Other Sections of the Report
You can find the rest of the report in the following links:
About the 2025 Regional Climate Health Monitoring Report RCHMR Extreme Heat Extreme Cold Air Quality Communicable DiseasesClimate Change and Mental Health
Projected climate impacts for the tri-county region include more extreme heat days, poorer air quality days, larger wildfires, and heavier rainfall increasing the risk of floods and landslides. These natural disasters can directly impact people’s mental health by causing sleep deprivation and triggering anxiety and stress. Extreme heat exposure has been linked to aggression, crime, and violence, which compromises the community trust and cooperation that are needed to effectively respond to and withstand collective trauma. Direct exposure to extreme weather events can also cause property damage, displacement, and changes to livelihoods. The resulting loss of place and identity can lead to depression, anxiety, substance use, and post-traumatic stress disorder. Additionally, severe weather can disrupt access to health services, schools, and social networks that are critical for supporting mental well-being. Even those not directly impacted may experience “eco-anxiety” from witnessing landscape changes, ecosystem loss, and the growing threat of extreme weather.
Certain populations are more sensitive to the adverse impacts from climate change or have less capacity to adapt. For example, people with pre-existing mental health conditions may be less able to protect themselves, or whose medications, life stage (e.g., age or pregnancy), or health conditions may interfere with thermoregulation. Other groups particularly susceptible to climate anxiety and impacts include youths who may feel they have limited control over mitigation efforts; low-income and frontline communities with fewer resources for recovery; communities of color, immigrants, and refugees who face barriers to culturally appropriate mental health care; and Indigenous populations who are at risk of losing traditional ways of life tied to the environment.
Analyses from our previous regional report point to a clear need to start tracking mental health impacts of climate change in the tri-county region. During the 2021 heat dome, Google searches for “mental health services” in the Portland area peaked, indicating the acute distress caused by this unprecedented severe weather event. Additionally, interviews with emergency responders of the 2020 wildfires and 2021 heat dome revealed a severe lack of mental health support for people dealing with the compounded traumas of climate disasters, the COVID-19 pandemic, and systemic racism.
These impacts underscore the need for public health and behavioral health agencies to collaborate more closely. This partnership is essential for tracking, understanding, and addressing the disproportionate mental health effects of climate change on our communities, to bolster community resilience and adaptability amid climate change.
The Tri-County Climate-Mental Health Survey
Staff in the Public Health and Behavioral Health Divisions collaborated to develop a first-ever survey for the tri-county region that assesses impacts of severe weather on the mental health and well-being of residents. A multidisciplinary team was assembled, composed of mental health providers, clinical managers, data analysts, and program specialists from across the tri-counties, who brought collective expertise in mental health, suicide prevention, environmental health, climate resilience, and more.
To develop the survey, the team reviewed the literature on validated scales and health indicators for climate-related mental health. Collaborators contributed and refined questions through an iterative process, focusing on their utility for program planning and public health monitoring. The final questions were chosen to better understand: 1) the prevalence of climate distress and anxiety, 2) emotional and behavioral responses to climate change, 3) opinions on government climate responses, and 4) coping strategies for distress.
The final online survey was translated into 7 languages, took less than 20 minutes to complete, and was incentivized with a raffle for a $25 VISA gift card (50 available).
Dissemination: We used multiple methods to promote the survey: behavioral health providers circulated flyers and the survey link to clients, staff posted flyers in health clinics and disseminated them at community events. In addition, Multnomah County produced a short clip about the survey for their social media accounts, and conducted two in-person surveying events at a county clinic in an underserved Portland neighborhood. Data collection occurred from January 20 to May 28, 2025. Following rigorous data cleaning, 297 responses were retained for analysis.
Survey Respondents
Among 297 survey respondents, 158 (53.2%) were Multnomah, 70 (23.6%) Clackamas, and 69 (23.2%) Washington County residents. Most respondents were Millennial-aged (39%), female (73%), have a Bachelor’s degree (44%), and identified as White race (60%). About 92% of respondents took the survey in English.
Compared to the overall regional population, the survey sample has a higher proportion of females, racially minoritized individuals, and people who identified as transgender or nonbinary.
Across the region, more than 75% of respondents said their mental health has been affected by extreme weather. Many reported things like a worsening mood, a return or increase in mental health symptoms, and heightened anxiety during extreme weather events. This pattern was consistent across the tri-counties, suggesting that the mental health impacts of climate change are widespread and not limited to just one geographic area.
References
Cannady A, Haggerty B, Singh J, et al. 2012-2022 Regional Climate and Health Monitoring Report. Clackamas County, Multnomah County, Washington County; 2023. https://www.washingtoncountyor.gov/public-health/documents/2023-regional-climate-and-health-monitoring-report/download?inline
Clayton S, Manning C, Krygsman K, Speiser M. Mental Health and Our Changing Climate: Impacts, Implications, and Guidance. American Psychological Association, and ecoAmerica; 2017. Accessed August 9, 2024. https://www.apa.org/news/press/releases/2017/03/mental-health-climate.pdf
Clayton S, Brown LA. Climate Change and Mental Health. JAMA. 2024;331(20):1761. doi:10.1001/jama.2024.1839
Choi HM, Heo S, Foo D, et al. Temperature, Crime, and Violence: A Systematic Review and Meta-Analysis. Environ Health Perspect. 2024;132(10):106001. doi:10.1289/EHP14300
Palinkas LA, Wong M. Global climate change and mental health. Curr Opin Psychol. 2020;32:12-16. doi:10.1016/j.copsyc.2019.06.023
Munro A, Kovats RS, Rubin GJ, et al. Effect of evacuation and displacement on the association between flooding and mental health outcomes: a cross-sectional analysis of UK survey data. Lancet Planet Health. 2017;1(4):e134-e141. doi:10.1016/S2542-5196(17)30047-5
Schwartz, PhD RM, Rasul, Ma R, Kerath, Ms SM, et al. Displacement during Hurricane Sandy: The impact on mental health. J Emerg Manag. 2018;16(1):17-27. doi:10.5055/jem.2018.0350
Shultz JM, Sands DE, Holder-Hamilton N, et al. Scrambling For Safety In The Eye Of Dorian: Mental Health Consequences Of Exposure To A Climate-Driven Hurricane: Study examines the mental health consequences of exposure to Hurricane Dorian. Health Aff (Millwood). 2020;39(12):2120-2127. doi:10.1377/hlthaff.2020.01203
Cooper R, Fleming J. Extreme heat and mental illness: Toolkit for mental health care providers. Published online 2019. https://earth.ucsf.edu/sites/g/files/tkssra5626/f/wysiwyg/ExtremeHeat/EXTREME%2BHEAT%2BAND%2BMENTAL%2BILLNESS_%C2%A0%2BTOOL%2BKIT%2BFOR%2BMENTAL%2BHEALTH%2BCARE%2BPROVIDERS-3%20%281%29.pdf
Emotions
When thinking about climate change, about 75% of respondents endorsed feeling sadness, anxiety/fear, and helplessness at least moderately, making these the most common emotional responses. In contrast, optimism was endorsed the least, with only 28% reporting it to a similar degree. Over half of respondents also felt grief and anger, while fewer than half reported feelings of guilt or shame. These emotional patterns were similar across the three counties.
These local findings align with findings from a similar survey of U.S. youths ages 16-25yrs. This population endorsed feeling anxiety (65.8%) and powerless (65.8%) most often, and optimism (29.2%) least often, when thinking about climate change.
References
- Lewandowski RE, Clayton SD, Olbrich L, et al. Climate emotions, thoughts, and plans among US adolescents and young adults: a cross-sectional descriptive survey and analysis by political party identification and self-reported exposure to severe weather events. Lancet Planet Health. 2024;8(11):e879-e893. doi:10.1016/S2542-5196(24)00229-8
Behavior
Evidence suggests that concerns about climate change affect a range of personal decisions, from voting, purchasing, to family planning. Similarly, climate change may influence housing choices by making high-risk locations (e.g., areas susceptible to wildfire, flood, poor air quality) less attractive places to live and invest.
This trend is evident in our tri-county region, where a majority of survey respondents said that climate change influences their life decisions, most notably how to vote (73%) and what to buy (72%). Other key areas include where to live (64%), what to eat (63%), and how to travel (61%). Less than half (47%) said their decision on whether to have children is influenced by climate change. The emphasis on civic and consumer behavior indicates the public views policymakers and businesses as important to climate action.
Perceived Government Response
Climate change is now understood as the greatest public health emergency of our time, leading to growing demands for governments to help communities reduce their climate risks. These calls for action include lawsuits filed by children against governments for promoting fossil fuels and devastating natural resources. Policymakers, therefore, have a critical role in climate mitigation efforts, using tools such as public awareness campaigns, financial incentives, enacting strict regulations and land use policies.
Despite this need for leadership, survey results show a clear theme of skepticism or dissatisfaction with climate change response from all levels of government. Only 23% of respondents region-wide think that their local government is doing enough to respond to climate change. This ranges from 15% among Multnomah to 33% among Washington County respondents. The proportion who think their state/federal government is doing enough is slightly higher, at 29% region-wide, but varies widely by county. Just 10% of Multnomah and 32% of Clackamas County respondents think so. These results suggest that residents across the region are feeling that climate response efforts at all levels of government are falling short, and that there may be a sense of distrust or disillusionment. They also point to opportunities for improved communication, visibility, and tangible actions from public agencies to build community trust and demonstrate progress being made.
References
Lewandowski RE, Clayton SD, Olbrich L, et al. Climate emotions, thoughts, and plans among US adolescents and young adults: a cross-sectional descriptive survey and analysis by political party identification and self-reported exposure to severe weather events. Lancet Planet Health. 2024;8(11):e879-e893. doi:10.1016/S2542-5196(24)00229-8
Dillarstone H, Brown LJ, Flores EC. Climate change, mental health, and reproductive decision-making: A systematic review. Jia F, ed. PLOS Clim. 2023;2(11):e0000236. doi:10.1371/journal.pclm.0000236
Solomon CG, LaRocque RC. Climate change — a health emergency. N Engl J Med 2019;380:209-211.
Salas RN, Jacobs W, Perera F. The Case of Juliana v. U.S. - Children and the Health Burdens of Climate Change. N Engl J Med. 2019 May 30;380(22):2085-2087. doi: 10.1056/NEJMp1905504.
Noor D. ‘Gamechanger’: judge rules in favor of young activists in US climate trial. The Guardian. https://www.theguardian.com/us-news/2023/aug/14/montana-climate-trial-young-activists-judge-order. August 14, 2023. Accessed August 22, 2025.
Coping Strategies
Natural disasters and climate change have clear, measurable impacts on the emotional wellbeing of our community:
The majority of survey respondents (75%) said their mental health has been affected by extreme weather events.
Thinking about climate change evokes widespread feelings of sadness (79%), anxiety/fear (75%), and helplessness (73%), which are compounded by the belief that governments are not doing enough to address the crisis.
These impacts make identifying sources of mental health resilience especially important. When asked about what types of activities respondents engaged in to reduce stress when feeling anxious about climate change, 203 people provided answers. We analyzed these responses for themes using three methods that included manual review and two different text mining techniques accompanied with artificial intelligence (see Notes tab for more details).
Themes for Coping Identified by Manual Review
Summary of Themes for Coping Identified by Each Method
| Method: | Manual Review | LDA + AI | Dendrogram + AI |
| Purpose | To identify and summarize most common activities and themes. | To identify words frequently presented together | To identify words frequently presented together |
| Theme 1: | Reflection | Creative Distraction and Restful Solitude | Nature-based physical activity |
| Theme 2: | Movement | Nature, Family, and Active Grounding | Passive relaxation and solo activities |
| Theme 3: | Getting into nature | Mind-Body Integration and Intellectual Focus | Blend of mindfulness or breathwork with social support and outdoor movement |
| Theme 4: | Being in community | Joyful Outdoor Activity and Social Play | Focus on mind-body practices and structured/group settings |
| Theme 5: | A mix of connection and calming activities at home |
When we compared across methods used to identify common activities, we see strong overlap as well as some unique insights about community member’s coping strategies.
Activities with movement and exercise that ground people in their bodies, like yoga, biking, or mindful breathing were mentioned most.
Many of these activities like hiking also included getting into nature.
The theme of connection—being with others, whether sharing time with family, with community, or shared experiences—was evident in many of the activities.
Solo practices that support relaxation and creativity like reading or listening to music were also common.
Community members shared many strategies that work for them to reduce stress. Different approaches to summarizing these strategies show similar conclusions that community members find mental health resilience through simple, everyday actions like being in nature, moving their bodies, connecting with others, and engaging the mind in creativity or reflection. Sharing knowledge of these activities with other community members and organizations whose role is to promote community well being, and identifying resources and infrastructure that facilitate these activities can support mental health resilience in the face of the climate crisis.
Locally, steps to reduce contributions to climate change also protect spaces for many activities that promote resilience. This includes actions such as creating more walkable areas, conservation of green spaces, and reduced pollution for better air quality.
Notes
Methods for Survey Development, Implementation, and Analysis
A literature review was conducted to identify validated scales used to measure climate anxiety and climate-related mental health outcomes. Public health divisions at each county reached out to behavioral health partners to participate in review and discussion of survey questions that would be beneficial for understanding and improving services to the community. The final version of the survey was administered in Qualtrics and included a setting to screen for bot and survey farmer activity. Direct translation of the survey in Arabic, Chinese, Korean, Russian, Somali, Spanish, Ukrainian, and Vietnamese was included.
As described in the Overview, the survey was open from January 20-May 28, 2025 and participants were recruited through in-person recruitment, provider emails, flyers, and social media. Respondents could enter a raffle for a gift card reward by going to a separate link at the end of their survey. In-person responses were entered into Qualtrics by an epidemiologists.
The analytic sample includes respondents ages 16y and above residing in Clackamas, Multnomah, or Washington County and spent at least 2 minutes on the survey. A panel of three epidemiologists also manually reviewed the data to exclude potentially fraudulant observations that were likely completed by automated form fillers (“bots”) based on answers to open-text fields, clusters of similar responses, and patterns of contradicting answers to questions.
Results were presented as counts, percentages, and average scale scores for climate anxiety.
Methods for Identifying Themes of Coping Strategies
Manual ReviewPurpose: To identify the most common themes.
Word Frequency Analysis and Inductive thematic analysis with a group of epidemiologists and data analyst was used to identify words mentioned at least ten times and identify themes among these commonly used words for describing activities.
Latent Dirichlet Allocation (LDA) and Dendrogram
Purpose: To find what coping strategies/words appear together across survey responses.
The Latent Dirichlet Allocation and Dendrogram text mining techniques were applied to the responses to the coping strategies question using the textdata, topicmodels, tidytext, tm, dendexted, and RWEka R packages. Analysis included exploring groups of words or clusters by 2, 3, and 4 topics. The model with 4 groupings of words was selected and put into ChatGTP to generate the interpretation of the 4 themes that were reviewed by the analytic team.
