Climate-induced vulnerability and health outcomes in urban Bangladesh: the mediating role of psychological stress

Background: Climate change poses growing risks to urban health, particularly in low-income informal settlements where exposure to environmental hazards is frequent and adaptive capacity is limited. However, the psychosocial mechanisms linking climate exposure to health outcomes remain underexplored. Objective: This study examines the relationship between climate exposure, psychological stress, and physical health outcomes, with a focus on the mediating role of stress among low-income urban populations in Dhaka, Bangladesh. Methods: 384), complemented by secondary environmental data. Multivariable regression, mediation analysis with bootstrapping, and Structural Equation Modeling (SEM) were employed to assess direct and indirect pathways. Results: Climate exposures, including heatwaves, flooding, and waterlogging, were highly prevalent and significantly associated with increased psychological stress. Regression and mediation analyses indicate that psychological stress partially mediates the relationship between climate vulnerability and adverse health outcomes, while direct effects remain significant. Socioeconomic disadvantage and poor housing conditions further amplify health risks. Conclusion: Climate change functions as both an environmental and psychosocial stressor in low-income urban settings. Integrated interventions addressing environmental exposure, mental health, and structural inequalities are essential to mitigate climate-related health risks.