Chronic exposure to climate stress disproportionately affects low-income households; however, the psychological health and climate distress levels of climate-vulnerable adolescents in low-resource settings has rarely been explored. We investigated the association between increased flood exposure and adolescent psychological health, climate distress, and temporal discounting (long-term planning capacity).

In this cross-sectional, mixed-methods study, we administered surveys to assess symptoms of anxiety and depression, temporal discounting, and climate distress. We surveyed 1200 adolescents aged 15–18 years from low-income households in Dhaka, Bangladesh (a low-flood-risk location) and Barisal, Bangladesh (a high-flood-risk location). We also conducted 16 focus group discussions among adolescents across both regions.

Between Aug 7 and Dec 15, 2023, adolescents living under higher flood exposure in Barisal had significantly greater odds of anxiety symptoms (adjusted odds ratio 1·94 [95% CI 1·41–2·65], p<0·0001) and depressive symptoms (3·52 [1·94–6·40], p<0·0001) relative to those under low flood exposure in Dhaka. Adolescents experiencing anxiety symptoms had significantly greater odds of exhibiting temporal discounting (2·00 [1·16–3·45], p=0·013). Our focus group discussions suggest pathways by which cognitive overload during extreme floods contribute to adolescent preferences against long-term flood adaptation planning.

An increased prevalence of anxiety and depressive symptoms among flood-vulnerable adolescents in low-income settings might be related to temporal discounting behaviour that could threaten their climate change resilience.