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Heat-Related Mental Health Hospitalizations in Italy:A Global Sensitivity Analysis Approach to Evaluate Generalized
Emiliano Ceccarelli1,2, Alessio Lachi3, Arianna Guaita2,4
1Department of Statistical Sciences, La Sapienza University, Rome, Italy.
Summary
High summer temperatures significantly increase mental health hospitalizations. Modeling choices, especially temperature spline knots, greatly impact risk estimates, highlighting the need for sensitivity analysis in heat-related mental health research.
Area of Science:
- Environmental Epidemiology
- Public Health
- Mental Health Research
Background:
- Rising global temperatures are linked to adverse mental health outcomes.
- The impact of modeling assumptions on these associations is not well understood.
Purpose of the Study:
- To investigate the short-term association between high temperatures and mental health hospitalizations in Italy.
- To assess the influence of structural modeling decisions on risk estimates using Global Sensitivity Analysis (GSA).
Main Methods:
- Utilized national hospital discharge data from 21 Italian cities (2005-2023).
- Employed a Distributed Lag Nonlinear Model (DLNM) within a Generalized Additive Model (GAM) framework.
- Performed GSA to evaluate the impact of temperature and lag spline specifications and seasonal inclusion.
Main Results:
- A nonlinear increase in hospitalization risk was observed with temperatures exceeding 40°C, with relative risks approaching two.
- The number and placement of knots in temperature splines were the primary drivers of variability in risk estimates.
- GSA revealed substantial uncertainty stemming from structural assumptions, exceeding standard confidence intervals.
Conclusions:
- High summer temperatures are consistently associated with increased psychiatric hospitalizations in Italy.
- GSA enhances transparency and robustness in evaluating heat-health impacts by clarifying the influence of modeling choices.
- Structural modeling assumptions significantly shape the inference of heat-related mental health risks.
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