"There is no hope; only strong wind": How climate change impacts adolescent mental health in southern Madagascar.

Introduction: Climate change threatens children's and adolescents' health worldwide, but there is limited evidence of its effects on mental health in the low- and middle-income countries which are most affected. We focus on southern Madagascar to elucidate pathways through which climate change impacts mental health. Materials and Methods: In this preliminary study, we collected survey ( Results: Adolescents were extremely anxious and depressed, with high climate anxiety. Adolescents indicated that climate changes influenced mental health through loss of household resources, uncertainty about the future, and disruption of coping mechanisms. Discussion: Climate changes exacerbated the existential threats faced by the adolescents. In Madagascar, our results tentatively suggest that interventions and policies should address food and water security, promote adaptive farming practices, and build resources for coping. Conclusion: Climate changes are having a profound impact on adolescent mental health in southern Madagascar. The mechanistic links through which these impacts occur may be different than in other, more frequently studied contexts. Research examining these pathways in more depth in Madagascar is urgently needed.