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adversely affect the productivity of workers (Kjellstrom, Holmer, and Lemke, 2009). Evidence shows that daily wage
workers are not able to work continuously during heat waves, which affects their earning. People are forced to go out for
work as they have no other choice. Vegetable vendors, construction workers, auto repair mechanics, rickshaw pullers,
roadside kiosk operators, and other weaker sections in India have to work in the heat, thereby making them susceptible to
the adverse impacts of heat waves such as dehydration, sun-strokes, and other health risks (NDMA, 2009b).
Exposure to heat waves also affects the mental health of populations. Evidence suggests that extreme heat exposure
made people susceptible to symptomatic mental disorders, dementia, mood (affective) disorders, neurotic, stress-related,
and somatoform disorders, disorders of psychological development, and other mental health consequences, for which
admissions to hospitals rose during heat waves. At the same time, hospital admissions increased more among men, the
elderly, and people in rural areas (Hansen, Nitschke, Ryan, et al., 2008; Trang, Rocklöv, Giang, et al., 2016). People also
suffer psychologically and feel depressed when they are unemployed. People with low incomes have a higher likelihood
to be afflicted by a chronic disease or other ailments such as mental illness or obesity due to heat waves (Kovats and
Hajat, 2008).
In India, very limited evidence is available on how natural disasters affect the mental health of the affected populations.
Heat waves are known to cause physiological and psychological stresses and even lead to death. It is known as a silent
disaster as it develops gradually and harms both human beings and animals in the country. Global warming has resulted
in increased heat wave conditions in India, consequently resulting in increased deaths due to heat waves in different
parts of India, particularly in the north-western, southern, and south-eastern regions (Akhtar, 2007). Sudden increases
are recorded in deaths arising due to mental and behavioral disorders during heat waves, especially among older persons
(Solanki, 2016; Shukla, 2013). In Odisha, India, the increase in the frequency of extreme weather events has had an
impact on the mental health of the people. The study conducted in Odisha showed that due to the extreme heat, water
scarcity, and unavailability of labor force, majority of people suffered from a drought-like situation. They lost scope of
agricultural productivity because of heat waves and scarcity of water. Many people migrated to other areas to work at
low wages, which disturbed their financial condition. Loss of livelihood and income sources caused psychological stress.
People became depressed as they had to struggle incessantly to meet their income needs, family commitments, and food
requirements (Patel, 2018a).
3.2. Droughts and Mental Health
Drought has long been documented as one of the most insidious natural disasters and causes of human misery. Like
other natural disasters, droughts often have significant health effects, typically mediated through complex environmental,
economic, and social pathways. The catalog of harmful health effects associated with drought is still being assembled.
Water scarcity also affects the functioning of public institutions such as schools and public health centers. Some of
the health impacts owing to shortage of water include diarrhea, which occurs due to the consumption of contaminated
water, while inadequate water intake can lead to dehydration. These factors are also a leading cause of infant mortality.
Other health impacts of droughts include water-related diseases such as Escherichia coli and cholera, airborne, and dust-
related diseases, vector-borne diseases such as malaria and West Nile virus, and mental health ailments (Stanke, Kerac,
Prudhomme, et al., 2013). Women, children, and infants constitute the most vulnerable sections of the population in the
event of a drought. Previous studies have shown that drought not only affects people physically but also psychologically.
There was a high degree of concordance among the identified literature, leaving a strong impression of increased risk for
adverse mental health impacts associated with drought. Studies have highlighted how droughts have affected the mental
health of people in terms of emotional stress and anxiety (Dean and Stalin, 2010; Hart, Berry, and Tonna, 2011).
Along with the western US, China, eastern and southern Africa, and the Mediterranean region, India featured
among the areas that were most drought-prone between 1984 and 2013 (FAO, 2015). In India, droughts are projected
to exacerbate the levels of poverty and affect the means of livelihood sustainability. Most major droughts in India have
been followed by a recession. It leads to a shortage of raw material supplies for agro-based industries and it also reduces
the demand for industrial products owing to the low purchasing capacity of rural consumers. Losses in agriculture affect
the livelihood of farmers as small- and medium-sized farmers turn into agricultural laborers (NDMA, 2009b; Singh,
Bantilan, and Byjesh, 2014).
Defining health outcomes associated with drought is also challenging, particularly in the area of mental health.
Interpretations of mental health outcomes vary across studies, and often outcomes are not explicitly defined. Although
mental health concepts are complex and vary with social, cultural, and familial norms and values, categorization of
adverse mental health outcomes is a prerequisite of further study. We considered mental health to be more than just
the absence of a mental illness or disorder and determined by a host of socioeconomic, biological, and environmental

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