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Mental health and urban design: helpful evidence-based information

INFORMATION
EVIDENCE
Urban living is associated with an increase of:
  • Mood disorders by 39%
  • Anxiety disorders by 21%
  • Schizophrenia by 100% (double the risk of having schizophrenia)
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
  • Schizophrenia by more than double (up to 2.37 times higher)
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.
  • Cocaine and heroin addiction
Substance Abuse and Mental Health Services Administration (SAMHSA) A Comparison of Rural and Urban Substance Abuse Treatment Admissions: The TEDS Report. 2012.
Urban living is associated with a decrease of:
  • Dementia by 10% (rural living)
  • Alzheimer disease by 100% (double the risk, rural upbringing)
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.
  • Alcohol and prescription drug abuse
Substance Abuse and Mental Health Services Administration (SAMHSA) A Comparison of Rural and Urban Substance Abuse Treatment Admissions: The TEDS Report. 2012.
  • Suicide
Urban design factors shown to objectively impact mental health:
Access to green space (nature)
Access to natural settings in neighbourhoods and in the course of people’s daily routines seems to help improve and maintain mental health and wellbeing. Access to green space has been associated with reduced depression, stress, mood symptoms associated with dementia, and violence, and improved social and cognitive functioning, including for children with attention deficit hyperactivity disorder (ADHD). 

Important reviews of the research literature:
​

Cities, Green Space and Mental Wellbeing by Roe, J. (2016) in: Environmental Science: Oxford Research Encyclopedias.
Greenspace and Health: A Critical Literature Review by Crouche K, Meyers L, Bretherton J (2007)
Active space (opportunities for physical activity in daily life)
Exercise and mental health are closely correlated. Regular exercise improves mood and wellbeing, and has been associated with reducing depression, including depression associated with chronic physical illnesses, and reducing some symptoms associated with attention deficit disorder, dementia, schizophrenia (blunted emotions, loss of drive, thinking difficulties), and helps counteract weight gain associated with some anti-psychotic medications, reducing the risk of diabeted and heart disease. Exercise can be as effective as antidepressants for the treatment of mild to moderate depression.

Important reviews of the research literature:

Exercise Interventions for Mental Health: A Quantitative and Qualitative Review by ​Stathopoulou G, Powers MB, Berry AC, Smits JAJ, Otto MW (2006) in Clinical Psychology: Science and Practice 13:179–193

Exercise and Mental Health: An Exercise and Sports Science Australia Commissioned Review by Morgan AJ, Parker AG, Alvarez M, Jimenez AF, Jorm AF (2013) in JEP online 16(4): 64-73
Pro-social space (an environment designed to promote positive social interaction)
Urban design should facilitate positive, safe and natural interactions among people and promote a sense of community, integration and belonging. Residents in neighbourhoods with high quality public open spaces tend to have lower psychological distress.

Important reviews of the research literature:

Planning for Wellbeing by Corcoran R, Marshall G. (2016) in Journal of Urban Design and Mental Health 2016;1:5

​
Quality or quantity? Exploring the relationship between Public Open Space attributes and mental health in Perth, Western Australia by Francis J, Wood LJ, Knuiman M  et al. (2012) in Soc Sci Med;74:1570–7
Safe space
A sense of safety and security is integral to people’s mental health and wellbeing. Urban dangers include traffic, getting lost, environmental pollutants, and risks posed by other people. Appropriate street lighting and surveillance, distinct landmarks that help people with dementia navigate their neighbourhoods, and people-centric design of residential, commercial and industry routes are good examples of important urban design interventions. However, a balanced approach is necessary: a safe environment may improve accessibility and comfort, but risk-averse city design can reduce action opportunities and people’s sense of agency and choice.
Important review of the research literature

Clark C, Myron R, Stansfeld S, Candy B (2006) A systematic review on the effect of the built and physical environment on mental health. Journal of Public Mental Health 6;2:14-27
Housing design
Housing can have substantial impact on mental health. Increases in depression have been found where properties are dilapitated, where access to housing is via a long corridor, and where there is a lack of private garden and shared recreational space. 

Important review of the research literature

A systematic review of the relationship between objective measurements of the urban environment and psychological distress by Gong Y, Palmer S, Gallacher J, Marsden T, Fone D (2016) in Environment International.
Self-rated urban happiness levels
Self-rated urban happiness has been associated with efficient public transport, access to cultural and leisure facilities, affordable, safe, clean, attractive, and living environments that foster social connections.
Important review of the research literature

Understanding the Pursuit of Happiness in Ten Major Cities by KM Leyden, A Goldberg, P Michelbach (2011) in Urban Affairs Review 2011:47;861. 
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