Impacts of hot and cold nights on mental disorders: A three-stage nationwide hospital-based time-series study with 1.2 million patients in China

Background: Climate change has shifted and will continue to alter the patterns of daytime and nighttime temperatures. However, it remains unclear whether hot days and nights, as well as cold days and nights, have varying impacts on mental disorders. Methods: Daily hospital-based data on 1.2 million outpatient visits for mental disorders were obtained from 15 Chinese cities (2011-2015). The index of hot day excess, hot night excess, cold day excess, and cold night excess were used to measure the intensity of hot/cold days and nights. Firstly, a distributed lag non-linear model was used to estimate the risk of mental disorders associated with hot/cold days and nights for each city. Secondly, city-specific estimates were pooled by multivariate meta-analysis to obtain national effect estimates. Thirdly, the attributable fraction of mental disorders was estimated for the nation, genders, age groups, heating methods, and air conditioning penetration rates. Results: Our findings revealed that both hot and cold nights were associated with a higher risk of mental disorders compared to hot and cold days. The attributable fraction of mental disorders was higher for cold (night: 25.74%; day: 19.65%) in contrast to heat (night: 16.91%; day: 7.24%). Males, the elderly, cities using central heating, and cities with low air conditioning penetration rates were vulnerable to cold nights. Conclusions: This nationwide study highlights the adverse effects and significant burden of hot and cold nights on mental disorders. It underscores the potential for mitigating these impacts through the adoption of air conditioning, particularly in southern cities across China.