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Cold Spell and Mental and Behavioral Disorders: A Higher Risk from Higher Cold Spells’ Intensity and Duration

  • Yarui Fan 1,2,†,   
  • Junwei Yan 3,4,5,6,†,   
  • Ruiyun Tang 1,2,   
  • Zimeng Gong 1,2,   
  • Jian Cheng 1,2,7,*

Received: 06 Mar 2026 | Revised: 13 May 2026 | Accepted: 28 May 2026 | Published: 10 Jun 2026

Abstract

Cold spells are increasingly recognized as important climate-related stressors for human health. However, evidence on the effects of cold spells on mental and behavioral disorders remains limited, particularly regarding how cold spells’ intensity and duration influence hospitalization risk and whether the effects differ across disease types and population subgroups. We conducted a time-series study using the hospitalizations for mental and behavioral disorders in Hefei city of Anhui Province of China during the cold season (November to February) from 2016 to 2019. A cold spell was defined as daily mean temperature was below the 2.5th, 5th, or 7.5th percentile and lasted for at least 2–5 consecutive days. A total of 12 cold spell definitions were used. The distributed lag non-linear model combined with a generalized additive model was used to estimate hospitalization risk, with stratified analyses by disease subgroup and population characteristics. Cold spell was significantly associated with an increased risk of hospitalization for mental and behavioral disorders. Under the main cold spell definition (daily mean temperature below the 2.5th percentile for ≥3 consecutive days), the association was strongest among patients with schizophrenia [Relative risk (RR) = 1.75, 95% confidence interval (CI):1.50, 2.03)], while no statistically significant associations were observed for depressive disorder (RR = 0.92, 95%CI:0.64, 1.32) or bipolar disorder (RR = 1.03, 95%CI:0.76, 1.41). Stronger associations were observed among urban residents (RR = 2.41, 95%CI:2.09, 2.78) and individuals aged >42 years (RR = 2.11, 95%CI:1.83, 2.44). Notably, hospitalization risk of mental and behavioral disorders varied by cold spell’s characteristics, with a higher risk associated with lower temperature threshold and longer cold spell duration. Results also remained robust across multiple sensitivity analyses. Cold spells are associated with increased hospital admissions for mental and behavioral disorders, with heterogeneous effects across disease types and population subgroups. These findings highlight the need to incorporate cold spell exposure into climate-related mental health risk assessment and prevention strategies.

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Fan, Y.; Yan, J.; Tang, R.; Gong, Z.; Cheng, J. Cold Spell and Mental and Behavioral Disorders: A Higher Risk from Higher Cold Spells’ Intensity and Duration. Environmental Change and Disease Dynamics 2026, 1 (1), 3.
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