Urban Living and mental Health

Living in an urban environment is long known to be a risk factor for psychiatric diseases such as major depression or schizophrenia. This is true even though infrastructure, socioeconomic conditions, nutrition and health care services are clearly better in cities than in rural areas. Higher stress exposure and higher stress vulnerability seem to play a crucial role. Social stress may be the most important factor for the increased risk of mental disorders in urban areas. It may be experienced as social evaluative threat, or as chronic social stress, both of which are likely to occur as a direct consequence of high population densities in cities. As for the impact on mental health, social stress seems to outweigh other urban stressors such as pollution or noise. Living in crowded areas is associated with increased social stress, since the environment becomes less controllable for the individual. Social disparities also become much more prominent in cities and can impose stress on the individual. Further, disturbance of chronobiological rhythmsis is more frequent in cities than in rural areas and has a negative influence on mental health and beyond. A recent meta-analysis showed that urban dwellers have a 20 per cent higher risk of developing anxiety disorders, and a 40 per cent higher risk of developing mood disorders. For schizophrenia, double the risk has been shown, with a ‘dose-response’ relationship for urban exposure and disease risk. Longitudinal studies on patients with schizophrenia indicate that it is urban living and upbringing per se, rather than other epidemiological variables, that increase the risk for mental disorders.

As urbanisation of our world is inevitable, we urgently need to improve our understanding of the threatening – as well as the health protective – factors of urban living. Evidence is beginning to surface that indicates that the urban population shows a stronger brain response to stress, and stronger cognitive impairment under stress. A recent fMRI study in the journal Nature, conducted by a German research group, showed that these effects seem to occur irrespective of age, gender, general health status, marital or income status. In this study, the amygdala (a brain region that regulates emotions such as anxiety and fear) showed higher activation under stress in healthy individuals from large cities compared to their counterparts from rural regions. Interestingly, activation grew with the size of the current home city. Further, activity in another brain region associated with depression, the perigenual anteriour cingular cortex, was positively correlated with the time that an individual had spent in a large city as a child. The more years someone had spent growing up under urban conditions, the more active this brain region tended to be.