS) Seattle Times

SEATTLE — Checking air quality and staying indoors when smoke inundates the Seattle area has become second nature during Washington’s wildfire season in recent years. But new research highlights how wildfires can affect a less visible aspect of well-being: mental health.

A University of Washington study published in late February found an increase in prescriptions to treat depression and anxiety or stabilize mood in the six weeks after wildfires. The study used prescription data, commercial insurance claims and pharmacy records to examine the impact of 25 large California wildfires from 2011 to 2018.

“California experienced a substantial burden of wildfires from 2011 to 2018, and as wildfires become more intense and frequent in the context of anthropogenic climate change, it is increasingly important to understand and address their mental health effects,” the authors wrote.

Extensive research has focused on how wildfires and smoke affect cardiovascular and respiratory health; a study published in February found that the overlap of extreme heat and wildfire smoke had a compound effect and increased hospitalizations.

But few studies have examined how fires affect mental health. Previous research on the connection has been more qualitative, using focus groups to examine the effect of one fire in one region, said Zack Wettstein, the lead author of the study and a UW Medicine emergency medicine doctor. He conducted the research as a guest researcher with the Centers for Disease Control and Prevention’s Climate and Health Program.

“All too often we’re overlooking these mental health impacts,” Wettstein said. “There are a lot of vulnerable groups of people and these fires have substantial mental health impact we need to prepare for.”

Sleep disruption and decreased sense of safety likely affect mental health, particularly among those who must evacuate and face property loss, researchers wrote. Wildfires can also cause or exacerbate mental health conditions such as post-traumatic stress disorder, anxiety, depression and complex grief.

Wettstein has practiced emergency medicine in California, Idaho and Washington during wildfire season. Summer is already one of the busiest times in the emergency department, he said, and fires add an influx of patients.

“When smoke waves and heat waves roll through, it feels like we’re being inundated with patients experiencing a range of conditions from these exposures,” Wettstein said. “We’re seeing lots of folks coming in with stress and anxiety related to smoke exposure, let alone folks in closer proximity to fires who are evacuating, or have lost family or property.”

The study recommends “ensuring access to mental health services and supporting programs that promote mental health resilience before, during and after wildfires” as interventions to mitigate mental health effects. Wettstein hopes that hospitals will consider how to allocate resources during wildfire season and plan for potential surges.

“I don’t know how much people have considered upstaffing our mental health teams in the emergency department and otherwise,” Wettstein said. “There are opportunities to consider what to do in advance of these events. Providers can make sure their patients have enough medication on hand, so they don’t find themselves short.”

As in all studies, there are limitations: The data only includes patients enrolled on commercial insurance, meaning it didn’t reflect the experience of uninsured people, or those on Medicaid or Medicare. The data didn’t specify whether the prescriptions were new or refills, making it hard to tell whether smoke exposure led to new diagnoses or exacerbated existing mental health conditions.

Researchers also focused on metropolitan statistical areas (MSAs), a geographic designation the CDC uses to highlight urbanized areas with a population of at least 50,000. This means that rural communities, which “face a disproportionate burden of wildfire exposure and concomitant lack of mental health resources,” the authors wrote, are likely underrepresented.

There hasn’t been a similar study done in Washington, Wettstein said; he sees a “huge opportunity” to use this approach to examine other regions of the U.S. besides California.

The research findings raise a broader question: How do we deliver mental health care, especially when an emergency affects broad swaths of the population?

“Our mental health care system is already overtaxed,” Wettstein said. “With the projections of climate related impacts on temperature, air quality and other conditions in Washington, there’s going to be a greater burden of health impacts related to these events. What can we do to help prepare our system and make it more resilient, so we can treat everybody?”

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©2024 Seattle Times. Visit at seattletimes.com. Distributed by Tribune Content Agency, LLC.

The government agency tasked with ensuring city-owned buildings and vehicles don’t contribute to climate change is facing a $1 billion cut to its preliminary capital commitment plan. Of those, $775 million directly impacts environmental efforts.

The agency tasked with managing city government’s buildings and vehicles is facing some hefty budget cuts, which lawmakers and advocates say could jeopardize New York City’s ability to comply with its own climate mandates.

The Department of Citywide Administrative Services (DCAS) could see over $1 billion in cuts under the preliminary capital commitment plan, which covers long‑term investments in facilities and infrastructure for the next five years. Of those, $775 million come from “reductions to resiliency, sustainability and energy efficiency projects,” according to the Comptroller’s office.

Councilmember Lincoln Restler, who chairs the committee on governmental operations, says the reduction is so significant that it makes up 17 percent of all cuts in Mayor Eric Adam’s capital plan.

“If Mayor Eric Adams is committed to climate justice, he needs to work with the City Council to reverse these indefensible cuts,” Restler told City Limits

At a City Council hearing last month, DCAS officials broke down some of the elements being slashed in the budget. They include a $538 million reduction to energy conservation projects that will help make government agencies and city-owned buildings more climate friendly. On top of that, the Department will see an annual cut of $15 million for electric vehicles purchases. 

DCAS is tasked with managing the city’s properties and various agencies, including making sure they meet their environmental goals. Not only does it handle the purchasing of climate-friendly electric vehicles for the city’s expansive fleet, but it also distributes resources for energy efficiency upgrades that aim to decarbonize city buildings. That includes switching out old cooling and heating systems for more efficient ones powered with non-polluting electric energy. 

Making cuts to the agency’s environmental arm, Restler says, will directly impact the city’s ability to meet its climate mandates like the landmark building emissions law, Local Law 97. 

“[The cuts] may save the city some money today, but it undermines our ability to manage the pending climate disaster that is upon us. There is no room for backsliding or backstepping or compromising in the fight against climate change,” the councilmember said.

Leading by example?

The department’s energy management program will be taking the $538 million hit in the capital budget. The total budget for DCAS’ capital plan—which spans from fiscal year 2024 to 2028—is approximately $1.7 billion, according to the agency.

Another $295 million for these energy efficiency efforts will be diverted or pushed back to the next capital plan, according to DCAS officials. 

“Our active and in-progress decarbonization projects remain unimpacted and will continue to contribute towards compliance with our emission reduction mandates,” DCAS spokesperson Dan Kastanis said in an email. 

“Despite recent fiscal headwinds, we remain unwavering in our commitment to advance fleet electrification goals and Local Law 97 mandates,” he added.

Local Law 97 (LL97), went into effect this year promising to curtail carbon pollution from buildings, which contribute to nearly 70 percent of the city’s greenhouse gas emissions. The law sets a cap on the amount of carbon that buildings larger than 25,000 square feet can emit over a series of compliance periods, the first one of which kicks in next year.

The city and its related authorities own or lease over 17,000 properties, according to the Department of City Planning (DCP), though it was not immediately clear how many are subject to LL97 rules. 

Last December, Beatrice Thuo, executive deputy commissioner for citywide operations at DCAS, admitted at a public hearing that they “expect to fall short of our Local Law 97 reduction target for 2025.”

The department has also pledged to reduce emissions generated by government operations 40 percent by 2025 and 50 percent by 2030.

At the December hearing, Thuo said they were working hard to get “as close to” that goal as possible.” But added that they have faced a series of “challenges” to achieving that 40 percent goal, including the pandemic, contracting delays and pressure on the administration to curtail spending that are “outside of the city’s control.”

Still, the environmental community is alarmed by the cuts and the department’s inability to meet Local Law 97’s first compliance period.

“All of this makes me question how serious the administration is about addressing citywide emissions reductions,” said Shravanthi Kanekal, senior resiliency planner at New York City Environmental Justice Alliance.  

“These budget cuts are going to hurt the public sector’s progress in building decarbonization and we can’t expect the private sector to completely comply when the public sector is not complying. We expect the city to lead by example when it comes to building decarbonization,” Kanekal added.

And her colleague, Senior Transportation Planner Kevin Garcia, believes the city should also be setting the example when it comes to electrifying its vehicles. 

“When you look at the larger budget the $15 million cut seems small, but it’s not just this budget, it’s future budgets as well,” Garcia said. “We’re concerned that this first cut is going to lead to a ripple effect of additional cuts or that the city may decide that they don’t need to put funding towards electric vehicle purchasing.”

Last year, DCAS’ budget for new electric vehicles was $25 million; this year it’s down to $10 million. The reduction will translate to 350 to 375 fewer electric cars in the city’s streets per year, according to DCAS Commissioner Dawn Pinnock.

The department said that as of March of this year there are 5,000 electric vehicles among the 28,000 cars the city owns, representing 18 percent of the overall fleet. 

The goal, signed into law by Mayor Adams in the fall of last year, is to transition the city’s entire automobile fleet—including all of its school buses—to zero emissions vehicles by 2038.

DCAS says its on track to meet this year’s electrification target of securing 5,500 electric vehicles. 

“We are pleased to report that the City is exceeding previous estimates in transitioning our fleet to zero-emission vehicles,” Kastanis of DCAS said in an email.

While environmental groups have applauded the agency for staying on track with their electrification goals, they worry that budget cuts could snowball and ruin that head start. 

Adams recently secured a $15 million federal grant from the U.S. Department of Transportation’s (USDOT) to build an electric truck and vehicle charging depot in the Bronx. 

But Jaqi Cohen, director of climate and equity policy at the environmental non-profit Tri-State Transportation Campaign, warns that relying on applications for federal grants only isn’t wise, since New York isn’t always guaranteed to get them. 

“When it comes to our zero emissions transition in general, New York plays a really disproportionate role in the United States because other cities are looking to see how we implement this transition so they can follow suit,” Cohen said.

“With the whole country watching, we need to be throwing everything we can into ensuring the success of transitioning to zero emissions.”

To reach the reporter behind this story, contact Mariana@citylimits.org. To reach the editor, contact Jeanmarie@citylimits.org

Want to republish this story? Find City Limits’ reprint policy here.

Jose Miranda is back in the big leagues after being called up by the Twins on Monday afternoon. Where exactly he plays in the field remains to be seen.

Though he has played some third base during his time in the majors, Miranda has spent most of his time at first base as of late.

It will be interesting to see if the Twins try Miranda at the hot corner with everyday third baseman Royce Lewis out with a right quad strain. If Miranda isn’t an option at third base, he could play first base in a pinch, or more likely, fill in as a designated hitter.

After battling through a lingering right shoulder injury for most of last season, Miranda is looking to gain some traction in the early stages of this season. In a corresponding move, relief pitcher Daniel Duarte was placed on the 15-day injured list with a right triceps strain.

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When Tory Eisenlohr-Moul was training as a therapist, she saw people who had chronic suicidal thoughts — thoughts that would abruptly change from week to week. But when one of Eisenlohr-Moul’s patients mentioned her menstrual cycle was impacting her symptoms, the clinical psychologist homed in on how menses might be part of the equation.

“I started having people track their mood symptoms against their menstrual cycle and it seemed, for a lot of my patients, this was a really important reason that their suicidal thoughts and depression were changing week to week,” said the associate professor of psychiatry at the University of Illinois Chicago. “I thought if we had some evidence that this was common then maybe we could do something about it.”

Eisenlohr-Moul led researchers to study how suicidal thoughts fluctuate across the menstrual cycle. The result is a longitudinal study, published in the American Journal of Psychiatry in December, where Eisenlohr-Moul, postdoctoral researcher and clinical psychologist Jaclyn Ross, and M.D. and Ph.D. student Jordan Barone followed 119 female patients who tracked their suicidal thoughts and mental health symptoms daily over at least one menstrual cycle. They found that female patients with a history of suicidality experience an increased risk of suicidal ideation or suicidal planning in the days surrounding menstruation.

The researchers defined suicidal ideation as thinking: “I wish I could go to sleep and never wake up; I might be better off dead.” Suicidal planning is thinking about how and when someone might kill themself and what methods to use. Planning gets more specific and is more active than ideation.

Barone said data from female patients was found and surveyed in clinical trials in Chicago and North Carolina. Study participants had to have a regular menstrual cycle, not be on birth control pills or have a hormonal intrauterine device, and not have been recently pregnant.

The patients were asked a list of questions about thinking about death, thinking about killing themselves, or wishing they were dead. If they responded yes to having any of those symptoms within the past month, they were asked to track those symptoms.

According to the study, earlier research on menstrual cycles and suicidal thoughts looked at patterns in which suicide attempts increased in the days just before or during menses. Ross said the unique strength of the UIC study is the research team had the ability to measure day to day to see when suicidal ideation increases in intensity and when people tend to shift from suicidal ideation to suicidal planning. UIC’s study found suicidal ideation was more severe and suicidal planning was more likely to occur during “the week before and during menses” compared to other times.

“We do find that both suicidal ideation and planning are peaking premenstrually for most people,” Ross said. “Where they tend to experience the lowest levels of ideation and planning is during that early luteal phase (right after ovulation). Then it steadily ticks up and peaks during that peri-menstrual phase. We found that it tended to be those depressive symptoms, hopelessness, losing interest in things we usually enjoyed — those were the types of symptoms that were driving those increases in intensity in suicidal ideation during the peri-menstrual phase. It was depression that really drove it for suicidal planning.”

Suicidal ideation was one thing Shalene Gupta contended with. The Boston-based journalist remembers extreme feelings in her mid-20s. Then in 2020, she was diagnosed with premenstrual dysphoric disorder, or PMDD, a severe form of premenstrual syndrome that includes physical/behavioral symptoms that usually resolve with the onset of menstruation.

“I just thought that I was a bad person with poor emotional control because, once a month, I would have these really terrible fights with my boyfriend,” she said. “I tend to be a calm, conflict-averse, highly boring type-A personality. These were really terrible. There’d be screaming, walking around at midnight, threatening to break up. And I could always predict these fights were going to happen within a couple of days before my period happened.”

The pair broke up after six years together. It was when she started dating her now husband, and the fight pattern continued, that she started researching menstrual rage, PMS and anger. A call to her doctor led Gupta, 36, to getting help for the disorder. Gupta wrote a book about her menstruation journey, “The Cycle: Confronting the Pain of Periods and PMDD,” where she cites Eisenlohr-Moul’s work. Gupta describes the history of PMDD, which was a known condition since the 1960s, but a feminist debate in the 1980s — and fears about the condition discrediting women everywhere — kept it from being added to the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic tool published by the American Psychiatric Association.

A PMDD diagnosis requires a mix of symptoms that include: increased mood swings, anger or irritability, depression, anxiety, decreased interest in activities, difficulty concentrating, lethargy, marked change in appetite, sleeping patterns, a sense of being overwhelmed, or physical symptoms such as breast tenderness, joint or muscle pain, bloating or weight gain. To count as PMDD, symptoms must be severe enough to interfere with someone’s work, education or relationships. The symptoms must also appear a week before menstruation and then disappear the week after menstruation.

Gupta got help by way of antidepressants. Treatment can also be found with birth control. Gupta said 5% to 10% of the population has classic PMDD, a condition that has a 30% to 80% chance of being transmitted from parent to offspring.

Given the data in the UIC study, Eisenlohr-Moul said the medical community can’t use a cookie-cutter definition of premenstrual syndrome, or PMDD. A broader understanding of all of the different ways people can be sensitive to the menstrual cycle needs to be established, she said, so the medical community can provide more specific treatments.

Ross, who runs a private practice clinic for premenstrual disorders, agreed. She cites the large variability in the effects across patients and their menstruation cycle to show that the health care field really needs to individualize approaches to treatment in these suicidality and menstruation cases, especially when it comes to psychotherapy. Eisenlohr-Moul said it’s equally important to change the way we talk about PMS and PMDD as a society — that it’s more of a disorder people can have, and not a default characteristic of women who have periods. 

“Historically, we’ve thought about premenstrual mood symptoms as some people have them and some people don’t,” Eisenlohr-Moul said. “If you look in the general population, you see that it’s 1% that have significant changes worth talking about. But it turns out that when you recruit people who just happen to be female with suicidality, most people have some degree of change, and it doesn’t look the same for everyone. It’s not so black and white, like you have it or you don’t. It’s a gradient: How sensitive are you to these hormonal changes in the brain?”

The American College of Obstetricians and Gynecologists recently released new clinical treatment guidelines for physicians treating premenstrual disorders. Eisenlohr-Moul said although premenstrual disorders are caused by an abnormal brain sensitivity to normal cyclical hormone flux, medical treatment can be provided by gynecologists, psychiatrists or primary care providers. Psychologists and other mental health professionals can help patients better cope and reduce the stress that can worsen the condition.

Researchers suggest women track their symptoms across their menstrual cycle, which could help clinicians make personalized recommendations about care. Symptom trackers and menstruation resources for patients can be found at the International Association for Premenstrual Disorders. Gupta agrees about the benefit of tracking one’s menstruation symptoms and notes that mental symptoms surrounding menstruation are a disorder.

“If you’re having regular breakdowns, it is important to figure out the timing,” she said. “That’s something I think doctors should ask.” She tracked hers and said it took about two months of tracking before getting her official diagnosis.

Tory Eisenlohr-Moul, left, and Jaclyn Ross in Chicago on March 15, 2024. (Terrence Antonio James/Chicago Tribune)

“We’re doing a lot of biomarker studies,” Eisenlohr-Moul said. “Jordan’s dissertation is looking at one of the markers that we think might be especially important for progesterone sensitivity, one of the hormones that people can be sensitive to. Others are more focused on sensitivity to estrogen and how that can affect different systems. We’re trying to go down more specific pathways to understand the biology (of menses) so we can develop treatments. Biological targets … behavioral targets … just because somebody’s symptoms are caused by hormones doesn’t mean that a behavioral intervention can’t help to right the ship and keep people functioning and even reverse some of those biological changes. We’re trying to come at this from all angles.”

Gupta is hopeful about the ongoing research with menstruation and mental health. She said too often menstruation is stigmatized, and seen through a sexist lens to discredit people.

“I read Elon Musk’s 600-page biography by Walter Isaacson. (Musk) has undiagnosed bipolar disorder. He’s talked about it. And he gets to be the CEO of six companies, and no one is like, ‘Hey, maybe we shouldn’t let him do that because he has undiagnosed bipolar disorder,’” she said. “If that’s the case, then if somebody has PMDD, and they’re getting treatment for it, they’re managing it, that shouldn’t be a reflection on what opportunities we give them as a society.”