Summary
Background Chronic exposure to climate stress disproportionately affects low-income households; however, the
psychological health and climate distress levels of climate-vulnerable adolescents in low-resource settings has
rarely been explored. We investigated the association between increased flood exposure and adolescent
psychological health, climate distress, and temporal discounting (long-term planning capacity).
Methods In this cross-sectional, mixed-methods study, we administered surveys to assess symptoms of anxiety and
depression, temporal discounting, and climate distress. We surveyed 1200 adolescents aged 15–18 years from
low-income households in Dhaka, Bangladesh (a low-flood-risk location) and Barisal, Bangladesh (a high-flood-risk
location). We also conducted 16 focus group discussions among adolescents across both regions.
Findings Between Aug 7 and Dec 15, 2023, adolescents living under higher flood exposure in Barisal had significantly
greater odds of anxiety symptoms (adjusted odds ratio 1⋅94 [95% CI 1⋅41–2⋅65], p<0⋅0001) and depressive symptoms
(3⋅52 [1⋅94–6⋅40], p<0⋅0001) relative to those under low flood exposure in Dhaka. Adolescents experiencing anxiety
symptoms had significantly greater odds of exhibiting temporal discounting (2⋅00 [1⋅16–3⋅45], p=0⋅013). Our focus
group discussions suggest pathways by which cognitive overload during extreme floods contribute to adolescent
preferences against long-term flood adaptation planning.
Interpretation An increased prevalence of anxiety and depressive symptoms among flood-vulnerable adolescents in
low-income settings might be related to temporal discounting behaviour that could threaten their climate change
resilience.