Project relevance

In the EU, mental illness has become a societal (84 million patients and 84,000 deaths attributed to mental illness or suicide in 2015) and economic (over €600 billion/year) burden (OECD/European Union, 2018). Neurological conditions are the 5th highest non-communicable cause of death attributable to the environment. Over the past 20 years, there has been an increase in mental illnesses and neurological conditions in the countries bordering the Mediterranean Sea. The Mediterranean (Mare medi terraneum in Latin) is a semi-enclosed ‘sea in the middle of the land’ with the largest (2,969 Mkm2) and deepest (average depth 1,460 m; maximum depth 5,267 m) basin on Earth, and a complex socio-political, climatic and ecological area characterised by high biodiversity. The heavily industrialized countries in the north and the highly developed agricultural countries surrounding its basin make the Mediterranean Sea particularly sensitive to the accumulation of chemical contaminants that may cause a progressive degradation of the marine ecosystem. The Mediterranean Sea has been identified as one of the seas most affected by marine pollutants of anthropogenic origin in the world. According to the Horizon 2020 Mediterranean Report, many human activities, including agricultural waste, industrial emissions, municipal solid waste and urban wastewater, are degrading the Mediterranean Sea, contributing to the accumulation and diffusion of anthropogenic pollutants in the entire region, as recently described for microplastic hotspots. Indeed, pollution by toxic metals, industrials chemicals, plastic wastes is a problem in 87% of the Mediterranean Sea area with more than 130 pollution ‘hot spots’ identified in the coastal Mediterranean ecosystems. Moreover, water turn-over is limited with a permanence time of about 100 years. This particular situation encouraged the development of European research projects in line with the present proposal, e.g. PLASTICØPYR (European Regional Development Fund – POCTEFA 2014-2020) that aims to characterize Mediterranean pollutants with special emphasis on micro/nano-plastics.

Exposure to pollutants, in turn, threatens the health and well-being of many people living along the coast. In addition to cancer, neurodevelopmental disorders and endocrine dysfunction, heavy metals, constituents of air pollution,
organic solvents and food contaminants have been associated to childhood problems with hyperactivity, attention, and impulse control, and to an increased risk of psychiatric diseases, such as schizophrenia and depression , often combined with neurological conditions including highly prevalent pain sensitization. Notably, an increased incidence of psychiatric illnesses is relevant to Mediterranean Countries. The Eastern Mediterranean Region (EMR), for example, is witnessing an increase in mental illnesses, with a prevalence ranging from 15.6% to 35.5%, and
more than 100 million sufferers. Depression and anxiety disorders are the most frequent mental disorders in the EMR, with rates in women much higher than in men. Psychiatric disorders also have a large prevalence in the South-Western Mediterranean, where heavy metals and pesticides accumulate in marine animal tissues. Substance-use disorders are very common in all Mediterranean areas, and a strong link between exposure to pollutants and drug addiction has been reported. Importantly, behavioural traits like hyperactivity, compulsion and impulsivity that are
common behavioural traits in drug addiction but also in many other psychiatric diseases (e.g. ADHD, eating disorders, OCD, bipolar disorder) are also frequent in Mediterranean countries, and have been associated with exposure to
environmental pollutants.

Numerous epidemiological, clinical and animal studies indicate adverse associations between pollution and mental illnesses, especially in children and adolescents; yet the biological mechanistic pathways responsible remain
elusive. However, pollutants are persistent sources of neuroinflammation and reactive oxygen species production, two processes that are strongly related to the pathogenesis of brain diseases and are modulated by endocrine disruptors
and sex steroid hormones. We hypothesize that pollutants present in the Mediterranean Sea expose nearby populations to an increased risk of psychiatric disease and comorbid conditions. To date, no therapeutic treatment is
designed to target pollution-based psychiatric diseases and associated neurological conditions. It is therefore clear that action should be taken now to understand the role of pollutants in psychiatric disorders and to devise
therapeutic approaches.

Developing collaboration between international experts in different aspects of neurobiology will contribute to the training of experts in this field, linking environmental studies and the understanding and prevention of mental
illnesses. Young researcher training is crucial to answer the priority objectives of the 8th Environment Action Program (8th EAP) in order to protect health and well-being of citizens from environmental-related risks and impacts. By consolidating the training of young international scientists, PsyCoMed will directly contribute to
several European programs, including the EU4Health program, i.e. by preventing diseases and cross-border health threats, and improving medicinal products. PsyCoMed will also contribute to advancing the European Green Deal’s ambition to protect health and well-being from pollution by providing new evidence on the cellular and molecular mechanisms involved in pollution effects on mental health. The recent approaches for addressing mental health in the EU still remain focused on social conditions (WHO, 2019, The ‘Mental Health: fact sheet’). The next WHO Europe mental health action plan should recognize the environment as a major determinant of mental health and therein PsyCoMed may contribute by providing recommendations.