Abstract
Abstract A changing climate indirectly threatens health by acting as a stressor from perceived threats to well-being. Few studies assess youth-centered climate anxiety in clinical settings. The emergency department (ED) is a prominent source of adolescent mental health triage. The primary objective was to understand demographic and clinical predictors of climate anxiety among ED pediatric patients. Secondarily, to externally validate an abbreviated version of the climate change anxiety scale (CCAS). In this cross-sectional study, data was collected from 2023 to 2024 in a single-center pediatric ED, with 860 patients ages 12–17 years approached via convenience sampling; 116 did not complete study surveys. Exposures included demographic factors (age, gender, race, ethnicity, insurance payor), chief complaint type (mental health or medical), temporal season, and General Anxiety Disorder–7 (GAD-7) score. The main outcome was climate anxiety, measured on the CCAS. 744 participants, with 79.8% presenting with medical complaints and 28.1% reporting climate anxiety. Females had 1.49 times higher odds of experiencing greater climate anxiety compared to males (95% CI 1.05, 2.12), p =.027. Having public health insurance increased the odds of experiencing climate anxiety (OR = 1.82, 95% CI 1.21, 2.73), p =.004, as well as warm seasonality (OR = 1.51, 95% CI (1.07, 2.13), p =.018. Participants with moderate or severe GAD-7 had five times higher odds of elevated climate anxiety than those with minimal generalized anxiety ( p <.001). The CCAS-short form (CCAS-S) demonstrated high sensitivity (91.4%–96.8%) and specificity (85%–95.5%) in detecting mild to severe levels of distress compared to the full CCAS. A four-tiered threshold of CCAS-S severity showed excellent reliability (quadratic weighted kappa = 0.838). We identified clinical predictors of climate anxiety and externally validated the CCAS-S in a large pediatric cohort. Given the increasing impact of the changing climate on human health, we advocate utilizing the tool alongside routine pediatric mental health assessments.