Is urban living good for mental health?

How does urban blue space affect human well-being? A study based on the stimulus-organism-response theory

With rapid urbanization and social change, mental health issues have surged. Urban blue spaces (UBSs) offer a potential tool to increase well-being, yet the way in which sensory stimuli shape landscape perception and well-being remains underexplored. Intergenerational integration, a crucial aspect of well-being, refers to shared experiences and social interactions among different age groups, improving cognition and reducing loneliness. However, the role of UBSs in facilitating such interactions remains insufficiently studied. This research, grounded in the Stimulus-Organism-Response (S-O-R) framework, examines how perceived multisensory stimuli (visual, auditory, olfactory, and tactile) influence landscape perception and well-being. Structural equation modeling (SEM) of survey data (n = 532) reveals that perceived visual, auditory, and tactile stimuli significantly enhance landscape perception and well-being, while olfactory stimuli have no significant effect. Landscape perception mediates the relationship between visual, auditory, and tactile stimuli and well-being, but not for olfactory stimuli. These findings underscore the importance of optimizing sensory environments in UBSs to enhance psychological restoration. The study provides empirical insights for urban planners and policymakers, advocating for nature-based strategies that enhance visual aesthetics, maintain site quality, integrate natural soundscapes, and improve water accessibility to maximize restorative benefits and foster intergenerational inclusion.

A Systematic Review of the Influence of Social Determinants of Health on Mental Health Service Utilization and Outcomes Among Asian American Cancer Survivors

OBJECTIVE

The purpose of this review was to identify relationships between social determinants of mental health service utilization and outcomes among Asian American cancer survivors in the United States (U.S.).

METHODS

We performed a systematic literature search in PubMed, PsycINFO, CINAHL, and Embase for peer-reviewed studies between January 2000 and May 2024. Based on the Healthy People 2023 framework, social determinants of health (SDOH) were categorized into five SDOH domains. We extracted data using a table of evidence, and we assessed study quality using the Johns Hopkins Evidence-Based Practice.

RESULTS

Ten non-experimental studies, with either "High" or "Good" quality, met eligibility criteria. Two examined mental health service utilization, and nine reported mental health outcomes. Seventy percent of the studies recruited samples from the health systems. The rest were from community settings. Seventy percent included the Asian American subgroup, mainly Chinese Americans. Higher education, English proficiency, more years residing in the U.S., and having social support correlated with better psychological quality of life. Higher-income and education levels were associated with more psychotropic medication use. However, zip code levels were used to estimate actual income and education.

CONCLUSION

We identified significant SDOH factors that influenced mental health outcomes among Asian American cancer survivors. More research is needed to understand the social determinants of mental health service utilization barriers in this population. Allocating more funding to health research tailored to Asian American cancer survivors, along with data disaggregation, standardizing socioeconomic status measures, and diversifying sampling sources, is essential to enhancing their mental health outcomes.

Unemployment and mental health: a global study of unemployment's influence on diverse mental disorders

Introduction

Globally, one in five individuals faces unemployment, which substantially increases their risk of developing mental disorders. Understanding the relationship between unemployment and specific mental health outcomes is crucial for formulating effective policy interventions.

Methods

This study examines the relationship between unemployment and mental disorders across 201 countries from 1970 to 2020. Using a fixed-effects model, we analyze the impact of unemployment on various mental health outcomes, including anxiety, depression, bipolar disorder, drug use, and eating disorders, with a focus on demographic variations.

Results

The analysis reveals a significant positive association between unemployment and mental disorders, particularly anxiety, depression, and bipolar disorder. Moreover, distinct patterns emerge, linking unemployment to higher rates of drug use and eating disorders in specific demographics.

Discussion

These findings underscore the critical interplay between socio-economic factors and mental health, highlighting the need for proactive strategies to address the dual burden of unemployment and mental health disorders. Targeted interventions, such as employment support programs and accessible mental health services, are essential to improve global mental health outcomes. These initiatives can also alleviate the economic burden of unemployment by boosting workforce participation and productivity. Long-term economic gains may offset the increased healthcare expenditures associated with mental health support.

Effect of nature on the mental health and well-being of children and adolescents: meta-review

BACKGROUND

Urbanisation is taking place worldwide and rates of mental illness are rising. There has been increasing interest in 'nature' and how it may benefit mental health and well-being.

AIMS

To understand how the literature defines nature; what the characteristics of the nature intervention are; what mental health and well-being outcomes are being measured; and what the evidence shows, in regard to how nature affects the mental health and well-being of children and adolescents.

METHOD

A meta-review was conducted, searching three databases for relevant primary and secondary studies, using key search terms including 'nature' and 'mental health' and 'mental well-being'. Inclusion criteria included published English-language studies on the child and adolescent population. Authors identified the highest quality evidence from studies meeting the inclusion criteria. Data were extracted and analysed using descriptive content analysis.

RESULTS

Sixteen systematic reviews, two scoping reviews and five good quality cohort studies were included. 'Nature' was conceptualised along a continuum (the 'nature research framework') into three categories: a human-designed environment with natural elements; a human-designed natural environment; and a natural environment. The nature 'intervention' falls into three areas (the 'nature intervention framework'): access, exposure and engagement with nature, with quantity and quality of nature relevant to all areas. Mental health and well-being outcomes fit along a continuum, with 'disorder' at one end and 'well-being' at the other. Nature appears to have a beneficial effect, but we cannot be certain of this.

CONCLUSIONS

Nature appears to have a beneficial effect on mental health and well-being of children and adolescents. Evidence is lacking on clinical populations, ethnically diverse populations and populations in low- and middle-income countries. Our results should be interpreted considering the limitations of the included studies and confidence in findings.

The relationship between mental well-being and wealth varies by wealth type, place and sex/gender: Evidence from Namibia

This paper explores the impact of livelihood strategies and place on mental well-being. Identifying different socioeconomic factors that impact mental well-being across contexts is pressing given the global rise in mental health disorders. Numerous studies in the population and social sciences have emphasized the protective role of material wealth on human health and well-being; however, scholars frequently assess wealth as a one-dimensional variable, which may fail to capture diverse forms of wealth. Acknowledging different forms of wealth may be particularly important in settings where agricultural economies coexist with cash economies. Using data from the 2013 Namibia Demographic Health Survey (n = 13 377), we use a newly developed measure of success in agricultural activities, an agricultural wealth index, or AWI, generated by Hackman et al., (2021). To examine the role of different forms of wealth on mental health symptoms. We find mental well-being, assessed through three survey questions, is lower among urban dwellers and females and shows varied associations with wealth type and sex/gender. In general, success in agricultural activities is associated with better mental well-being, while the association with market success is null or and conditional upon sex/gender and place. This study adds to recent work on the value of using multidimensional measures of wealth and raises important questions about why wealth type and sex/gender differentially impact mental well-being.

The association between urbanization and depression in the elderly: A network analysis from the complexity science perspective

IMPORTANCE

The global increase in urbanization has coincided with a rise in depression prevalence. However, the effect of urbanization on depression remains controversial, especially for the elderly.

OBJECTIVE

To clarify how urbanization impacts depression in the elderly from a network perspective.

DESIGN, SETTING, AND PARTICIPANTS

This sectional cohort study used data from China Health and Retirement Longitudinal Study (CHARLS).

MAIN OUTCOMES AND MEASURES

The occurrence of depressive symptoms in urban and rural elderly residents. Network metrics of depressive symptoms.

RESULTS

Of the 13,993 participants, lower incidence of depressive symptoms was observed in urban (26.3 %, 95 % CI, 24.7 %-27.8 %) than in rural (40.4 %, 95 % CI, 39.5 %-41.3 %, P < 0.0001) residents. However, higher incidence of depressive symptoms was observed in urban (26.3 %, 95 % CI, 25.2 %-28.4 %) than in rural (17.5 %, 95 % CI, 16.1 %-18.9 %, P < 0.0001) residents in a subset of 2898 pairs of participants after PSM. No difference in the network structure and metrics between urban and rural residents before (M = 0.071, p = 0.054, S = 0.037, p = 0.80) and after (M = 0.085, p = 0.133, S = 0.086, p = 0.47) PSM was detected. The networks structure revealed that negative affect was strongly connected to somatic symptoms and that the two anhedonic symptoms were also strongly connected.

CONCLUSIONS

The current study indicated the homogeneity of the ultimate nature of depression between rural and urban residents from the network perspective, supporting the viewpoint that urbanization might not impose influence on depression. Further researches delving deeper into the complexity of the issue may provide new insights into our understanding of depression in an urban environment among the elderly.

Factors influencing smoking cessation attempts and success in Iranian male adults: national survey data

BACKGROUND

Smoking cessation is a dynamic process that often involves a series of unsuccessful quit attempts before long-term abstinence is achieved. To implement interventions that lead to long-term abstinence, it will be necessary to understand the determinants of smoking cessation. Therefore, the main objective of the present study was to determine the effect of factors influencing both smoking cessation attempts and successful smoking cessation in the general population of Iran.

METHODS

The data of 1293 participants whose information was obtained through a national cross-sectional study entitled "Survey of Risk Factors of Noncommunicable Diseases in 2016" were analyzed. There were three response levels: "quit attempt and successful quit", "quit attempt and unsuccessful quit", and "no quit attempt and unsuccessful quit". A multinomial logistic regression model was used to assess the effect of covariates on response.

RESULTS

The mean (sd) age of all participants was 47.21 (13.65) years. According to the results, 883 people (68.29%) did not attempt to quit smoking, and of those who attempted to quit smoking, only 64 (15.61%) men were successful. The factors of living in an urban area (OR = 1.71) and past smoking intensity (OR = 1.967) were associated with no quit attempt and unsuccessful quitting. In addition, physician recommendation to quit smoking was a protective factor for no quit attempt and unsuccessful quit (OR = 0.599). Alcohol consumption was also a protective factor against successful quitting for both attempters (OR = 0.351) and nonattempters (OR = 0.359).

CONCLUSIONS

Tobacco control programs should be implemented with a greater focus on heavy smokers and alcohol users. In addition, the role of health professionals in encouraging smokers to quit smoking should not be ignored.

The association between urbanization and adolescent depression in China

Background

With the rapid urbanization in many countries, more attention is being paid to the relationship between urbanization and mental health, especially depression. However, in countries with rapid urbanization, few empirical studies exist on the relationship between urbanization and adolescent depression.

Methods

Nationally representative survey data from the China Family Panel Studies in 2012, 2016 and 2018 were used. Data of 1,588 adolescents were obtained from 25 provinces. Depression was measured using the Center for Epidemiology Studies of Depression 20-item score. The urbanization rate was obtained from the National Bureau of Statistics of China. The generalized estimating equation was used to estimate the statistical relationship.

Results

The participants' mean age at baseline was 15 years, and 51.2% (813/1,588) of participants were male. After adjusting for all covariates (gender, age, ethnicity, level of education, marital status, urban/rural areas, body mass index, self-rated health, academic pressure, smoking, drinking and exercise), the rate of urbanization was monotonically and negatively associated with adolescent depression (odds ratio 0.34, 95% CI [0.14-0.79]). Compared with female adolescents, male adolescents had a lower risk of depression (odds ratio 0.80, 95% CI [0.67-0.97]).

Conclusion

In the context of China, urbanization has a positive effect on the mental health of adolescents. Female adolescents are more likely to experience depression than male adolescents.

Predictors of sustained physical activity: behaviour, bodily health, and the living environment

This study examined the determinants of sustained physical activity. Eighty-four participants undertook a 7-weeks walking regime (i.e., a 1-h biometrically-monitored walk, at least 5 days/week), with bioelectrical impedance (BIA) and total cholesterol capillary blood measurements performed before and after programme. To investigate behavioural habit formation, 7 weeks after walking termination, all participants were interviewed and (health) re-tested. Data were modelled with an artificial neural network (ANN) cascading algorithm. Our results highlight the successful prediction of continued physical activity by considering one's physical fitness state, the environmental living context, and risk for cardiovascular disease. Importantly, those artificial neural network models also taking body mass index (BMI) and blood cholesterol as predictors excel at predicting walking continuation (i.e., predictions with 93% predictability). These results are first to highlight the type and importance of available physiological drivers in maintaining a sustained physical activity regime such as walking. They are discussed within the framework of habit formation and the nowadays health and/or wellbeing focus.

Short working hours and perceived stress: Findings from a population-based nationwide study

Background

Evidence on the potential negative health effects of short working hours remains limited. This study aimed to investigate the association between short working hours and perceived stress in a population-based sample from China.

Methods

This cross-sectional study included 4368 participants aged 18-65 years from the China Health and Nutrition Surveys (CHNS) 2015. Working hours were categorized into <35, 35-40, 41-54, and ≥55 h/week. Perceived stress was assessed using the Perceived Stress Scale-14 (PSS-14).

Results

Of the 4368 participants, 817 (18.7 %) reported short working hours (<35 h/week) and 1817 (41.6 %) reported perceived stress. Short working hours were associated with higher perceived stress compared to standard working hours (35-40 h/week) (Adjusted odds ratios (AOR) = 1.25, 95 % confidential intervals (CI): 1.04-1.51). Stratified analysis showed that short working hours were significantly associated with more perceived stress in subjects aged 36-50 years (AOR = 1.43, 95 % CI: 1.16-1.70), while long working hours (≥55 h/week) were significantly related to less perceived stress among low-income subjects (AOR = 0.56, 95 % CI: 0.33-0.94). Reduced income partially mediated the effects of short working hours on perceived stress (indirect effects = -0.002, 95 % CI: -0.007∼-0.001).

Conclusion

Reduced working hours may be associated with increased risk of perceived stress in China, particularly among people aged 36-50 years and those with low income. Reduced income may be a possible reason for the increased perceived stress caused by short working hours. Future longitudinal studies are needed to examine these relationships and to explore mechanisms.

Examining the Relationships between the Incidence of Infectious Diseases and Mood Disorders: An Analysis of Data from the Global Burden of Disease Studies, 1990-2019

Mood disorders are among the commonest mental disorders worldwide. Epidemiological and clinical evidence suggests that there are close links between infectious diseases and mood disorders, but the strength and direction of these association remain largely unknown. Theoretical models have attempted to explain this link based on evolutionary or immune-related factors, but these have not been empirically verified. The current study examined cross-sectional and longitudinal associations between the incidence of infectious diseases and mood disorders, while correcting for climate and economic factors, based on data from the Global Burden of Disease Studies, 1990-2019. It was found that major depressive disorder was positively associated with lower respiratory infections, while bipolar disorder was positively associated with upper respiratory infections and negatively associated with enteric and tropical infections, both cross-sectionally and over a period of 30 years. These results suggest that a complex, bidirectional relationship exists between these disorders. This relationship may be mediated through the immune system as well as through the gut-brain and lung-brain axes. Understanding the mechanisms that link these groups of disorders could lead to advances in the prevention and treatment of both.

Higher depression risks in medium- than in high-density urban form across Denmark

Urban areas are associated with higher depression risks than rural areas. However, less is known about how different types of urban environments relate to depression risk. Here, we use satellite imagery and machine learning to quantify three-dimensional (3D) urban form (i.e., building density and height) over time. Combining satellite-derived urban form data and individual-level residential addresses, health, and socioeconomic registers, we conduct a case-control study (n = 75,650 cases and 756,500 controls) to examine the association between 3D urban form and depression in the Danish population. We find that living in dense inner-city areas did not carry the highest depression risks. Rather, after adjusting for socioeconomic factors, the highest risk was among sprawling suburbs, and the lowest was among multistory buildings with open space in the vicinity. The finding suggests that spatial land-use planning should prioritize securing access to open space in densely built areas to mitigate depression risks.

Urbanicity and alcohol use epidemiology in the 21st century

PURPOSE OF REVIEW

This review aimed to gather recent studies that could identify the specificities in the relationship between urbanization and alcohol use epidemiology in the current century.

RECENT FINDINGS

Although we find lower rates of alcohol use among adolescents in urban environments than in rural ones, this difference tends to diminish until it disappears by the time they reach adulthood. In addition to excessive marketing and increased accessibility, several urban environment characteristics have been related to alcohol use. First, problematic alcohol use is linked to stress and mental health problems like depression and anxiety, which are common in metropolitan areas. Second, alcohol use behaviors are influenced by homelessness, loneliness, and deprivation in megacities, where female and male individuals have presented more similar alcohol use behaviors (i.e. gender convergence). Third, treatment levels for alcohol use disorders are very low.

SUMMARY

There is a new epidemiological wave of alcohol consumption in large urban centers, largely influenced by advertisement and marketing. Social and psychological risk factors and subpopulations of interest were identified for preventive interventions in large urban centers (i.e. advertisement regulation). In addition, increasing the availability of treatment, including specific medications for alcohol use disorder, should be strongly encouraged.

Assessing the degree of urbanisation using a single-item self-report measure: a validation study

The differential impact of rural versus urban residence on mental health remains a controversial topic that requires more in-depth investigations. This calls for a valid and easy measure to assess the degree of urbanisation. The purpose of the present study was to determine the utility of a single-item self-report measure (SIDU) as a tool to classify areas along the rural-urban continuum. The validity of the SIDU was assessed by comparing its scores (1-7) to a commonly used objective surrogate measure of the degree of urbanisation (i.e. surrounding address density, SAD) in two independent older adult samples (A: N = 36, 65+; B: N = 121, 55+). SIDU scores approximated SAD scores, with r = .77 to 0.82, (A), and r = .79 to 0.83 (B). A SIDU threshold score of 6 most accurately distinguished extremely urbanised areas from other areas. Altogether, our findings suggest that SIDU scores could be used as proxy of SAD. Since self-report leaves room for the consideration of additional aspects that confer an urban settlement, this single-item scale may be even more comprehensive, and circumvents the collection and handling of highly sensitive location data when the primary goal is solely to distinguish urbanisation subgroups.

Urban precarity and youth mental health: An interpretive scoping review of emerging approaches

Circumstances of living are key to shaping emotional and affective experiences, long term health, wellbeing and opportunities. In an era characterised by rapid urbanisation across the majority of the world, there is increasing interest in the interaction between mental health and urban environments, but insufficient attention is paid to how mental health is situated in space and time. Socio-economic inequalities are prevalent in many urban environments globally, making conditions of living highly precarious for some social groups including young people. There remains a large volume of unmet mental health service needs, and young people are impacted by uncertain economic futures. The purpose of this scoping review is to develop an interdisciplinary and globally-informed understanding of the urban conditions which affect youth mental health across a range of scales, and to identify protective factors which can promote better youth mental health. We seek to broaden the scope of urban mental health research beyond the physical features of urban environments to develop an interpretive framework based on perspectives shared by young people. We illustrate how concepts from social theory can be used as an integrative framework to emphasise both young people's lived experiences and the wider cultural and political dynamics of urban mental health.

Rural-urban differences in body appreciation and associations with life satisfaction in adults from Sabah, Malaysia

Studies of body appreciation have typically focused on measurement of the construct in urban populations and there remains very little research on body appreciation in rural communities. To fill this gap, the present study examined rural-urban differences in body appreciation in an adult Kadazan-Dusun sample from the state of Sabah in Malaysia. Participants from rural (n = 215) and urban (n = 219) locales in the West Coast administrative district of Sabah were asked to complete Malay versions of the Body Appreciation Scale-2 (BAS-2) and the Satisfaction With Life Scale, and to provide their demographic details. Multi-group confirmatory factor analysis evidenced both partial metric invariance (by allowing loadings for three items to vary) and partial scalar invariance (by freeing the intercept for one item) on the BAS-2. Between-group analyses indicated that rural participants had significantly greater body appreciation than urban participants overall. Additionally, urban men had significantly greater body appreciation than urban women, but there was no gender difference in the rural subsample. Finally, correlational analyses indicated that body appreciation was significantly associated with life satisfaction in both the rural and urban subsamples. The present results highlight the importance of further considering the phenomenology of body appreciation in rural communities.

Suicidal attempts and self-poisoning: 1-year retrospective cohort study from the quaternary hospital in Thai metropolitan area

Background and Aims

In Thailand, suicide is the leading cause of death among middle-aged adults. We believe suicide characteristics depend on different cultural/socioeconomic status. This study aimed to describe the characteristics and associated factors of suicidal attempts by self-poisoning in Bangkok, the metropolitan city of Thailand.

Methods

Records of all patients visiting the emergency department of King Chulalongkorn Memorial Hospital, Bangkok, Thailand, with self-poisoning suicidal attempts throughout 2021 were collected and analyzed.

Results

Self-poisoning accounted for 110 attempts (by 74 patients). Females aged 11-30 were the most prevalent group. Pharmaceutical agents were commonly used. Most patients (86.4%) had underlying psychiatric illness(es), mostly major depressive disorder. Female, history of psychiatric illness and follow-ups, personality comorbid, and previous attempts reached statistical significance by univariate regression for factors associated with reattempting suicide, but only personality comorbid was significant from multivariable study (p = 0.02). Reattempting mostly recurred within 8 days after the prior attempt.

Conclusion

Majority of self-poisoned patients in Bangkok were young adults taking medications, which differs from the overall Thai population where most instances involve patients of older patients (30-50 years) and ingestion of agricultural substances. Appropriate strategies are needed for specific psychosocial/socioeconomic contexts and within the critical period after previous nonfatal attempts.

Exposure to Green and Historic Urban Environments and Mental Well-Being: Results from EEG and Psychometric Outcome Measures

Previous studies have identified the benefits of exposure to green or historic environments using qualitative methods and psychometric measures, but studies using a combination of measures are lacking. This study builds on current literature by focusing specifically on green and historic urban environments and using both psychological and physiological measures to investigate the impact of virtual exposure on well-being. Results from the psychological measures showed that the presence of historic elements was associated with a significantly stronger recuperation of hedonic tone (p = 0.01) and reduction in stress (p = 0.04). However, the presence of greenness had no significant effect on hedonic tone or stress. In contrast, physiological measures (EEG) showed significantly lower levels of alpha activity (p < 0.001) in occipital regions of the brain when participants viewed green environments, reflecting increased engagement and visual attention. In conclusion, this study has added to the literature by showing the impact that historic environments can have on well-being, as well as highlighting a lack of concordance between psychological and physiological measures. This supports the use of a combination of subjective and direct objective measures in future research in this field.

Residential green space and mental health-related prescription medication sales: An ecological study in Belgium

BACKGROUND

Residential green space has been associated with mental health benefits, but how such associations vary with green space types is insufficiently known.

OBJECTIVE

We aimed to investigate associations between types and quantities of green space and sales of mood disorder medication in Belgium.

METHODS

We used aggregated sales data of psycholeptics and psychoanaleptics prescribed to adults from 2006 to 2014. Generalized mixed effects models were used to investigate associations between relative covers of woodland, low-green, grassland, and garden, and average annual medication sales. Models were adjusted for socio-economic background variables, urban-rural differences, and administrative region, and included random effects of latitude and longitude.

RESULTS

Urban census tracts were associated with 9-10% higher medication sales. In nationwide models, a 10% increase in relative cover of woodland, garden, and grass was associated with a 1-2% decrease in medication sales. The same association was found for low green but only for men. In stratified models, a 10% increase in relative cover of any green space type in urban census tracts was associated with a decrease of medication sales by 1-3%. In rural census tracts, no protective associations between green space and mood disorder medication sales were observed, with the exception of relative woodland cover for women (-1%), and low green was associated with higher medication sales (+6-7%).

CONCLUSIONS

Taken together, these results suggest that living in green environments may be beneficial for adult mental health. Woodland exposure seemed the most beneficial, but the amount of green space was more important than the type. Results underline the importance of conserving green space in our living environment, for the conservation of biodiversity and for human health.

Association of environmental and socioeconomic indicators with serious mental illness diagnoses identified from general practitioner practice data in England: A spatial Bayesian modelling study

BACKGROUND

The evidence is sparse regarding the associations between serious mental illnesses (SMIs) prevalence and environmental factors in adulthood as well as the geographic distribution and variability of these associations. In this study, we evaluated the association between availability and proximity of green and blue space with SMI prevalence in England as a whole and in its major conurbations (Greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle).

METHODS AND FINDINGS

We carried out a retrospective analysis of routinely collected adult population (≥18 years) data at General Practitioner Practice (GPP) level. We used data from the Quality and Outcomes Framework (QOF) on the prevalence of a diagnosis of SMI (schizophrenia, bipolar affective disorder and other psychoses, and other patients on lithium therapy) at the level of GPP over the financial year April 2014 to March 2018. The number of GPPs included ranged between 7,492 (April 2017 to March 2018) to 7,997 (April 2014 to March 2015) and the number of patients ranged from 56,413,719 (April 2014 to March 2015) to 58,270,354 (April 2017 to March 2018). Data at GPP level were converted to the geographic hierarchy unit Lower Layer Super Output Area (LSOA) level for analysis. LSOAs are a geographic unit for reporting small area statistics and have an average population of around 1,500 people. We employed a Bayesian spatial regression model to explore the association of SMI prevalence in England and its major conurbations (greater London, Birmingham, Liverpool and Manchester, Leeds, and Newcastle) with environmental characteristics (green and blue space, flood risk areas, and air and noise pollution) and socioeconomic characteristics (age, ethnicity, and index of multiple deprivation (IMD)). We incorporated spatial random effects in our modelling to account for variation at multiple scales. Across England, the environmental characteristics associated with higher SMI prevalence at LSOA level were distance to public green space with a lake (prevalence ratio [95% credible interval]): 1.002 [1.001 to 1.003]), annual mean concentration of PM2.5 (1.014 [1.01 to 1.019]), and closeness to roads with noise levels above 75 dB (0.993 [0.992 to 0.995]). Higher SMI prevalence was also associated with a higher percentage of people above 24 years old (1.002 [1.002 to 1.003]), a higher percentage of ethnic minorities (1.002 [1.001 to 1.002]), and more deprived areas. Mean SMI prevalence at LSOA level in major conurbations mirrored the national associations with a few exceptions. In Birmingham, higher average SMI prevalence at LSOA level was positively associated with proximity to an urban green space with a lake (0.992 [0.99 to 0.998]). In Liverpool and Manchester, lower SMI prevalence was positively associated with road traffic noise ≥75 dB (1.012 [1.003 to 1.022]). In Birmingham, Liverpool, and Manchester, there was a positive association of SMI prevalence with distance to flood zone 3 (land within flood zone 3 has ≥1% chance of flooding annually from rivers or ≥0.5% chance of flooding annually from the sea, when flood defences are ignored): Birmingham: 1.012 [1.000 to 1.023]; Liverpool and Manchester: 1.016 [1.006 to 1.026]. In contrast, in Leeds, there was a negative association between SMI prevalence and distance to flood zone 3 (0.959 [0.944 to 0.975]). A limitation of this study was because we used a cross-sectional approach, we are unable to make causal inferences about our findings or investigate the temporal relationship between outcome and risk factors. Another limitation was that individuals who are exclusively treated under specialist mental health care and not seen in primary care at all were not included in this analysis.

CONCLUSIONS

Our study provides further evidence on the significance of socioeconomic associations in patterns of SMI but emphasises the additional importance of considering environmental characteristics alongside socioeconomic variables in understanding these patterns. In this study, we did not observe a significant association between green space and SMI prevalence, but we did identify an apparent association between green spaces with a lake and SMI prevalence. Deprivation, higher concentrations of air pollution, and higher proportion of ethnic minorities were associated with higher SMI prevalence, supporting a social-ecological approach to public health prevention. It also provides evidence of the significance of spatial analysis in revealing the importance of place and context in influencing area-based patterns of SMI.

The effectiveness of adapted group mindfulness-based stress management program on perceived stress and emotion regulation in midwives: a randomized clinical trial

Background

Midwives' stress can have negative consequences on their emotional state, burnout, and poor quality of midwifery care. This study aimed to determine the effectiveness of an adapted mindfulness-based stress management program on perceived stress and the emotional regulation of midwives.

Methods

The study was a parallel randomized clinical trial on the midwives working in general hospitals of Zanjan, Iran. In this study, 121 midwives registered to participate based on the census sampling method were screened using a cut point of ≥ 28 in the Perceived Stress Scale (PSS). From the initial sample, 42 subjects had inclusion criteria assigned to two groups of control (n = 21) and intervention (n = 21) using online random allocation. The intervention group received an 8-week adapted mindfulness-based stress management program. This program emanates from the Kabat-Zinn's MBSR program, which has been adjusted according to the Iranian culture. The ANCOVA and repeated measure analysis of variance test were used to compare groups over time.

Results

The results showed that the group intervention effectively affected perceived stress (P = 0.001) and difficulty in emotion regulation during the post-intervention period (P = 0.001). Moreover, the interventions were effective in emotion regulation (P = 0.003), but it was not effective on perceived stress (P = 0.125) at the 3-month follow-up.

Conclusions

This adapted mindfulness-based program successfully reduced stress and increased emotion regulation strategies in midwives; however, the long-term outcomes of this treatment program need further consideration.

Investigating the Association between Environmental Quality Characteristics and Mental Well-Being in Public Open Spaces

The issues related to the urban environment and mental well-being have become increasingly important in recent decades. Although this association has been mainly investigated in developed countries, there is limited knowledge on whether similar results can be acquired in the urban environments of developing countries like Iran. This study intends to present a new dynamic and active approach to determine the environmental quality characteristics that influence the mental well-being of urban residents and to engage people to healthy urban public environments. In this respect, the research is directed by both qualitative and quantitative surveys in the public open spaces of Kermanshah, Iran. Firstly, the data are collected by Grounded Theory (GT) to identify significant environmental quality characteristics related to mental well-being by applying 24 semi-structured interviews. Secondly, the questionnaire survey based on Structural Equation Modeling (SEM) is applied to examine the association between each characteristic of the developed conceptual framework. The results reveal that the environmental quality characteristics of public open spaces, directly and indirectly, relate to users’ mental well-being. It should be noted that the public open spaces with unique functional and intrinsic features seem to have different impacts on mental well-being.

Developing a model linking self-reported nature exposure and positive body image: A study protocol for the body image in nature survey (BINS)

Exposure to natural environments has been shown to be associated with more positive body image, but much of the existing research is limited to Western European nations and little is known about the robustness of these associations in other national contexts. In this protocol paper, we present a conceptual model of the direct and indirect associations (i.e., via self-compassion, connectedness to nature, and restorative experiences in nature) between nature exposure and body appreciation. This model brings together conceptualisations from existing research, but also extends it in a number of important ways. The model will be tested through the Body Image in Nature Survey (BINS), a researcher-crowdsourced project involving researchers in multiple nations worldwide. Data collection began in December 2020 and is expected to be completed in February 2022. Data will be analysed to examine the extent to which our conceptual model is robust across nations, as well as other sociodemographic characteristics. We will also determine the extent to which key variables included in our survey are invariant across nations and associated with cultural, socioeconomic, and gender-related factors. The BINS will likely have important implications for the development of nature-based interventions to promote healthier body appreciation in diverse national contexts.

(Re) thinking urban mental health from the periphery of São Paulo in times of the COVID-19 pandemic

Urban mental health studies traditionally search for causal relationships between elements of the city and the prevalence of mental disorders. This paper discusses the importance of (re)thinking the 'lived urban experience' from the perspective of city residents about how the immediate environment affects their mental health and how people cope with inequalities. A participatory-action research was implemented in a peripheral area of São Paulo - Brazil, in which volunteers from the territory made phone calls to neighbours to provide emotional support during the COVID-19 pandemic. Weekly supervision meetings were held between volunteers and researchers to discuss the experiences shared by community counterparts. Narratives have shown that the lived experience in the city is mediated by multiple layers of 'urban insecurities'. These difficulties pressured people to organise and resist in face of pervasive inequalities as well as to respond to unfolding experiences of social suffering. We highlight the potential of participatory methodologies to observe the ways in which subjects face their structural issues and the suffering that emerge in these circumstances. The understanding of how these conflicts are lived at a subjective level can support studies that are wondering about the mechanisms of how social conflicts 'get under the skin'.

Vulnerabilidade social e transtornos mentais

A saúde mental representa parte essencial da vida das pessoas, podendo resultar no aumento da desigualdade de renda e de vulnerabilidade social. Assim, as relações entre saúde/doença mental e vulnerabilidade social incitam uma série de reflexões e de contextualizações para sua maior compreensão. Esta scoping review apresenta como objetivo mapear as produções científicas sobre as vulnerabilidades das pessoas com transtornos mentais em suas diferentes relações sociais. Divide-se em cinco etapas, com buscas nas bases de dados: MEDLINE via Pubmed; SCOPUS e Academic Search Premier, e busca nas referências dos artigos encontrados, a fim de responder à questão de pesquisa: “Como ocorre à vulnerabilidade das pessoas com transtorno mental em suas diferentes relações sociais?”. Foram encontrados 211 artigos e após as exclusões de estudos não pertinentes, foram incluídos 31 artigos. Os artigos foram organizados em 3 (três) categorias: 1 – a vulnerabilidade das pessoas com transtornos mentais e os serviços de saúde; 2 – a vulnerabilidade das pessoas com transtornos mentais e os determinantes sociais; e 3 – a vulnerabilidade das pessoas com transtornos mentais e a violência/vitimização. Dessa forma, sugere-se o desenvolvimento de mais estudos sobre a temática, assim como a reavaliação das políticas públicas voltadas às pessoas com transtornos mentais, no intuito de se tornarem mais eficazes, tanto na garantia dos direitos desse grupo como na manutenção de sua saúde mental.

Prevalence and Associated Factors of the Severity of Depression, Anxiety and Stress Among Low-Income Community-Dwelling Adults in Kuala Lumpur, Malaysia

Growing prevalence of mental illnesses and the role they play in the global disease burden is an emerging public health issue. The prevalence of depression and anxiety is on the rise in Malaysia. Low-income urban communities are among the key affected populations with regards to mental health problems. This cross-sectional study was aimed to determine the prevalence and severity of depression, anxiety and stress, and their associated factors among adults in the low-income community of Kuala Lumpur, Malaysia. A total of 248 participants aged 18-60 years old were recruited. Data were collected via face-to-face interviews using the Depression, Anxiety and Stress Scale-21 Items (DASS-21). Chi-squared test was used to examine the association between the variables. Multiple ordinal regression model was introduced to identify the predictors of depression, anxiety and stress. The proportions of participants with depression, anxiety and stress were 24.2% (95% CI: 19.6-30.4), 36.3% (95% CI: 29.9-43.0), and 20.6% (95% CI: 15.4-26.5), respectively. There was a statistically significant association of ethnicity (p = 0.002) and age (p = 0.014) with the severity of depression, ethnicity (p = 0.001) and age (p = 0.024) with the severity of anxiety, and ethnicity (p < 0.001) and marital status (p = 0.006) with the severity of stress. In a multivariable analysis, only non-Malay ethnicity was an independent predictor of the severity of depression [OR = 2.43, 95% CI (1.25, 4.72), p = 0.009], anxiety [OR = 2.55, 95% CI (1.41, 4.62), p = 0.002] and stress [OR = 4.28, 95% CI (2.06, 8.89), p = <0.001]. Mental health interventions should target low-income communities to address social inequalities of mental health within economically disadvantaged populations.

The effect of COVID-19 on mental well-being in Switzerland: a cross-sectional survey of the adult Swiss general population

BACKGROUND

In addition to the threat of the COVID-19 pandemic to physical health, mental health is challenged by the emotional response to the situation and the official measures taken to stop the pandemic. This study aimed to assess the prevalence of impaired mental well-being due to COVID-19 and explore associated factors.

METHODS

The study was an observational, population-based, nationwide, cross-sectional online survey of a representative sample of the general Swiss population performed between March and April 2020. Participants reported on mental well-being, self-isolation/quarantine, their risk for developing severe COVID-19, and their work situation. Multivariable logistic regression analyses assessed risk factors for impaired mental well-being due to the pandemic.

RESULTS

Data from 1022 individuals were analysed. The median age was 44 years (range 18 to 78) and 49% were women. A third of respondents reported that the COVID-19 pandemic impaired their mental well-being and almost half reported specific mental health concerns. Impaired mental well-being was associated with having health problems (OR = 1.88, 95% CI: 1.29-2.74, vs no problems), being or living with someone at risk for severe COVID-19 (OR = 1.38, 95% CI: 1-1.9,), smoking (OR = 1.8, 95% CI: 1.24-2.61), living in urban residential environments (OR = 1.62, 95% CI: 1.13-2.32, vs rural), not being able to work due to closed workplace (OR = 1.66, 95% CI: 1.04-2.67), aged between 18 and 29 years old (OR = 1.99, 95% CI: 1.32-3.01, vs 45 to 59 years old), and living in a single household (living with someone, OR = 0.65, 95% CI: 0.44-0.97,vs single household). Overall, the most significant covariates of impaired mental well-being were specific mental health concerns: feeling depressed (OR = 7.21, 95% CI: 4.5-11.55), feeling less pleasure in doing things than before (OR = 6.28, 95% CI: 4.1-9.62), feeling anxious (OR = 6.13, 95% CI: 3.91-9.59) and feeling lonely (OR = 4.08, 95% CI: 2.53-6.58).

CONCLUSION

Impaired mental well-being can carry long-term consequences. We encourage policymakers to implement strategies to promote mental health during this pandemic situation. Special attention should be addressed to the youngest, those at risk for severe COVID-19 and those with government-imposed work restrictions.

Patterns of multimorbidity and their association with hospitalisation: a population-based study of older adults in urban Tanzania

BACKGROUND

while the HIV epidemic remains a considerable challenge in sub-Saharan Africa, a dramatic reduction in the associated mortality has led to a fundamental shift in the public health priorities aimed at tackling multimorbidity. Against the unprecedented level of urbanisation taking place in Tanzania, the burden of multimorbidity and its consequences among ageing adults, in the form of costly inpatient hospitalisation, remain unquantified.

METHODS

we used data from one of Africa's largest urban population cohort, the Dar es Salaam Health and the Demographic Surveillance System, to quantity the extent of multimorbidity (occurrence of 2 ≥ health conditions) and discordant multimorbidity (occurrence of conditions in 2 ≥ domains in mental health, non-communicable and communicable health) among 2,299 adults aged ≥40 years in Dar es Salaam, Tanzania. We fitted logistic regression models to investigate the association between multimorbidity and inpatient hospitalisation.

RESULTS

the prevalence of multimorbidity and discordant multimorbidity were 25.3 and 2.5%, respectively. Although the severe forms of multimorbidity (2.0% with ≥4 health conditions) and discordancy were low, hospitalisation was significantly higher based on the regression analyses. Household food insecurity was the only socio-economic variable that was significantly and consistently associated with a greater hospitalisation.

CONCLUSION

we found an alarmingly high degree of multimorbidity among this ageing urban population where hospitalisation was driven by multimorbidity. As public health resources remain scarce, reducing costly inpatient hospitalisation requires multilevel interventions that address clinical- and structural-level challenges (e.g. food insecurity) to mitigate multimorbidity and promote long-term healthy independent living among older adults in Tanzania.

Exposure to green space and prevention of anxiety and depression among young people in urban settings: a global scoping review

Purpose

There is a mental health crisis, particularly among young people. Despite many young people living in urban settings, reviews about the association between exposure to green or natural environments and mental health tend to focus on either children or adults. The aim of this review is to examine the scope of the global literature for this age group, to inform a systematic review on the role of exposure to green space in preventing anxiety and depression amongst young people aged 14–24 years.

Design/methodology/approach

Seven databases were searched for quantitative and qualitative sources published from January 2000 to June 2020. This identified 201 sources and their characteristics are described here. Gaps in the literature are also highlighted.

Findings

The number of relevant studies published per year has increased over time. Most studies are set in North America (28%) or Europe (39%). The most common study designs were observational (34%) or experimental (28%). A wide range of exposures and interventions are described.

Research limitations/implications

This review included literature from predominantly high-income countries and has shown the under-representation of low-middle income countries and lack of ethnic diversity in study populations. It has also highlighted the lack of clinical measures of anxiety and depression as outcomes.

Originality/value

This inter-disciplinary review has contributed to the field by describing the geographic distribution of the literature and the broad range of exposures to green spaces being reported. Unlike previous scoping reviews, this review focused specifically on young people and on measures of anxiety and depression and their pre-cursers.

Risk factors for prospective increase in psychological stress during COVID-19 lockdown in a representative sample of adolescents and their parents

BACKGROUND

COVID-19 lockdown measures imposed extensive restrictions to public life. Previous studies suggest significant negative psychological consequences, but lack longitudinal data on population-based samples.

AIMS

We aimed to prospectively identify increased psychological stress and associated risk factors in parent-child dyads.

METHOD

We conducted a prospective, observational online study on a representative German sample of 1221 adolescents aged 10-17 years and their parents. Psychological stress and psychosocial variables were assessed before the pandemic (baseline) and 1 month after the start of lockdown (follow-up), using standardised measures. We used multilevel modelling to estimate changes in psychological stress, and logistic regression to determine demographic and psychosocial risk factors for increased psychological stress.

RESULTS

The time of measurement explained 43% of the psychological stress variance. Of 731 dyads with complete data, 252 adolescents (34.5%, 95% CI 31.0-37.9) and 217 parents (29.7%, 95% CI 26.4-33.0) reported a significant increase in psychological stress. Baseline levels were lower than in dyads without increased psychological stress. Risk factors for increased psychological stress included sociodemographic (e.g. female parents, severe financial worries) and emotion regulation aspects (e.g. non-acceptance of emotional responses in parents, limited access to emotion regulation strategies in adolescents), explaining 31% of the adolescent (Nagelkerke R2 = 0.31) and 29% of the parental (Nagelkerke R2 = 0.29) model variance.

CONCLUSIONS

This study is the first to prospectively show an increase in psychological stress during COVID-19 lockdown in a representative family sample. Identified demographic and psychosocial risk factors lead to relevant implications for prevention measures regarding this important public health issue.

Changes in psychotic-like experiences and related influential factors in technical secondary school and college students during COVID-19

OBJECTIVE

Although students have been found to be at high risk of distress during the COVID-19 pandemic, little is known about the pandemic's impact on psychotic-like experiences (PLEs). We conducted a study in technical secondary school and college students before and during the pandemic to explore changes in PLEs and relevant influential factors.

METHODS

A total of 938 students completed both waves of the survey through electronic questionnaires. PLEs were assessed using the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P15). Childhood trauma, perceived stress, resilience, and demographic factors were evaluated at baseline, and psychological status was measured during the pandemic.

RESULTS

The overall CAPE-P15 scores significantly decreased during the pandemic. Students with persistent PLEs showed the most severe COVID-19 related psychological symptoms, followed by new-onset and remitted individuals; those without PLEs exhibited the mildest symptoms (all p < .001). A single parent family (OR = 4.707), more childhood trauma (OR = 1.056), and a higher family income (OR = 1.658) were predictive of new-onset PLEs during the pandemic, while better resilience was a protective factor, associated with remission of previous PLEs (OR = 0.932).

CONCLUSIONS

Despite a downward trend in the prevalence of PLEs during the pandemic, PLEs predict greater serious psychological impact due to COVID-19, especially for students with persistent PLEs. Interventions that cultivate students' resilience are urgently needed to reduce PLEs and improve mental health, especially for students from single parent households or those who have experienced childhood trauma.

The impact of socioeconomic and stimulus inequality on human brain physiology

The brain undergoes profound structural and dynamical alteration in response to its stimulus environment. In animal studies, enriched stimulus environments result in numerous structural and dynamical changes along with cognitive enhancements. In human society factors such as education, travel, cell phones and motorized transport dramatically expand the rate and complexity of stimulus experience but diverge in access based on income. Correspondingly, poverty is associated with significant structural and dynamical differences in the brain, but it is unknown how this relates to disparity in stimulus access. Here we studied consumption of major stimulus factors along with measurement of brain signals using EEG in 402 people in India across an income range of $0.82 to $410/day. We show that the complexity of the EEG signal scaled logarithmically with overall stimulus consumption and income and linearly with education and travel. In contrast phone use jumped up at a threshold of $30/day corresponding to a similar jump in key spectral parameters that reflect the signal energy. Our results suggest that key aspects of brain physiology increase in lockstep with stimulus consumption and that we have not fully appreciated the profound way that stimulus expanding aspects of modern life are changing our brain physiology.

Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study

We studied Finnish 18-year-old males attending obligatory military call-up assessments in 1999 (n = 2340) and 2009 (n = 4309) on time-trend changes in psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence. Subjects filled in questionnaires, including the Young Adult Self-Report (YASR) for psychopathology and the Orientation to Life Questionnaire (SOC-13) for sense of coherence. The prevalence of minor mental health problems in the last 6 months decreased from 22.3% in 1999 to 18.6% in 2009 (OR 0.8, 95% CI 0.7-0.9), whereas severe mental health problems remained stable. Suicidal thoughts decreased from 5.7 to 3.7% (OR 0.6, 95% CI 0.5-0.8). The use of illicit drugs decreased from 6.0 to 4.7% (OR 0.8, 95% CI 0.6-0.95), but being drunk at least once a week increased from 10.3 to 13.4% (OR 1.3, 95% CI 1.0-1.5). Attention problems increased in YASR syndrome domains (mean score 2.9 vs 3.2, p < 0.001) and so did somatic complains (mean score 1.7 vs 1.9, p = 0.005). The SOC-13 scores remained stable. The percentage of males who had studied during the past 6 months increased from 91.4 to 93.4% (OR 1.3, 95% CI 1.1-1.6), while being employed decreased from 64.9 to 49.4% (OR 0.5, 95% CI 0.5-0.6). The positive findings included reductions in the prevalence of suicidal thoughts and the use of illicit drugs, but being drunk at least once a week increased. Self-reported somatic problems and attention problems increased. Despite changes in society and family structures, there were only minor overall changes in psychopathology.

Urbanicity mental costs valuation: a review and urban-societal planning consideration

Living in cities has numerous comparative advantages than living in the countryside or in small villages and towns, most notably better access to education, services and jobs. However, it is also associated with a roughly twofold increase in some mental disorders rate incidence compared with living in rural areas. Economic assessments reported a forecasted loss of more than 19 trillion dollars in global GDP between 2011 and 2030 and of around 7 trillion for the year 2030 alone when measured by the human capital method. If we exclude self-selection processes and make the hypothesis to be able to level down the mental illness rate incidence in urban areas to these of the rural by better urban-societal planning, around € 1.2 trillion could be saved yearly worldwide. Even a reduction of only 20% in urban mental illness rate would save around 250 billion dollars yearly.

The Association between Urbanization and Depression among the Middle-Aged and Elderly: A Longitudinal Study in China

Urbanization has been and will continue to be the mainstream trend of global population movement, including China. Depression is the most common mental disorders and the leading factor of disabilities. However, the impacts of urbanization on the depression occurrence are still unclear. This paper analyzed the data from 3 waves of the China Health and Retirement Longitudinal Study (CHARLS) with sample size as 8510 adults representing the middle aged and elderly group in China. Depression was identified and measured by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). Urbanization level was measured by population density, GDP per capita and secondary/tertiary industry as percentage to GDP in the China City Statistical Yearbook. The fixed effect regression model was used to explore the association between the changes of urbanization and depression. As result, depression is closely related to the urbanization, protective effects are found for 3 indicators above: The depression prevalence decreases while urbanization level increases (from lowest urbanization level to the highest: P < 0.01). Among the 10 depression symptoms, "Bothered", "Reduced energy leading to diminished activity" and "Hopelessness" are the most significantly improved with urbanization. The impact of urbanization on residents' mental health is a long-term, multi-factor interaction. Therefore we need to fully consider all possible influencing factors, and longer follow-up study to verify.

Nature exposure and positive body image: (Re-)examining the mediating roles of connectedness to nature and trait mindfulness

Previous studies have reported a significant association between nature exposure and positive body image, but understandings of the mechanisms that help to explain this link remain nascent. Here, we considered the extent to which trait mindfulness and connectedness to nature, respectively, mediate the aforementioned relationship both in parallel and serially. An online sample of 398 participants (199 women, 196 men, 3 other; age M = 28.1 years) from the United Kingdom completed measures of self-reported nature exposure, mindful awareness and acceptance, connectedness to nature, and body appreciation. Results indicated that inter-correlations between scores on all measures were significant and positive. Following the elimination of non-significant pathways, path analysis resulted in an adequately-fitting model in which the direct relationship between nature exposure and body appreciation was significant. In addition, connectedness to nature - but not trait mindfulness - significantly mediated the direct relationship. Finally, we also found evidence of a serial mediation, where the association between nature exposure and body appreciation was mediated by mindful awareness followed by connectedness to nature. The implications of these results for scholarly and practitioner understanding of the impact of nature exposure on positive body image are discussed in conclusion.

Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness

Traditionally, intrapersonal characteristics (distress tolerance) and interpersonal characteristics (social support) have been studied separately rather than simultaneously. In the current study, we address this gap by simultaneously examining these characteristics as potential indirect associations linking established urban stress-depression and urban stress-Post-Traumatic Stress Disorder (PTSD) relationships. Adults experiencing homelessness were recruited from six homeless shelters in Oklahoma City (n = 567). Participants self-reported urban life stress (Urban Life Stress Scale), distress tolerance (Distress Tolerance Scale), social support (Interpersonal Support Evaluation List 12), major depressive disorder (Patient Health Questionnaire-8), and PTSD symptoms (Primary Care Post-Traumatic Stress Disorder screener). Covariate-adjusted structural equation models indicated a significant indirect effect of distress tolerance on the urban stress-depression (b = 0.101, 95% CI = 0.061, 0.147) and urban stress-PTSD (b = 0.065, 95% CI = 0.023, 0.112) relationships. Additionally, a significant indirect effect of social support on the urban stress-depression (b = 0.091, 95% CI = 0.053, 0.133) and urban stress-PTSD relationships (b = 0.043, 95% CI = 0.006, 0.082) was evident. Further, both the urban stress-depression (b = 0.022, 95% CI = 0.011, 0.037) and urban stress-PTSD relationships (b = 0.014, 95% CI = 0.005, 0.026) were associated indirectly through social support to distress tolerance. Interventions that aim to increase social support may also increase distress tolerance skills and indirectly reduce depressive and PTSD symptoms in the context of urban stress among adults experiencing homelessness.

Urbanization, urbanicity, and depression: a review of the recent global literature

PURPOSE OF REVIEW

One of the defining trends of population movement in the last half century has been global urbanization. Depression is the most common mental disorder in the world, but it is unclear how urbanization and urban living affect depression outcomes. Grounded in a previously articulated conceptual framework, we systematically reviewed recently published studies on urbanization, urbanicity, and depression.

RECENT FINDINGS

Eleven articles were included in this review. Four studies found that living in urban areas was associated with elevated odds or more symptoms of depression. Three studies - all done in China - estimated protective effects of urbanization or urbanicity on depression. Two studies concluded no overall clear association. The remaining two articles stratified by urbanicity and found that greenspace was inversely associated with depression in more densely populated areas relative to rural areas. Other themes discussed included global and national trends such as aging, immigration, and planned urbanization in China, as well as urban living conditions such as traffic noise, air pollution, proximity to roadways, neighborhood social capital, and social cohesion.

SUMMARY

Urbanization may affect depression differentially across geographic regions and income levels. More research is needed, particularly in low-income and middle-income countries, and on intersections between urbanization and other emerging global trends.