An Adolescent-Caregiver Dyad Approach to Climate Anxiety in the Pediatric Emergency Department

Climate change and mental health research has predominantly focused on adults in non-clinical settings; investigations among youth and in clinical settings are lacking. Our objectives were to understand the relationship between adult caregiver and adolescent patient climate-anxiety and to examine caregivers' community-level concerns and their association with adolescent climate anxiety. This cross-sectional study occurred in a single-center pediatric emergency department (ED) and data collection spanned January to December 2024. Exposures included adolescent demographic factors (age group, sex, race and ethnicity, insurance payor) and adolescent and caregiver general anxiety disorder-7 (GAD-7) scores, as well as caregiver perspectives captured on (1) the climate change anxiety scale (CCAS), (2) a domestic and global issues poll, and (3) an environmental community survey. The outcome was adolescent climate anxiety, operationalized using the CCAS. In total, 557 patient-caregiver dyads completed CCAS surveys, with low within-dyad agreement in scores, ICC = 0.224 (95% CI 0.142, 0.274). Both caregivers and adolescents had higher levels of climate anxiety if the caregiver reported concerns about housing, public services, and pollution in their community (P < .05). Moderate-severe generalized anxiety (GAD-7) was the strongest predictor of climate anxiety in both adolescents and caregivers (OR_adj 6.59, 95% CI 3.52-12.30, P < .001). Caregivers viewing climate change as very important had higher odds of moderate-severe CCAS (OR_adj = 4.50 (95% CI 2.03, 9.98), P < .001), with no significant effect of their perception on adolescent CCAS (P = .172). Generalized anxiety and adult caregiver community-level concerns appear to be associated with adolescent climate anxiety in this large pediatric study, but there is no direct relationship between caregiver climate anxiety and the climate anxiety of the adolescent.