Potential links between the progress in environmental governance and the prevalence of mental disorder burden: New insight from a dynamic panel-data analysis for 197 countries

• Changes in the EPI were associated with trends in the burden of mental disorders . • The burden of mental disorders is worsened by adverse climate and air pollution. • Heavy metals (mainly lead) exposure exacerbates the burden of mental disorders. • Improved sanitation and water may fail to reduce the burden of mental disorders. Little is known about the extent to which addressing the serious challenges of environmental governance can alleviate the burden of mental disorders. This study aims to examine the potential association between the Environmental Performance Indicator ( EPI ) and the burden of mental disorders. We measured the burden of mental disorders [loss of healthy life expectancy (HLE) due to mental disorders] and the EPI [Climate Change Mitigation (CCH), Air Quality (AIR), Sanitation and Drinking Water (H2O), and Heavy Metals (HMT)] for 197 countries from 1995 to 2019. The dynamic panel model was used to investigate the dynamic relationships between the EPI and the burden. For every 1-point increase in CCH, AIR, H2O, and HMT, the loss of HLE due to mental disorders decreased by 31.839 (95 % confidence interval: 7.777∼55.900), 281.229 (137.504∼424.953), -188.598 (-367.575∼-9.621), and 331.589 (136.714∼526.465) person-years per 100,000 people, respectively. The advancement of sanitation and drinking water within the EPI does not appear to have had a favorable impact on reducing the burden of mental disorders. Efforts to reduce toxic by-products that may form during water treatment and include them in the assessment of the EPI may have potential benefits in reducing the burden of mental disorders.