The impact of air pollution is not only threatening our public health, yet also our mental health. Research shows that dirty air can impair breathing and aggravate various lung diseases.¹ Other potential effects are being investigated and many have suggested that air pollution can possibly inflict some of the earliest and most long-lasting damage on our cognitive and mental health.

One research conducted by Dr. Vivian Pun, Vital Strategies’ air pollution epidemiologist in the Environmental Health Division examining 4,000 older adults living across the United States, with the help of mental health data from the National Social Life, Health and Aging Project (NSHAP) as well as fine particulate matter data from the US Environmental Protection Agency and found that long term exposure to PM2.5 levels was significantly associated with moderate-to-severe anxiety symptoms and depressive symptoms, respectively. 
The study² was among the first to observe such a relationship, especially for depressive symptoms; and was subsequently supported by growing evidence linking air pollution exposure with a range of mental health illnesses (e.g., depression, anxiety, bipolar, suicidal risk) among adults³, and recently in children and adolescence?. Later studies also reported similar links between air pollution and mental health in cities with a wide range of pollution concentrations, such as in London (12.8ug/m3) and Beijing (50.4 μg/m3). 

How this happens remains poorly understood, but most likely, several factors work together towards this outcome. It has been suggested that PM2.5 may increase inflammation, oxidative stress, damage to blood vessels and degeneration in the brain. This can trigger depression-like responses; increase levels of the stress hormone cortisol, and aggravate major respiratory or cardiac medical conditions (e.g., stroke). 

Findings from the study also suggest that breathing in PM2.5 may especially impact the mental health of individuals with preexisting cardiopulmonary diseases (e.g., stroke, heart failure), and those living in communities of low socioeconomic status (e.g., high poverty and unemployment rate). These observations may be attributed to biological (e.g., people may be in poorer health) and/or behavioral (e.g., more stressful to begin with) mechanisms.²

In DKI Jakarta,  according to data from its Ministry of Health?, people in the age range 15 years and older have a 5,9%  prevalence of depressive disorders, which is nearly 500,000 people. Moreover, most Jakarta residents have been exposed to long-term exposure of PM2.5, approximately 40.00 µg/m3 daily, where the safe threshold recommended by WHO is 10 µg/m3. Given the link between long-term exposure of PM2.5 and mental illnesses (e.g., depressive), improving air quality would likewise improve mental health, along with other non-communicable diseases.

Air pollution is preventable in most cases, and effective evidence-based solutions are available to reduce air pollution at its source. Right now, cities may be focused on battling COVID-19, but this is a marathon, not a sprint. As municipalities reopen from COVID-19 lockdowns, governments must promote a sustainable and healthier “new normal” by identifying the leading sources of air pollution in their jurisdictions, and introducing evidence-based policies to control these emissions. 

It is imperative that governments raise awareness and address mental health stigma, generate mental health policies and legislation to support and improve existing mental health systems, and ensure better access to mental health services and treatments. Ultimately, a sustained improvement in air quality, coupled with an improved mental health system, will reduce mental disorders, other non-communicable diseases and minimize the vulnerability to infectious diseases like COVID-19.


References; 
¹9 out of 10 people worldwide breathe polluted air, but more countries are taking action. (n.d.). Retrieved September 29, 2020, from https://www.who.int/news-room/detail/02-05-2018-9-out-of-10-people-worldwide-breathe-polluted-air-but-more-countries-are-taking-action 
²Pun, V. C., Manjourides, J., & Suh, H. (2017). Association of Ambient Air Pollution with Depressive and Anxiety Symptoms in Older Adults: Results from the NSHAP Study. Environmental health perspectives, 125(3), 342–348. https://doi.org/10.1289/EHP494
³Braithwaite I, Zhang S, Kirkbride JB, Osborn DPJ, Hayes JF. Air pollution (Particulate matter) exposure and associations with depression, anxiety, bipolar, psychosis and suicide risk: A systematic review and meta-analysis. Environ Health Perspect. 2019;127(12). 
??Newbury JB, Arseneault L, Beevers S, et al. Association of air pollution exposure with psychotic experiences during adolescence. JAMA Psychiatry. 2019;76(6):614-623. 
?Roberts, S., Arseneault, L., Barratt, B., Beevers, S., Danese, A., Odgers, C. L., . . . Fisher, H. L. (2019). Exploration of NO2 and PM2.5 air pollution and mental health problems using high-resolution data in London-based children from a UK longitudinal cohort study. Psychiatry Research, 272, 8-17. doi:10.1016/j.psychres.2018.12.050
?Jia, Z., Wei, Y., Li, X., Yang, L., Liu, H., Guo, C., . . . Li, Z. (2018). Exposure to Ambient Air Particles Increases the Risk of Mental Disorder: Findings from a Natural Experiment in Beijing. International Journal of Environmental Research and Public Health, 15(1), 160. doi:10.3390/ijerph15010160
?Situasi Kesehatan Jiwa di Indonesia. Pusat Data dan Informasi Kementerian Kesehatan Republik Indonesia. Accessed in Sept 29,2020. 
?Calcia MA, et al. (2016). Stress and neuroinflammation: A systematic review of the effects of stress on microglia and the implications for mental illness. DOI: 10.1007/s00213-016-4218-9
?Braithwaite, Isobel., Zhang, Shuo., Kirkbride, James., Osborn, David., Hayes, Joseph., Air Pollution (Particulate Matter) Exposure and Associations with Depression, Anxiety, Bipolar, Psychosis and Suicide Risk: A Systematic Review and Meta-Analysis. 127 - 128. https://doi.org/10.1289/EHP4595.