Exposure to Climate-Related Stressors Undermines Mental Health in the Kurdistan Region of Iraq: A Cross-Sectional Study

Jan Ilhan Kizilhan^1,2Sumaia Al-Ghurbani^1*Jonathan Uricher¹Zelal Ag¹Ibraheem Khalil Musa²Bohar Suleiman Isa²

• ¹Institute for Transcultural Health Science, Baden-Wuerttemberg Cooperative State University, Stuttgart, Germany
• ²Institute for Psychotherapy and Psychotraumatology, University of Dohuk, Dohuk, Iraq

Introduction: Climate-related events such as droughts, extreme heat, and flooding intensify pressures on psychological well-being, particularly in vulnerable, low-resource, and conflict-affected settings. Iraq ranks as the world’s fifth most climate-vulnerable country, and the Kurdistan Region has been increasingly affected by frequent and intense extreme weather events that threaten livelihoods and community stability. Despite rising exposure, the mental health impacts of climate change in the Kurdistan Region remain largely understudied. This study investigates the effects of climate change–related stressors and extreme weather events on mental health through robust analytical methods, yielding the first rigorous empirical evidence from the region. Methods: An analytical cross-sectional study was conducted with a sample of 618 participants aged ≥18 years, residing in urban and rural areas of three governorates in the Kurdistan Region of Iraq: Duhok, Erbil, and Sulaymaniyah. Data were collected using a questionnaire that integrated measures from several validated psychological scales, including the PHQ-8, GAD-7, K10, PCL-5, and CC-MMDS. The data were analyzed using independent t-tests and analysis of variance (ANOVA) for group comparisons, and multiple linear regression for associations. Results: The final sample included N = 608 adults aged 18–75 years (51.6% male, %48.4 female), recruited from Duhok (32.9%), Erbil (33.9%), and Sulaymaniyah (33.2%). Descriptive analysis identified heatwaves, droughts, and dust storms as the most frequently reported extreme weather events. Multiple linear regression analyses revealed that exposure to extreme weather events significantly predicted increased posttraumatic stress disorder symptom levels (β = 0.23, p=0.008). Climate-related homelessness was also significantly associated with increased symptoms of depression (β = 0.38, p=0.014), anxiety (β = 0.42, p = 0.007), psychological distress (β = 0.32, p=0.042), and PTSD (β = 0.39, p=0.010), after accounting for potential confounders. Conclusion: The study found that individuals in the Kurdistan Region of Iraq who were exposed to climate-related stressors, such as extreme weather events and climate-induced homelessness, presented significantly poorer mental health outcomes compared to those without such exposure. These findings underscore the severe psychological impact of environmental changes and highlight the urgent need for targeted support within climate adaptation and disaster response strategies, especially for populations that are most directly affected.