Extreme weather events, such as floods, typhoons, heatwaves and droughts, are becoming more frequent and severe due to climate change, with profound and often lasting effects on human health and well-being.^1,2 A large and growing body of evidence, particularly from high-income countries, suggests that the mental health impacts of extreme weather are profound and multifaceted.^3,4,5 The Intergovernmental Panel on Climate Change’s (IPCC) Fourth Assessment Report, noteworthy for its expanded focus on the health impacts of climate change, recognised that exposure to extreme weather events such as hurricanes, floods or heatwaves can lead to psychological stress and trauma, affecting mental well-being.⁶ An extreme weather event can contribute to heightened levels of anxiety and depression, stemming from the uncertainty and fear associated with both the immediate threat and the long-term challenges associated with the event.^1,6,7 The loss of livelihoods, homes, possessions and sometimes family members or friends can trigger intense grief, and the grieving process may be prolonged and complicated by the unique circumstances of the event. Moreover, displacement, whether temporary or permanent, can induce significant stress as forced relocation, loss of community ties, and the challenges of adapting to a new environment all contribute to the hardships faced by those affected by extreme weather disasters.^3,5

In this work, we focus on the West African region. West Africa, characterised by its diverse climate and topography, specifically faces a range of extreme weather events that have significant implications for the well-being of its population.^1,8,9,10 In this region, droughts are persistent challenges, resulting in water scarcity, agricultural difficulties and food insecurity. Extended periods without rainfall can lead to crop failures, impacting the livelihoods of those heavily reliant on agriculture. The recurrent nature of droughts not only exacerbates economic vulnerabilities, but also poses a sustained threat to food security, contributing to economic hardships for communities that rely on agriculture and natural resources for their sustenance. In contrast to droughts, floods pose immediate and impactful threats as heavy rainfall often brings the risk of flash floods and river overflows. The consequences of flooding are far-reaching and include the displacement of communities and widespread damage to infrastructure and homes. The varied extreme weather events in West Africa, from droughts and floods to tropical cyclones, collectively contribute to a complex set of challenges that can impact the mental health of the region’s residents.

Climate-related challenges, including those impacting mental health, transcend national borders, making a regional lens useful. A regional approach allows us to account for shared environmental conditions and sociopolitical contexts across countries, while also broadening the population to which our review is directly applicable. Moreover, this regional focus is solutions-oriented, aligning with established mechanisms for cross-national collaboration, such as the Economic Community of West African States (ECOWAS), which has a proven track record of supporting regional health initiatives. Efforts like the ECOWAS Medicines Regulatory Harmonisation initiative offer valuable models for coordinated responses to emerging challenges,¹¹ including those at the intersection of climate change and mental health.

Mental health disorders remain a significant and often underreported challenge in West Africa with studies estimating lifetime prevalences of mental illness ranging from 1% to 15.8%.¹² Despite this substantial burden, access to mental healthcare remains critically limited. For instance, in 2009, it was estimated that 98% of Sierra Leoneans with mental illness were not receiving treatment, in part due to a lack of public psychiatric facilities outside of the capital.¹³ Reports from Liberia indicate that there are only a handful of psychiatrists for its population of over 4 million.¹⁴ These findings agree with data showing that over 90% of people living with mental illness are untreated in low- and middle-income countries, including West African nations, as compared to 44% – 70% in high-income countries.¹⁵ In addition to a lack of qualified mental health professionals, several other barriers contribute to this treatment gap including stigma, cultural perceptions, infrastructural deficiencies and economic constraints.^16,17,18 For example, Gambia and Ghana allocate 0.5% and 1.3% of their health budget to mental health, respectively.¹⁹ These allocations are well below international recommendations and benchmarks for mental health investment in low- and middle-income countries.^20,21,22 Given the limitations in existing mental healthcare, understanding the underlying contributors to mental health disorders is increasingly urgent. In this context, characterising the relationship between extreme weather events and mental health is especially important, as climate-related stressors may significantly contribute to the region’s mental health burden. As efforts continue to strengthen healthcare systems, identifying and addressing these climate-related factors could help narrow the mental health treatment gap by reducing the incidence and severity of mental health conditions.

We conducted a systematic review of the existing peer-reviewed literature to summarise and characterise the mental health impacts of extreme weather events in West Africa. By evaluating existing research, we aimed to identify knowledge gaps and inform future research priorities that will enable public health and clinical practitioners to make informed decisions and formulate policies aimed at mitigating the mental health impacts of climate change in the region.

This systematic review identifies three key themes: Firstly, while the direct effects of extreme weather events on mental health are often emphasised, these events may also indirectly impact mental health through pathways related to food insecurity, physical health deterioration and zoonotic disease exposure. Secondly, certain populations, such as women and low-income groups, appear to experience differential impacts. Thirdly, policy opportunities, such as expanding mental health services and strengthening social safety nets, may be useful for mitigating the mental health burden of climate-related weather events and supporting the most affected populations.

One major theme of the reviewed articles was that extreme weather events may have both direct and indirect effects on mental health. Indeed, floods or droughts themselves could be a source of distress in the included studies, but the indirect effects of extreme weather events provided additional cultural insights. For instance, Abass et al.³⁰ performed a mediation analysis and demonstrated that flood health-risk perception mediated 27% of the association of flood stressors with mental distress in Ghanian community-dwelling adults. Nuvey et al.³² provided the example of livestock impacts as a way that these events could have indirect effects on the mental health of farmers in Ghana. The authors repeatedly highlighted how climate disasters like droughts or floods could contribute to crop destruction and livestock disease and death, resulting in food insecurity that could worsen farmers’ mental well-being. Losses from the death of livestock could then result in the stressor of additional food insecurity and even worse mental well-being in farmers. Even if farmers sold diseased cattle at meat markets to recoup losses, consumption of diseased meat could contribute to poor physical health in the population, which is also associated with worse mental well-being. The results from Bangura et al.³⁹ further suggested the connection between climate, physical health and mental well-being. In their study of individuals living in rural Sierra Leone, climate-related livelihood insecurity was associated with prostitution, crime, violence and child labour. Each of these scenarios can contribute to stressful experiences like divorce, household breakdown and carry physical health risks that can simultaneously impact mental well-being. Sorgho et al.⁴⁰ mentioned how decreased income due to extreme weather events could limits one’s capacity to address health needs. Similarly, the work by Ajibade et al.³⁷ highlighted the disruption of coping mechanisms (e.g. social networks, financial resources, etc.) as another indirect way that climate could adversely impact mental well-being.

Importantly, the articles also demonstrated that beyond direct and indirect effects, truly understanding the effects of climate change on mental health required an appreciation of different vulnerabilities. The most robust representation of these different vulnerabilities was in the articles that highlighted differential climate effects between men and women study participants and those of differing socioeconomic status. In a sex-based analysis, Abass et al. reported that the magnitude of the association between flood exposure and psychological distress was greater for women than men. The authors believed that the disproportionate impact on women was related to their social position, including social suppression and lower levels of education.²⁹ Kadio et al.⁴¹ observed that pregnant and postpartum women faced heightened mental health vulnerabilities under extreme heat, exacerbated by cultural practices (e.g. postpartum confinement indoors) and economic pressures from reduced work productivity. These intersecting stressors, rooted in gender roles, limited healthcare awareness and livelihood disruptions, underscore women’s potential disproportionate psychological burdens in climate-vulnerable settings. Bangura et al.³⁹ further commented that some of the disproportionate impacts experienced by women could be due to gender roles as women often bear the burden of caring for children, but also the elderly and the sick even during times of disaster. Ajibade et al.’s work expands upon this assertion by reporting on how socioeconomic status could further impact the vulnerability of women. Specifically, they report that women from low-income Lagos neighbourhoods demonstrated greater flood-related adverse impacts and slower recovery when compared to women from higher-income neighbourhoods.³⁷ Osman et al.³⁴ identified socioeconomic status independent from sex as another important vulnerability as persons of lower education in their cohort were more likely to experience severe levels of flood-related depression. Apart from sex and socioeconomic status differences, Abass et al.²⁹ report different vulnerabilities with age, as the flood and distress relationship was more robust among younger individuals (20–59 years of age) when compared to their older counterparts (ages 60 years and above). There was no clear reason for this observed age difference, and the authors note that most of the existing literature supports older individuals being more impacted.

The reviewed articles also noted limits to individual resilience or ability to cope with the effects of climate change and alluded to a series of broader policy interventions that may prove to be beneficial. A major takeaway from the aforementioned discussion on sex vulnerabilities is the potential for sex-targeted policies or philanthropic initiatives to support women and other disproportionately impacted groups during disasters.³⁷ Akoteyon³⁸ emphasised that several of the sites of flooding and property losses in Lagos State, Nigeria, were areas of land that were developed without a proper environmental impact assessment (EIA). Thus, conducting and properly enforcing EIAs represents one potentially actionable target for future collective efforts. Adams et al. and Abass et al. echo the concern for rapid, uncontrolled development as a major contributing factor. These authors offer greater emphasis in municipal planning (e.g. increased greenspace allocation, appropriate drainage systems, sufficient waste management systems, etc.) as a potentially fruitful local policy focus.^30,31 Work by Osman and colleagues demonstrated that the relationship between flood exposure and depression could be modified by what personal property was damaged by a flood. They found that the level and cost of damaged items influenced the levels of depression participants reported.³⁴ These findings suggest that policies or insurance schemes aimed at replacing or supporting people who may have lost these impactful items is a possible intervention. Osman et al. also called for Ghana’s National Disaster Management Organisation (NADMO) to include psychological assistance provisions for individuals impacted by floods. Nuvey et al.³² called for more animal and human vaccination campaigns to help safeguard against climate-related zoonoses. Finally, Sorgho et al.⁴⁰ highlighted the lack of formal education on climate topics among other areas of education as an issue requiring attention. Consequently, efforts to enhance individual and population understanding of why extreme weather events occur and their specific risks may prove beneficial in the West African region. Not explicitly mentioned in the articles, but likely to be important to addressing the impacts of climate on mental health, are investments in research infrastructure (e.g. funding, data collection capacity) and bolstering mental health clinical capacity given that there is a shortage of mental health professionals in the region.

Our review revealed several gaps in the literature, particularly a paucity of research on adult mental health and extreme weather events in West Africa. Although our review provides important insights on mental health impacts, it does have some limitations. Firstly, the included studies are from only four of 16 West African countries, which poses some limitations to the generalisability of the findings. Secondly, in contrast to symptoms of general distress, clinically diagnosed disaster-related mental health disorders (e.g. PTSD) were rarely investigated in the included studies. The studies included in our review represent a mix of quantitative and qualitative research approaches, and the majority are of high and moderate quality, but there remains a need for research with increased country representation, and a full range of mental health impacts, to truly capture outcomes that are representative of the entire region. Additionally, for mixed-methods studies, the qualitative and quantitative components sometimes differed in methodological quality; in these cases, we interpreted each component’s findings in light of its respective appraisal rather than treating the study as uniformly strong or weak. Thirdly, according to the United Nations International Children’s Emergency Fund (UNICEF),⁴² almost half of Africa’s present population is under the age of 18 years. Our review focuses on individuals greater than 18 years of age. As such, our study findings may not be generalisable to this substantial proportion of the West African population. Given that mental health impacts of climate exposures may differ between adults and children, who are in their earlier stages of development, there is further impetus for future research that is centred on the mental health experiences of children in the context of extreme weather events in West Africa. Fourthly, most of the studies focused on flooding, and there remains a need for studies that examine other weather-related exposures. Fifthly, many of the included studies are cross-sectional in nature and cannot speak to causal relationships. Studies with longitudinal data are needed to better elucidate temporal relationships. Sixthly, heterogeneity in mental health outcome assessment, including the use of different validated instruments and variation in diagnostic frameworks across settings, may limit direct comparability of findings across studies. Seventhly, although we intentionally focused on the West African region, some may view this geographic emphasis as limiting the broader generalisability of our findings. However, we argue that this regional focus has allowed us to propose more context-specific solutions to address the mental health impacts of climate change, while still identifying areas of overlap with challenges and approaches observed in other regions.

For example, studies from Australia have described feelings of hopelessness among farmers facing drought conditions,⁴³ mirroring similar sentiments reported by farmers in Ghana confronting climate-related stressors.³² Likewise, a review from Latin America and the Caribbean highlighted how climate-related mental distress can indirectly contribute to rising rates of noncommunicable diseases such as obesity and diabetes, conditions that, in turn, exacerbate psychological distress.⁴⁴ This was among the indirect effects that we observed from our analysis. That same Latin America and Caribbean-based review emphasised the mental health toll of climate-related migration, particularly due to the loss of community and social ties, an issue also identified in two of our included studies from Ghana.^33,35 These parallels suggest that, despite geographic differences, shared lessons and strategies may be valuable across regions. Additionally, a review on extreme weather and mental health in South and Southeast Asia identified women and individuals of lower socioeconomic status as particularly vulnerable populations,⁴⁵ consistent with the themes in our West African review. The same study also pointed to pre-existing psychological conditions and past trauma as risk factors, elements not explicitly surfaced in our findings, but which warrant further investigation in future West African research. Notably, the Asia-based review emphasised the importance of longitudinal data to better characterise causal relationships. Given that most studies we identified were cross-sectional, we echo the call for longitudinal research to strengthen the evidence base in West Africa. Finally, this review protocol was not registered in PROSPERO (International Prospective Register of Systematic Reviews) or another registry, which we acknowledge as a limitation.

In conclusion, the range of cultural and geographic differences across the African continent prompted our focus on the region of West Africa to allow for a more nuanced understanding of any observed relationships. We believed that a nuanced understanding would also improve the chances of actionable solutions-oriented idea generation. In this systematic review examining relationships of extreme weather events and adult mental health in West Africa, we screened over 2900 articles and identified 13 that met inclusion criteria. These articles suggested direct and indirect relationships of climate events with mental health and highlighted populations that may be particularly vulnerable to these effects including women and persons of lower socioeconomic status. The articles also provide insights to potentially address these climate and health challenges. Possible solutions include policies to support women, targeted psychological assistance provisions, vaccination campaigns to reduce climate-related zoonoses, reforms to building and development mechanisms, more robust property insurance programmes and broader population climate health education. Continued investments in research infrastructure and mental health clinical capacity may also be important for addressing these dire needs.