Climate change is an ecological crisis that poses a significant threat to human health [1]. It has been widely reported that climate change can negatively impact mental health [2,3], both through direct and indirect exposure to natural hazards, as well as through the overarching awareness of climate change and the associated environmental decline, known as eco-anxiety [4]. The detrimental impacts of exposure to natural hazards such as bushfires and drought on mental health and well-being have been widely reported and can be enduring [5-7]. An emerging body of research has also routinely highlighted the deleterious impact of eco-anxiety on a range of mental health outcomes [8,9]. As climate change continues to accelerate the intensity, frequency, and severity of climate-related natural hazards [10], there is an increased likelihood of exposure and repeated exposures to these events. Direct exposure to natural hazards also increases climate change distress and concern [11], compounding exposure-related distress and leaving exposed individuals especially vulnerable to poor mental health outcomes.

Although much of the existing literature has explored the mental health outcomes of adults, children and young people are considered to be a priority at-risk group in relation to climate change [12,13]. Children are likely to be the most affected by climate change [14,15] and from early and developmentally significant life stages [16] while having contributed minimally to the climate crisis. Young people around the world report high levels of climate change concern [17], with higher levels of eco-anxiety observed in young people than in older age groups [18-21]. These high rates of eco-anxiety are also related to distress and poor mental health in children [22,23].

Young people are also especially vulnerable to direct and indirect exposure to natural hazards [24], in part due to exposure to parental stress [25,26] and erosion of normal support systems [27] at an age where coping skills are still emerging [28]. Recent evidence highlights high levels of depression, stress, anxiety, substance misuse, adjustment disorder symptoms, and low resilience in young people following the Black Summer 2019-2020 bushfires in Australia, especially for those who were directly exposed [11]. Children and young people residing in rural areas are further at increased susceptibility to poor mental health in relation to climate change due to (1) already higher rates of psychological distress compared with their metropolitan counterparts [29], (2) more likely exposure to adverse climate change–related hazard events, and (3) limited mental health service access in rural areas [30]. Despite the body of evidence pointing to the impacts of climate change on mental health, evidence to guide practice remains scant, with few interventions for eco-anxiety currently evaluated [3,31].

Psychological resilience is a key protective factor for mental health and is understood as a process of adaptation to a stressor [32]. It has been argued that building resilience may be a key way to protect against impacts of climate change on mental health [33-35]. Climate change resilience—the ability to prepare for, adapt, and respond to climate-related hazards such as extreme weather events [36]—has most commonly focused on physical resilience, with less emphasis to date on how to build or foster psychological climate-resilience (ie, the ability to psychologically adapt to climate-related stressors).

Although psychological resilience has been widely studied, how to best build resilience and how resilience intersects with broader social factors and challenges such as climate change remains less well established [32]. Concomitantly, research examining how to build psychological climate-resilience remains in the nascent stages. This study thus crucially builds the literature base around developing psychological climate resilience in children in order to protect mental health.

To date, evidence for interventions to support climate change–related distress remain scant, and interventions proposed to date lack empirical assessment. Suggestions from the limited literature point to fostering hope and optimism [37] and empowering young people to feel a sense of efficacy to support coping—such as through taking climate action—as potentially beneficial [22,24]. Meaning-focused coping in relation to climate change has been shown to predict better mental health outcomes in young Swedes [38], suggesting the potential value of fostering this specific coping style. However, allowing children to explore and express negative emotional states is also critical [39]. Additionally, the use of ecotherapy, enhancing connection with nature [31,40], and mindfulness, alongside psychoeducation [33] have also been proposed. Group-based approaches may also be well placed to treat eco-anxiety, allowing for social support [31]. Given that the mental health care sector will struggle to cope with the impacts of climate change [33,41,42], group-based approaches may also be more feasible as a treatment modality. However, little is known regarding the effectiveness of any eco-anxiety–informed interventions, with minimal evaluation of any interventions currently undertaken [31].

This study pilots a novel group-based mental health and resilience intervention in relation to eco-anxiety for rurally located children who have been impacted by natural hazards. Specifically, the objective of this project is to explore the acceptability, feasibility, and clinical utility of a group-based eco-anxiety intervention.

This project is an exploratory trial to assess the acceptability, feasibility, and clinical utility of a group-based intervention using a pre-post design with a single group (trial registration ACTRN12624001287527). This protocol is presented in line with SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) reporting guidelines [43].

Data will be collected before and after the intervention. The primary assessed outcomes will include changes in the psychological symptoms, resilience, and subjective ratings of distress, with secondary outcomes examining change in climate emotions, from preintervention to postintervention. Acceptability will also be assessed post intervention. Data will be collected by trained independent data collectors.

Hard copy data are collected and reviewed for any missing or inaccurate data. Data are then entered by a trained researcher. Data entry will be verified by a second researcher and all values inspected to ensure data quality. Hard copy data are securely stored in a locked filing cabinet. Unique identifier codes are stored separately to the data and accessible only to the project leads. Electronic data are securely stored on password-protected University cloud system. All data management and analyses are undertaken by the research team and are independent of the funding body. Adverse events will be identified by the research team through review of pre-post data upon collection. The research team will have access to the final deidentified dataset. Due to the small and short-term pilot nature of the study, no independent auditing systems are in place.

Acceptability will be determined based on the acceptability Likert scale results as well as the open-ended survey feedback. Open-ended questions will be analyzed via content analysis, and Likert scale acceptability items will be descriptively reported. Feasibility will be assessed based on the completion of the program by individual participants, that is, the ability to recruit into the study and the proportion of participants completing the full program, with feasibility determined by recruiting the minimal sample size and an 80% completion/retention rate [54,55]. Utility will be demonstrated through improvements in subjective distress, mental health symptoms, or resilience between preintervention and postintervention. A paired-sample 2-sided t test will be performed for the outcome measures to identify any changes in the outcomes before and after the intervention. Baseline missing data will be removed pairwise, and analyses will be performed using the last observation carried forward.

This study has been approved by the University of New England’s Human Research Ethics Committee (HE23-080). Parental consent will be provided prior to children taking part in the study. The confidentiality and the nature of the study will be explained to the participants, and their assent will also be obtained prior to the commencement of the intervention. Study data will be deidentified, with participants assigned a unique code for linking their preintervention and postintervention data. Any potentially identifiable information provided in the open-ended responses will also be removed from any published materials to ensure privacy. Parents and children will be made aware that they are able to withdraw at any time without providing a reason and without consequence, and adherence will be recorded as the number of modules completed. Protocol amendments will be reported to the ethics committee and the trial registry. Catering during the intervention modules is provided, but no other compensation is provided to the participants.

Intensifying climate change will exacerbate mental health symptoms and increase disorder prevalence, which will pose a significant strain for the mental health system [4]. Crucially, with escalating climate change, more individuals will be exposed to natural hazards and be more likely to face repeated exposures [10], with repeated exposure shown to further increase a range of mental health symptoms beyond single exposure alone [56]. Exposure to natural hazards also exacerbates climate change distress [11], further compounding the mental health sequalae of climate change. Accordingly, building resilience and adaptive capacity for future exposures is critical for protecting mental health. Interventions specifically addressing the mental health impacts of climate change and natural hazards are typically ad hoc and are not routinely or consistently delivered [57]. The evidence base also remains limited [31]. By building an evidence base for children, especially rural-dwelling children who are the most vulnerable to natural hazards, this study will contribute to informing mental health care by providing an evidence-informed intervention. Clinicians largely report feeling ill-equipped for treating eco-anxiety or climate-related distress in therapy [58], with practitioners in rural areas especially needing guidance on how to support mental health in relation to climate change [59]. Thus, this study will provide valuable guidance for clinicians. This brief group-based intervention to improve coping and resilience can be used to protect mental health in the future, which is critically needed to promote well-being as climate change escalates [60].

This study builds off the limited research evidence to date regarding supporting children and young people experiencing eco-anxiety, especially following exposure to a natural hazard. This study extends prior work by drawing on the preliminary and available evidence to date for promoting mental health and managing climate change–related distress. For example, this study brings together previously identified or suggested components to support young people, such as fostering meaning-making coping [38] and empowering children [22] such as through encouraging them to take action [31], balanced with also providing a safe and supportive space to explore and express negative emotional states [39]. Further, this study integrates aspects of ecotherapy and fostering a relationship with nature [31,40]. Although these components have previously been suggested as means through which individuals might be supported, the evaluation of any eco-anxiety intervention or treatment component has been minimal [3,31].

Current evidence for the treatment of eco-anxiety includes a qualitative evaluation of a dream-discussion–based group-processing program conducted with 7 adult climate activists [61]. Another evaluation study surveyed past participants of Carbon Conversations—a climate change education program of small, facilitated groups who meet 6 times to discuss topics related to climate change and allows for the discussion of emotional responses to climate change [62]. The results of this evaluation showed that 50% of those who responded to the survey rated the program as helpful for facing their worries about climate change; however, no preassessment/postassessment was undertaken, limiting the understanding of the effectiveness of the group in reducing any distress or mental health outcomes. Participants were also adults and predominantly older than 30 years. To date, the examination of eco-anxiety following exposure to natural hazards also remains minimal, and there are no treatments evaluated for this. Therefore, this study expands upon existing work by taking the proposed treatment components from prior work and testing an intervention specifically designed for children and adolescents.

Due to the nature of this pilot study, the sample size is small. This study is also not a randomized controlled trial, and random assignment to groups was not possible. Replication of results in randomized controlled trials with larger samples would be warranted after refinement of the intervention from the pilot. Although the current design is appropriate to gain insight into the effects of the intervention, the research would be strengthened by having longer follow-up times to better assess if the intervention effects are sustained. Outcome measures are child self-report only, and diagnostic interviews or parent reports may also be useful to incorporate into future research designs.

This study tests a novel group-based intervention for supporting rural children who have experienced a natural hazard in relation to eco-anxiety. The impacts of climate change on mental health are rapidly gaining attention [63], and eco-anxiety has been widely shown to be detrimental for mental health [64]. Exposure to natural hazards also amplifies climate distress [11]. Children and young people are among the most vulnerable for eco-anxiety [65,66], with those in rural areas also more prone to experiencing repeated exposures to natural hazards, making rural children and young people an especially vulnerable population. Yet, empirical studies on eco-anxiety in children remain relatively minimal, with most studies being descriptive only [22]. Although the deleterious impacts of climate change on mental health are widely recognized, mental health clinicians report feeling underprepared for dealing with climate change [58], and service delivery remains fragmented after natural hazards [57]. To date, the evidence base for interventions for treating eco-anxiety remains sparse [3,31] and even more so for young people and children. This study will provide preliminary evidence of a group-based treatment for children and adolescents experiencing eco-anxiety that can inform practitioners.