Climate Stressors, Mental Health Outcomes, and Alcohol-Related Harm Among Rural Adults in Banaskantha District, Gujarat, India: A Community-Based Cross-Sectional Public Health Surveillance Study (2021 - 2025)

Background Climate variability introduces sustained socioeconomic stressors that disproportionately affect rural agrarian populations. Drought, crop loss, and social isolation have been associated with psychological distress and maladaptive coping behaviours, including harmful alcohol use. However, integrated community-level evidence linking climate stressors, mental health symptoms, and alcohol-related harm in rural India remains limited. Methods A community-based cross-sectional public health surveillance study was conducted between 2019 and 2025 in Banaskantha district, Gujarat, India, under the Family Adoption Program. Adults aged 18–70 years with at least five years of residence were recruited from rural talukas experiencing varying levels of climate stress. Depressive and anxiety symptoms were screened using validated PHQ-9 and GAD-7 instruments. Alcohol-related harm was assessed using documented clinical morbidity and reported functional impairment. Climate stress exposure was classified ecologically based on drought frequency, agricultural loss, and social isolation indicators. Analyses were descriptive and exploratory. Results Among 300 participants, depressive symptoms (PHQ-9 ≥ 10) were identified in 26.0%, anxiety symptoms (GAD-7 ≥ 10) in 21.7%, and alcohol-related harm in 32.3%. The highest prevalence of all outcomes was observed in talukas with sustained drought and social isolation. A graded pattern was observed across climate stress exposure categories, with increasing mental health symptoms and alcohol-related harm corresponding to higher climate stress intensity. Conclusions Mental health symptoms and alcohol-related harm were common among rural adults exposed to sustained climate stressors in Banaskantha district. The findings suggest interconnected psychosocial pathways linking environmental stress, psychological distress, and harmful coping behaviours. Integrated mental health surveillance and climate-responsive public health strategies are needed in vulnerable rural settings.