As climate change intensifies extreme heat events globally, a critical but underexamined question is how gender-specific vulnerabilities amplify both physiological and psychological harm — particularly among women in low-resource agricultural settings where cooling access is a privilege, not a baseline.
This cross-sectional study enrolled 350 rural women across 15 villages in Tamil Nadu, India, between April and August 2025 — peak summer months in one of South Asia's hottest regions. Ambient heat load was objectively quantified using Wet Bulb Globe Temperature monitors, capturing real-world exposure during the most thermally demanding hours. Psychological burden was assessed using a culturally adapted Hogg Eco-Anxiety Scale (HEAS), which captures rumination, affective distress, behavioral shifts, and personal impact concerns — going beyond generic stress inventories. Multivariable logistic regression, adjusting for age, education, income, and cooling resource access, identified significant associations between heat exposure severity and both self-reported heat-related illness and psychological distress outcomes.
This study is methodologically notable for integrating objective environmental measurement with validated psychological instrumentation in a field setting — a pairing rarely executed in low- and middle-income country (LMIC) research. The HEAS adaptation for Tamil-speaking rural women is itself a meaningful contribution, as most eco-anxiety research has been conducted in high-income, Western contexts. That said, the cross-sectional design cannot establish causality, and the 350-participant sample, while adequate for logistic regression, limits generalizability across India's diverse rural landscape. The study does not appear to include a comparison male cohort, which would sharpen the gender-specific inference. Still, the convergence of physiological strain metrics with psychological distress data represents an incremental but meaningful advance: it positions heat as a mental health stressor worthy of clinical and policy recognition, not merely an occupational hazard. For health practitioners in tropical regions, screening for climate-linked anxiety in high-heat-exposure populations — especially women with agricultural or outdoor domestic roles — deserves integration into primary care protocols.
