Mentally Fogged Or Irritated? Patients Surge As Poor Air Quality Fuels Mental Health Distress

Feeling mentally fogged, unusually anxious or emotionally drained this week? You may not be imagining it. As Delhi-NCR continues to grapple with very poor to severe air pollution—with official data showing

air quality lingering above safe limits and emergency curbs re-imposed—doctors warn that the impact is not limited to the lungs or heart.

Mental health professionals told News18 that prolonged exposure to toxic air is increasingly linked to anxiety, low mood, sleep disruption, and cognitive fatigue—quietly adding to the growing health burden.

The most reported symptoms during prolonged pollution episodes include anxiety, low mood, irritability, poor sleep, and a persistent sense of mental fatigue or “brain fog”. Research has linked exposure to fine particulate matter to changes in mood, attention, and emotional regulation, while clinics report a seasonal rise in patients seeking help for anxiety, depressive symptoms, and sleep disturbances during high-pollution periods.

Psychiatrists told News18 that air pollution often acts as an aggravating factor, worsening pre-existing mental health conditions and reducing people’s ability to cope with everyday stress.

Rise In Anxiety, ‘Brain Fog’

Mental health clinicians say worsening air quality is increasingly reflected in patient footfall and symptom severity. At Maarga Mind Care, Dr Girishchandra BG, medical director and senior consultant psychiatrist, says monthly patient numbers rise during polluted months—from around 1,900 patients in 2024 to approximately 2,185 patients in 2025, a 15 per cent increase till November.

“Clinically, prolonged exposure to polluted air is associated with increased neuroinflammation and oxidative stress, which can disrupt mood regulation, attention, memory, and sleep,” he added. “In practice, we expect higher rates of anxiety, depressive symptoms, cognitive fatigue, and reduced concentration during sustained high-pollution periods.”

Other clinical psychologists report similar trends. Mehezabin Dordi, clinical psychologist at Sir H.N. Reliance Foundation Hospital, said, “Clinically, the most common symptoms seen during periods of poor air quality are low mood, increased anxiety, irritability, and a general sense of mental fatigue.”

“Many people report poor sleep, feeling emotionally flat, or unusually overwhelmed,” she said. “Concentration and memory can also take a hit, often described as ‘brain fog’.”

She noted that pollution tends to aggravate existing vulnerabilities. “In people who already have mental health conditions, these symptoms tend to worsen rather than appear for the first time,” Dordi said. “Older adults may show increased confusion, agitation, or faster cognitive decline during prolonged exposure to polluted air.”

Clinicians also notice a seasonal rise in patient inflow. “Most clinicians do notice a rise in footfall during months with consistently poor air quality, especially in urban Indian settings,” she said. “There is also some increase seen in patients seeking help for anxiety, depressive symptoms, sleep disturbances, and stress-related complaints.”

How Doctors Track Changes

To identify the impact of poor air quality on mental and cognitive health, clinicians rely on standardised assessment tools rather than subjective complaints alone. Short cognitive screening tests are used to assess functions such as attention, memory, orientation and language, helping detect subtle changes linked to prolonged environmental stress, particularly among older adults and those with existing vulnerabilities.

As Girishchandra explains, “Cognitive changes are commonly evaluated using the Mini Mental State Examination (MMSE)”, a brief screening tool widely used in routine clinical practice. For emotional symptoms, doctors use validated questionnaires to assess anxiety and depression in a structured manner, helping measure symptom severity and track changes over time, including response to treatment.

What Research Says

Psychiatrists say these clinical patterns are increasingly supported by scientific evidence. Dr Neha Aggarwal, consultant psychiatrist at Adayu, a Fortis Healthcare network hospital in Gurugram, said air pollution significantly affects mental health through both biological and psychological pathways.

“Rising levels of PM2.5 and other pollutants are associated with higher rates of anxiety, depressive symptoms, irritability, cognitive fatigue, and disrupted sleep,” she said.

“Biologically, pollutants trigger neuroinflammation and oxidative stress, which interfere with brain areas responsible for mood, attention, and emotional regulation,” she added.

Drawing from clinical experience, she said patient inflow rises visibly during pollution spikes. “Whenever air quality worsens, we see a clear rise in patient inflow,” she said. “People come in with heightened anxiety, low mood, irritability, and severe sleep disruption — often because pollution causes throat irritation, coughing, and blocked breathing at night.”

“Many also report fatigue and sadness linked to the dark, hazy environment and reduced sunlight during smog spells,” she said, noting that this affects circadian rhythm and mood regulation. “Patients with existing mental-health conditions experience noticeable symptom spikes, and even healthy individuals feel unusually restless or low during these periods.”

Research findings mirror these observations. Studies from China have shown that spikes in pollutants such as PM2.5, PM10, NO₂ and SO₂ are linked to higher psychiatric outpatient visits, including for anxiety and depression. A large UK cohort study has also found that long-term exposure to air pollutants is associated with greater mental-health service use among people with mood and psychotic disorders.

A 2022 systematic review and meta-analysis published in journal Frontiers in Psychiatry and other peer-reviewed journals found that exposure to air pollution—particularly fine particulate matter (PM2.5 and PM10)—is consistently associated with higher risk of internalising mental health conditions such as anxiety and depressive disorders.

Another systematic review of epidemiological studies examining long-term exposure to particulate matter showed a clear association between higher PM2.5 exposure and increased symptoms of depression and anxiety. For example: the research across multiple populations reported that prolonged PM2.5 exposure was linked with stronger depressive and anxiety symptom scores, even after adjusting for other demographic and health-related factors.

Experts believe that the evidence reinforces the need to view air pollution as a comprehensive public health issue. Integrating mental-health screening during high-pollution periods could help detect early psychological distress, enable timely intervention, and reduce long-term morbidity — underscoring that polluted air affects not just the body, but the brain as well.