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Editorial

Urbanization and mental health

toward a disorder-based understanding

Szabo, Christopher P.

Current Opinion in Psychiatry: May 2019 - Volume 32 - Issue 3 - p 196–197
doi: 10.1097/YCO.0000000000000500
THE IMPACT OF URBANISATION ON MENTAL HEALTH: Edited by Christopher P. Szabo
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Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa

Correspondence to Christopher P. Szabo, Department of Psychiatry, 7 York Road, Parktown 2193, Johannesburg, South Africa. E-mail: christopher.szabo@wits.ac.za

Urban living, with increasing urbanization is a reality of contemporary life. Although the elucidation of direct causation for psychiatric illness remains a challenge, at a biological level, social/environmental factors appear more amenable to exploration that yields information of immediate utility. One such factor is urban living. Certainly at face value it would appear so. The collection of articles for the current section on urbanization and mental health brings together content that takes a predominantly illness-based approach to understanding the possible relationship between mental illness and urban life [1–8]. Notwithstanding the conclusions in each article, it would appear intuitive to ascribe, or more realistically infer, a link between urban living and mental illness. Of interest is that despite the diverse range of illnesses/conditions reviewed, there is one common theme – quality of data. More specifically the inconsistency of findings that relate as much to methodological issues as true differences between studies. Aside from potential methodological issues contributing to the findings – with comparisons difficult to make – the differences themselves raise issues that require further study. Clearly methodological issues will require careful consideration in terms of further study, specifically design. However, based on the data, such as it is, there are a number of recurring themes identified. The most obvious one is ‘green space’ and ‘exposure to nature’. Aside from an association between these variables and mental illness (with greater exposure associated with less illness – broadly speaking), there is a suggestion that a treatment package incorporating such exposure has therapeutic benefit as noted in the article by Lecic-Tosevski [2]. The role of urban design in mitigating effects is also a further common theme between the articles and this speaks to another emergent theme, policy (and ultimately government). Orderly, planned urbanization is clearly most desirable, and whilst this may characterize urban settings in the developed world it does not necessarily mitigate putative risks. In fact the article by Ventimiglia and Seedat [8] raises the possibility of microbial exposure in urban environments impacting on immune response to psychosocial stressors. Orderly urbanization is not typical of the developing world and raises a concern that in countries potentially least resourced, such a risk factor may exacerbate the existent treatment gap, as noted by Robertson [5] with reference to the BRICS-Africa regions. Regarding individual risk it appears that those with vulnerability may, for a host of urban setting specific factors, within an urban environment be most likely to manifest with illness notwithstanding the potential benefits of urban living. This of course begs the question, is urban living good for health and more specifically mental health [2,8].

In essence, although the articles in this section do not offer definitive answers – each one provides the status quo of knowledge and in doing so identifies deficits in the data as well as highlights areas for future research. Such research will need to take into account a more nuanced understanding of how the urban environment interacts with individual vulnerability. Aside from attempting to create a living environment conducive to health generally – specific considerations for improved mental health may emerge more decisively from appropriately designed studies. The current articles indeed serve as potential road maps for such research endeavor.

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Acknowledgements

None.

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Financial support and sponsorship

None.

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Conflicts of interest

There are no conflicts of interest.

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REFERENCES

1. Hoare E, Jacka F, Berk M. The impact of urbanization on mood disorders: an update of recent evidence. Curr Opin Psychiatry 2019; 32:198–203.
2. Lecic-Tosevski D. Is urban living good for mental health? Curr Opin Psychiatry 2019; 32:204–209.
3. Robbins RN, Scott T, Joska JA, Gouse H. Impact of urbanization on cognitive disorders. Curr Opin Psychiatry 2019; 32:210–217.
4. Morgan N, Mall S. Pathways between urbanization and harmful substance use. Curr Opin Psychiatry 2019; 32:218–223.
5. Robertson LJ. The impact of urbanization on mental health service provision: a Brazil, Russia, India, China, South Africa and Africa focus. Curr Opin Psychiatry 2019; 32:224–231.
6. Fett A-KJ, Lemmers-Jansen ILJ, Krabbendam L. Psychosis and urbanicity: a review of the recent literature from epidemiology to neurourbanism. Curr Opin Psychiatry 2019; 32:232–241.
7. Gorrell S, Trainor C, Le Grange D. The impact of urbanization on risk for eating disorders. Curr Opin Psychiatry 2019; 32:242–247.
8. Ventimiglia I, Seedat S. Current evidence on urbanicity and the impact of neighbourhoods on anxiety and stress-related disorders. Curr Opin Psychiatry 2019; 32:248–253.
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