Centre for Urban Design and Mental Health
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  • Home
  • About
    • Mission and vision
    • Need and opportunity
    • Our people
    • Friends and Partners
    • Join us
  • Learn
    • Facts and Figures
    • What is mental health?
    • How the city affects mental health
    • How mental health affects the city
    • How urban design can impact mental health
    • Mind the GAPS Framework
    • How to measure mental health
    • Courses
  • Book
  • Cities
  • Journal
    • Edition 1
    • Edition 2
    • Edition 3
    • Edition 4
    • Edition 5
    • Edition 6
    • Edition 7
    • Edition 8
    • Submit to Journal
  • Events
    • Washington DC Dialogue
    • London Dialogue
    • Tokyo Dialogue
    • Hong Kong Dialogue
    • Restorative Cities Event
  • PRESS
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Facts and Figures

Urban living is associated with increases in the following mental health problems:
  • Increase in mood disorders by up to 39%
  • Increase in anxiety disorders by up to 21%
  • Double the risk of schizophrenia (up to 2.37 times above average)
  • Increase in rate of cocaine and heroin addiction
  • Peen et al, 2010
  • Peen et al, 2010
  • Peen et al, 2010, Vassos et al, 2010
  • SAMHSA, 2012
Urban living is associated with decreases in the following mental health problems:
  • Almost half the suicide risk (varies with community size/density)
  • Decrease in dementia by 10% (compared to rural living)
  • Half the risk of Alzheimer's disease (compared to rural upbringing)
  • Decrease in alcohol, marijuana, methamphetamine, prescription drug abuse
  • CDC, 2015
  • Russ et al, 2012
  • Nunes, 2010
  • SAMHSA, 2012
Click here to view a more detailed data table from the literature review paper Cities and Mental Health

Interpreting the facts and figures

Challenges in making associations between urban living and mental health

It is practically challenging to design research that can demonstrate causative relationships between urban design and mental health. Therefore, most of the research in this field focuses on identifying associations.

Confounding factors
The associations between various mental disorders and urban living can be complex, and vary from study to study. This is because in addition to the urban environmental factors that impact on mental health, there are confounding factors. This is why many of our figures state 'up to'. For example, research found the risk of schizophrenia to be 2.37 times higher in cities than in rural areas; we report this as 'up to' because while the research takes key confounding factors into account, it is difficult to include every confounding factor which might affect the difference:

  • Pre-existing risk factors: People move to the city, in search of better services, economic and social opportunities, and distance from past negative experiences. This may be driven by poverty, unemployment, physical and mental health problems, previous trauma, personal crises, family break up, addiction, and immigration. These are all individual risk factors for experiencing mental health problems.
  • Socioeconomic factors: People with pre-existing risk factors, particularly low socioeconomic status, may encounter negative disparities in the city. For example, this can involve physical and psychological segregation into neighbourhoods characterised by poverty and social challenges, engendering feelings of injustice and hopelessness, and experiences of prejudice and discrimination that may affect mental health.
  • Reporting bias: Urban areas may be more likely to collect more detailed data on mental health compared to rural areas, for example because they are home to more universities or provide more services.
Challenges in measurement

Defining the urban environment
There is no one definition of urbanity. Many studies use a city's own boundary lines; others may break the city down into neighbourhood type (downtown, inner suburb, etc), density (people/hectare), etc. Care should also be taken in studies to consider full urban impact, rather than focusing solely on particular populations, such as distressed neighbourhoods, etc.

Measuring mental health
Some studies measure reported rates of specific mental illnesses; others use proxy measures (such as suicide rates, or amount of medication prescribed); still others use self-reported measures of symptoms such as low mood or stress levels, or of 'happiness'. Happiness (or lack of happiness) is a common measurement in this field. Happiness cannot be used as a proxy for mental illness, but it is sometimes used as a proxy description of mental health and wellbeing.

Happiness and its confounders
Many research papers employ the use of self-reported happiness in order to make comparisons and understand differences in urban settings.  Urban design and planning features that have been associated with people self-reporting happiness (Leyden et al) include:
  • Efficient public transport and biking options
  • Pedestrian-oriented spaces
  • Convenient access to cultural and leisure activities
  • Safe, clean, attractive cities, including green space and low crime rates
  • Places that foster social connections and facilitate participatory social events
  • Smaller communities (under 250,000)

However, studies (Ballas et al, Helliwell et al, Sharpe et al) have shown that self-reported happiness is also increased by:
  • positive financial situation (particularly compared to one's peers)
  • stable family status (including marriage)
  • having a secure and satisfying job
  • being healthy
  • good social capital (close friends, community connections)
  • social inclusiveness (not being a visible minority, having a feeling of belonging)
  • personal freedom, security, and civil rights
  • higher educational attainment
  • not being a recent immigrant
  • positive attitudes 
  • belief in a higher power

These factors should be taken into account when interpreting research that makes associations between happiness and urban settings.
This information was developed by Layla McCay, Centre for Urban Design and Mental Health, and Todd Litman, Victoria Transport Policy Institute. For further information on these facts and figures, please refer to the Victoria Transport Policy Institute Report, Urban Sanity.
References

Dimitris Ballas (2013), What Makes a ‘Happy City’? Cities 32(1):S39–S5

CDC (2015), Age-Adjusted Rates for Suicide, by Urbanization of County of Residence—United States, 2004 and 2013. Morbidity and Mortality Weekly Report. U.S. Center of Disease Control.

Richard Florida , Charlotta Mellander and Peter J. Rentfrow (2013), The Happiness of Cities. Regional Studies, 47(4):613627

John Helliwell, Richard Layard and Jeffrey Sachs (2015), World Happiness Report, United Nations

Kevin M. Leyden, Abraham Goldberg and Philip Michelbach (2011), Understanding the Pursuit of Happiness in
Ten Major Cities
Urban Affairs Review 47:861-888

Belina Nunes et al. (2010), Prevalence and Pattern of Cognitive Impairment in Rural and Urban Populations from Northern Portugal. BMC Neurology 2377(10):42

Adam Okulicz-Kozaryn (2016), Unhappy Metropolis (When American City Is Too Big), Cities

Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand. 2010 Feb;121(2):84-93. doi: 10.1111/j.1600-0447.2009.01438.x. Epub 2009 Jul 13. Read here

Russ TC, Batty GD, Hearnshaw GF, Fenton C, Starr JM. Geographical variation in dementia: a systematic review with meta-analysis. Int J Epidemiol. 2012 Aug;41(4):1012-32. doi: 10.1093/ije/dys103. Epub 2012 Jul 13.

Andrew Sharpe, Ali Ghanghro, Erik Johnson and Anam Kidwai (2011), Does Money Matter? Determining the Happiness of Canadians, Research Report No. 2010-09, Centre for the Studies of Living Standards

Substance Abuse and Mental Health Services Administration (SAMHSA) A Comparison of Rural and Urban Substance Abuse Treatment Admissions: The TEDS Report. 2012.

Vassos E, Pedersen CB, Murray RM, Collier DA, Lewis CM. Meta-analysis of the association of urbanicity with schizophrenia. Schizophr Bull. Nov;38(6):1118-23. doi: 10.1093/schbul/sbs096.
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