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Verhoog S, Eijgermans DGM, Fang Y, Bramer WM, Raat H, Jansen W. Contextual determinants associated with children's and adolescents' mental health care utilization: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:2051-2065. [PMID: 36129544 PMCID: PMC9490713 DOI: 10.1007/s00787-022-02077-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/31/2022] [Indexed: 11/19/2022]
Abstract
Determinants at the contextual level are important for children's and adolescents' mental health care utilization, as this is the level where policy makers and care providers can intervene to improve access to and provision of care. The objective of this review was to summarize the evidence on contextual determinants associated with mental health care utilization in children and adolescents. A systematic literature search in five electronic databases was conducted in August 2021 and retrieved 6439 unique records. Based on eight inclusion criteria, 74 studies were included. Most studies were rated as high quality (79.7%) and adjusted for mental health problems (66.2%). The determinants that were identified were categorized into four levels: organizational, community, public policy or macro-environmental. There was evidence of a positive association between mental health care utilization and having access to a school-based health center, region of residence, living in an urban area, living in an area with high accessibility of mental health care, living in an area with high socio-economic status, having a mental health parity law, a mental health screening program, fee-for-service plan (compared to managed care plan), extension of health insurance coverage and collaboration between organizations providing care. For the other 35 determinants, only limited evidence was available. To conclude, this systematic review identifies ten contextual determinants of children's and adolescents' mental health care utilization, which can be influenced by policymakers and care providers. Implications and future directions for research are discussedPROSPERO ID: CRD42021276033.
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Affiliation(s)
- S Verhoog
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - D G M Eijgermans
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Y Fang
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W Jansen
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Social Development, City of Rotterdam, Rotterdam, the Netherlands.
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Klompmaker JO, Mork D, Zanobetti A, Braun D, Hankey S, Hart JE, Hystad P, Jimenez MP, Laden F, Larkin A, Lin PID, Suel E, Yi L, Zhang W, Delaney SW, James P. Associations of street-view greenspace with Parkinson's disease hospitalizations in an open cohort of elderly US Medicare beneficiaries. ENVIRONMENT INTERNATIONAL 2024; 188:108739. [PMID: 38754245 PMCID: PMC11199351 DOI: 10.1016/j.envint.2024.108739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/20/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Protective associations of greenspace with Parkinson's disease (PD) have been observed in some studies. Visual exposure to greenspace seems to be important for some of the proposed pathways underlying these associations. However, most studies use overhead-view measures (e.g., satellite imagery, land-classification data) that do not capture street-view greenspace and cannot distinguish between specific greenspace types. We aimed to evaluate associations of street-view greenspace measures with hospitalizations with a PD diagnosis code (PD-involved hospitalization). METHODS We created an open cohort of about 45.6 million Medicare fee-for-service beneficiaries aged 65 + years living in core based statistical areas (i.e. non-rural areas) in the contiguous US (2007-2016). We obtained 350 million Google Street View images across the US and applied deep learning algorithms to identify percentages of specific greenspace features in each image, including trees, grass, and other green features (i.e., plants, flowers, fields). We assessed yearly average street-view greenspace features for each ZIP code. A Cox-equivalent re-parameterized Poisson model adjusted for potential confounders (i.e. age, race/ethnicity, socioeconomic status) was used to evaluate associations with first PD-involved hospitalization. RESULTS There were 506,899 first PD-involved hospitalizations over 254,917,192 person-years of follow-up. We found a hazard ratio (95% confidence interval) of 0.96 (0.95, 0.96) per interquartile range (IQR) increase for trees and a HR of 0.97 (0.96, 0.97) per IQR increase for other green features. In contrast, we found a HR of 1.06 (1.04, 1.07) per IQR increase for grass. Associations of trees were generally stronger for low-income (i.e. Medicaid eligible) individuals, Black individuals, and in areas with a lower median household income and a higher population density. CONCLUSION Increasing exposure to trees and other green features may reduce PD-involved hospitalizations, while increasing exposure to grass may increase hospitalizations. The protective associations may be stronger for marginalized individuals and individuals living in densely populated areas.
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Affiliation(s)
- Jochem O Klompmaker
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Daniel Mork
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Danielle Braun
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; Department of Data Science, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Steve Hankey
- Urban Affairs and Planning (UAP), School of Public and International Affairs, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Jaime E Hart
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | | | - Francine Laden
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Andrew Larkin
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Pi-I Debby Lin
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Esra Suel
- Faculty of the Built Environment, University College London, London, England
| | - Li Yi
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Wenwen Zhang
- Edward J Bloustein School of Planning and Public Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Scott W Delaney
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Peter James
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Schofield P, Jamil de Montgomery C, Damm AP, Agerbo E. Neighborhood social composition and refugee mental health - quasi-experimental evidence of associations from a Danish population register study. Psychol Med 2024:1-9. [PMID: 38766806 DOI: 10.1017/s0033291724001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Refugees are at an elevated risk of some mental disorders with studies highlighting the contributing role of post-migration factors. Studies of migrant groups show neighborhood social composition, such as ethnic density, to be important. This is the first longitudinal study to examine this question for refugees and uses a novel quasi-experimental design. METHODS We followed a cohort of 44 033 refugees from being first assigned housing under the Danish dispersal policy, operating from 1986 to 1998, until 2019. This comprised, in effect, a natural experiment whereby the influence of assigned neighborhood could be determined independently of endogenous factors. We examined three aspects of neighborhood social composition: proportion of co-nationals, refugees, and first-generation migrants; and subsequent incidence of different mental disorders. RESULTS Refugees assigned to neighborhoods with fewer co-nationals (lowest v. highest quartile) were more likely to receive a subsequent diagnosis of non-affective psychosis, incident rate ratio (IRR) 1.25 (95% confidence interval (CI) 1.06-1.48), and post-traumatic stress disorder (PTSD), IRR 1.21 (95% CI I.05-1.39). A comparable but smaller effect was observed for mood disorders but none observed for stress disorders overall. Neighborhood proportion of refugees was less clearly associated with subsequent mental disorders other than non-affective psychosis, IRR 1.24 (95% CI 1.03-1.50). We found no statistically significant associations with proportion of migrants. CONCLUSIONS For refugees, living in a neighborhood with a lower proportion of co-nationals is related to subsequent increased risk of diagnosed mental disorders particularly non-affective psychosis and PTSD.
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Affiliation(s)
- Peter Schofield
- Population Health Science, King's College London, London, UK
| | | | - Anna Piil Damm
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
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Grover S, Varadharajan N, Venu S. Urbanization and psychosis: an update of recent evidence. Curr Opin Psychiatry 2024; 37:191-201. [PMID: 38441163 DOI: 10.1097/yco.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
PURPOSE OF REVIEW Urbanization, a complex global phenomenon, has a significant bearing on schizophrenia/psychosis burden through various socioeconomic and environmental factors. This review focuses on recent evidence (2019-2023) linking urbanization, schizophrenia, and the role of green space. RECENT FINDINGS This review analyzed 43 articles that examined the correlation between urban birth or upbringing, urban living (urbanicity), and various schizophrenia/psychosis-related outcomes such as incidence, psychotic experiences, etc. The studies showed differing results across geographical locations. Socioeconomic factors like area deprivation, migrant status (ethnic density) and social fragmentation were independently associated with the risk of schizophrenia/psychosis irrespective of urbanicity. More recently, environmental factors such as green space reduction and air pollution have been explored in urban living conditions and were positively associated with an increased risk of schizophrenia/psychosis. SUMMARY There is a need for further investigation in low and middle-income countries. The impact of urbanization-related factors and green space on the risk of schizophrenia/psychosis calls for appropriate governmental commitments toward structured and healthy urban planning.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, Punjab
| | - Natarajan Varadharajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)
| | - Sandesh Venu
- Department of Psychiatry, Pondicherry Institute of Medical Sciences (PIMS), Kalapet, Puducherry, India
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Chew QH, Sim K. Bane or boon regarding urbanicity and psychotic spectrum disorders: a scoping review of current evidence. Curr Opin Psychiatry 2024; 37:212-224. [PMID: 38415716 DOI: 10.1097/yco.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW This review aims to provide an update on the association between urbanization and psychotic spectrum disorders, focusing on specific aspects of the urban environment that could be a bane or boon for the risk of psychosis. RECENT FINDINGS Majority of the included studies support previous evidence suggesting that urbanization is linked to a higher risk of psychotic experiences and psychotic spectrum disorders. A small minority, however, have also found specific factors in the urban environment that could give rise to positive outcomes, such as better social functioning and lower mortality rates in psychotic spectrum disorders, or mitigate the risks associated with urbanization. The perception of the urban environment was also an important factor that increased or mitigated stress levels in patients with psychosis, which in turn affected their susceptibility to psychotic symptoms. SUMMARY Specific aspects of the urban environment such as the availability and density of greenspaces are crucial for mitigating the effect of urbanization on risk of psychotic spectrum disorders, and should be incorporated into urban planning. At the same time, there is a need to further explore how modifiable risk factors of the urban environment such as air and noise pollution can be minimized to allow for more liveable cities in the context of psychotic spectrum conditions.
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Affiliation(s)
| | - Kang Sim
- West Region, Institute of Mental Health
- Yong Yoo Lin School of Medicine, National University of Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Franzoi D, Bockting CL, Bennett KF, Odom A, Lucassen PJ, Pathania A, Lee A, Brouwer ME, van de Schoot R, Wiers RW, Breedvelt JJ. Which individual, social, and urban factors in early childhood predict psychopathology in later childhood, adolescence and young adulthood? A systematic review. SSM Popul Health 2024; 25:101575. [PMID: 38125276 PMCID: PMC10731668 DOI: 10.1016/j.ssmph.2023.101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
Background A comprehensive picture is lacking of the impact of early childhood (age 0-5) risk factors on the subsequent development of mental health symptoms. Objective In this systematic review, we investigated which individual, social and urban factors, experienced in early childhood, contribute to the development of later anxiety and depression, behavioural problems, and internalising and externalising symptoms in youth. Methods Embase, MEDLINE, Scopus, and PsycInfo were searched on the 5th of January 2022. Three additional databases were retrieved from a mega-systematic review source that focused on the identification of both risk and protective indicators for the onset and maintenance of prospective depressive, anxiety and substance use disorders. A total of 46,450 records were identified and screened in ASReview, an AI-aided systematic review tool. We included studies with experimental, quasi-experimental, prospective and longitudinal study designs, while studies that focused on biological and genetical factors, were excluded. Results Twenty studies were included. The majority of studies explored individual-level risk factors (N = 16). Eleven studies also explored social risk factors and three studied urban risk factors. We found evidence for early predictors relating to later psychopathology measures (i.e., anxiety and depression, behavioural problems, and internalising and externalising symptoms) in childhood, adolescence and early adulthood. These were: parental psychopathology, exposure to parental physical and verbal violence and social and neighbourhood disadvantage. Conclusions Very young children are exposed to a complex mix of risk factors, which operate at different levels and influence children at different time points. The urban environment appears to have an effect on psychopathology but it is understudied compared to individual-level factors. Moreover, we need more research exploring the interaction between individual, social and urban factors.
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Affiliation(s)
- Daniele Franzoi
- Department of Psychiatry, Amsterdam Public Health (APH), Amsterdam University Medical Centres, University of Amsterdam, the Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Claudi L. Bockting
- Department of Psychiatry, Amsterdam Public Health (APH), Amsterdam University Medical Centres, University of Amsterdam, the Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Annick Odom
- Department of Psychiatry, Amsterdam Public Health (APH), Amsterdam University Medical Centres, University of Amsterdam, the Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul J. Lucassen
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
- Brain Plasticity Group, Swammerdam Institute for Life Sciences, University of Amsterdam, the Netherlands
| | | | | | - Marlies E. Brouwer
- Department of Psychiatry, Amsterdam Public Health (APH), Amsterdam University Medical Centres, University of Amsterdam, the Netherlands
| | - Rens van de Schoot
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, the Netherlands
| | - Reinout W. Wiers
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
- Faculty of Social and Behavioural Sciences, University of Amsterdam, the Netherlands
| | - Josefien J.F. Breedvelt
- Department of Psychiatry, Amsterdam Public Health (APH), Amsterdam University Medical Centres, University of Amsterdam, the Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
- The National Centre for Social Research, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Montanari A, Wang L, Birenboim A, Chaix B. Urban environment influences on stress, autonomic reactivity and circadian rhythm: protocol for an ambulatory study of mental health and sleep. Front Public Health 2024; 12:1175109. [PMID: 38375340 PMCID: PMC10875008 DOI: 10.3389/fpubh.2024.1175109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Converging evidence suggests that urban living is associated with an increased likelihood of developing mental health and sleep problems. Although these aspects have been investigated in separate streams of research, stress, autonomic reactivity and circadian misalignment can be hypothesized to play a prominent role in the causal pathways underlining the complex relationship between the urban environment and these two health dimensions. This study aims at quantifying the momentary impact of environmental stressors on increased autonomic reactivity and circadian rhythm, and thereby on mood and anxiety symptoms and sleep quality in the context of everyday urban living. Method The present article reports the protocol for a feasibility study that aims at assessing the daily environmental and mobility exposures of 40 participants from the urban area of Jerusalem over 7 days. Every participant will carry a set of wearable sensors while being tracked through space and time with GPS receivers. Skin conductance and heart rate variability will be tracked to monitor participants' stress responses and autonomic reactivity, whereas electroencephalographic signal will be used for sleep quality tracking. Light exposure, actigraphy and skin temperature will be used for ambulatory circadian monitoring. Geographically explicit ecological momentary assessment (GEMA) will be used to assess participants' perception of the environment, mood and anxiety symptoms, sleep quality and vitality. For each outcome variable (sleep quality and mental health), hierarchical mixed models including random effects at the individual level will be used. In a separate analysis, to control for potential unobserved individual-level confounders, a fixed effect at the individual level will be specified for case-crossover analyses (comparing each participant to oneself). Conclusion Recent developments in wearable sensing methods, as employed in our study or with even more advanced methods reviewed in the Discussion, make it possible to gather information on the functioning of neuro-endocrine and circadian systems in a real-world context as a way to investigate the complex interactions between environmental exposures, behavior and health. Our work aims to provide evidence on the health effects of urban stressors and circadian disruptors to inspire potential interventions, municipal policies and urban planning schemes aimed at addressing those factors.
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Affiliation(s)
- Andrea Montanari
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Universités, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Limin Wang
- Department of Geography, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Birenboim
- Department of Geography, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Basile Chaix
- Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Sorbonne Universités, Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
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Suokas K, Kurkela O, Nevalainen J, Suvisaari J, Hakulinen C, Kampman O, Pirkola S. Geographical variation in treated psychotic and other mental disorders in Finland by region and urbanicity. Soc Psychiatry Psychiatr Epidemiol 2024; 59:37-49. [PMID: 37308692 PMCID: PMC10799825 DOI: 10.1007/s00127-023-02516-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/06/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE In Finland, prevalence of schizophrenia is higher in the eastern and northern regions and co-occurs with the distribution of schizophrenia polygenic risk scores. Both genetic and environmental factors have been hypothesized to contribute to this variation. We aimed to examine the prevalence of psychotic and other mental disorders by region and degree of urbanicity, and the impacts of socio-economic adjustments on these associations. METHODS Nationwide population registers from 2011 to 2017 and healthcare registers from 1975 to 2017. We used 19 administrative and three aggregate regions based on the distribution of schizophrenia polygenic risk scores, and a seven-level urban-rural classification. Prevalence ratios (PRs) were calculated by Poisson regression models and adjusted for gender, age, and calendar year (basic adjustments), and Finnish origin, residential history, urbanicity, household income, economic activity, and physical comorbidity (additional adjustments) on an individual level. Average marginal effects were used to visualize interaction effects between region and urbanicity. RESULTS A total of 5,898,180 individuals were observed. All mental disorders were slightly more prevalent (PR 1.03 [95% CI, 1.02-1.03]), and psychotic disorders (1.11 [1.10-1.12]) and schizophrenia (1.19 [1.17-1.21]) considerably more prevalent in eastern and northern than in western coastal regions. After the additional adjustments, however, the PRs were 0.95 (0.95-0.96), 1.00 (0.99-1.01), and 1.03 (1.02-1.04), respectively. Urban residence was associated with increased prevalence of psychotic disorders across all regions (adjusted PR 1.21 [1.20-1.22]). CONCLUSION After adjusting for socioeconomic and sociodemographic factors, the within-country distribution of mental disorders no longer followed the traditional east-west gradient. Urban-rural differences, on the other hand, persisted after the adjustments.
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Affiliation(s)
- Kimmo Suokas
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014.
| | - Olli Kurkela
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014
- National Institute for Health and Welfare, Helsinki, Finland
- Laurea University of Applied Sciences, Vantaa, Finland
| | - Jaakko Nevalainen
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Helsinki, Finland
| | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| | - Olli Kampman
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, The Pirkanmaa Wellbeing Services County, Tampere, Finland
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
- Faculty of Medicine, Department of Clinical Medicine (Psychiatry), University of Turku, Turku, Finland
- Department of Psychiatry, The Wellbeing Services County of Ostrobothnia, Seinäjoki, Finland
| | - Sami Pirkola
- Faculty of Social Sciences, Tampere University, Tampere, Finland, Arvo Ylpön katu 34 (Arvo 1), 33014
- Tampere University Hospital, Tampere, Finland
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Pignon B, Szöke A, Ku B, Melchior M, Schürhoff F. Urbanicity and psychotic disorders: Facts and hypotheses. DIALOGUES IN CLINICAL NEUROSCIENCE 2023; 25:122-138. [PMID: 37994794 PMCID: PMC10986450 DOI: 10.1080/19585969.2023.2272824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
In the present qualitative literature review, we summarise data on psychotic disorders and urbanicity, focusing particularly on recent findings. Longitudinal studies of the impact of urbanicity on the risk for psychotic disorders have consistently shown a significant association, with a relative risk between 2 and 2.5. However, most of the original studies were conducted in Western Europe, and no incidence studies were conducted in low- and middle-income countries. European studies suggest that neighbourhood-level social fragmentation and social capital may partly explain this association. Exposure to air pollution (positive association) and green space (negative association) may also be part of the explanation, but to date, available data do not make it possible to conclude if they act independently from urbanicity, or as part of the effect of urbanicity on psychotic disorders. Finally, several studies have consistently shown significant associations between the polygenic risk score for schizophrenia and urbanicity, with several possible explanations (pleiotropic effects, results of prodromic symptoms, or selection/intergenerational hypothesis). Thus, more studies are needed to understand the factors that explain the association between urbanicity and the risk of psychotic disorders. Further studies should account for the interdependence and/or interactions of different psychosocial and physical exposures (as well as gene-environment interactions), and explore this association in low- and middle-income countries.
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Affiliation(s)
- Baptiste Pignon
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
| | - Andrei Szöke
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
| | - Benson Ku
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d‘Épidémiologie Et de Santé Publique, IPLESP, Equipe de Recherche en Epidémiologie Sociale, ERES, Paris, France
| | - Franck Schürhoff
- AP-HP, Hôpitaux Universitaires “H. Mondor”, DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Univ Paris-Est-Créteil (UPEC), Créteil, France
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Helmert C, Speerforck S, Fleischer T, Otten D, Kasinger C, Brähler E, Muehlan H, Altweck L, Hahm S, Schmidt S, Reusche M, Glaesmer H, Hinz A, Reyes N, Wirkner K, Engel C, Schomerus G, Ulke C. Explorative analyses on spatial differences in the desire for social distance toward people with mental illness in a diverging city. Front Public Health 2023; 11:1260118. [PMID: 38026313 PMCID: PMC10665488 DOI: 10.3389/fpubh.2023.1260118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Stigma is an individual and societal process based on attitudes and power and relates to both spatial disparities and social distinction. In this study, we examined differences in desire for social distance toward people with mental illness within a city using social and spatial information. Methods ANOVAs and Scheffé post-hoc tests analyzed varying desires for social distance toward people with mental illness within Leipzig (East Germany). Joint Correspondence Analyses (JCA) explored correspondences between desire for social distance, socio-economic status, age, life orientation, social support, duration of living in Leipzig, and shame toward having a mental illness in five city districts of Leipzig in LIFE study participants (by Leipzig Research Center for Civilization Disease, data collected 2011-2014 and 2018-2021, n = 521). Results Stigma varied among Leipzig's districts (F(df = 4) = 4.52, p = 0.001). JCAs showed that a higher desired social distance toward people with mental illness corresponded with spatial differences, high levels of pessimism, high shame of being mentally ill, low social support, low socio-economic status, and older age (75.74 and 81.22% explained variances). Conclusion In terms of stigma, where people with mental illness live matters. The results identified target groups that should be addressed by appropriate intervention and prevention strategies for mental health care.
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Affiliation(s)
- Claudia Helmert
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
| | - Sven Speerforck
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
| | - Toni Fleischer
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
| | - Danielle Otten
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Kasinger
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Holger Muehlan
- Department of Health and Prevention, Institute of Psychology, Greifswald University, Greifswald, Germany
| | - Laura Altweck
- Department of Health and Prevention, Institute of Psychology, Greifswald University, Greifswald, Germany
| | - Stefanie Hahm
- Department of Health and Prevention, Institute of Psychology, Greifswald University, Greifswald, Germany
| | - Silke Schmidt
- Department of Health and Prevention, Institute of Psychology, Greifswald University, Greifswald, Germany
| | - Matthias Reusche
- Institute of Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, Leipzig University, University Medical Center, Leipzig, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, Leipzig University, University Medical Center, Leipzig, Germany
| | - Nigar Reyes
- Institute of Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Kerstin Wirkner
- Department of Medical Psychology and Medical Sociology, Leipzig University, University Medical Center, Leipzig, Germany
- Leipzig Research Centre for Civilization Diseases (LIFE), Leipzig University, Leipzig, Germany
| | - Christoph Engel
- Institute of Medical Informatics, Statistics and Epidemiology (IMISE), Leipzig University, Leipzig, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
| | - Christine Ulke
- Department of Psychiatry and Psychotherapy, Leipzig University, University Medical Center, Leipzig, Germany
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Kasai K, Kumagaya SI, Takahashi Y, Sawai Y, Uno A, Kumakura Y, Yamagishi M, Kanehara A, Morita K, Tada M, Satomura Y, Okada N, Koike S, Yagishita S. "World-Informed" Neuroscience for Diversity and Inclusion: An Organizational Change in Cognitive Sciences. Clin EEG Neurosci 2023; 54:560-566. [PMID: 35695218 DOI: 10.1177/15500594221105755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
By nature, humans are "tojisha (participating subjects/player-witnesses)" who encounter an unpredictable real world. An important characteristic of the relationship between the individual brain and the world is that it creates a loop of interaction and mutual formation. However, cognitive sciences have traditionally been based on a model that treats the world as a given constant. We propose incorporating the interaction loop into this model to create "world-informed neuroscience (WIN)". Based on co-productive research with people with minority characteristics that do not match the world, we hypothesize that the tojisha and the world interact in a two-dimensional way of rule-based and story-based. By defining the cognitive process of becoming tojisha in this way, it is possible to contribute to the various issues of the real world and diversity and inclusion through the integration of the humanities and sciences. The critical role of the brain dopamine system as a basis for brain-world interaction and the importance of research on urbanicity and adolescent development as examples of the application of WIN were discussed. The promotion of these studies will require bidirectional translation between human population science and animal cognitive neuroscience. We propose that the social model of disability should be incorporated into cognitive sciences, and that disability-informed innovation is needed to identify how social factors are involved in mismatches that are difficult to visualize. To promote WIN to ultimately contribute to a diverse and inclusive society, co-production of research from the initial stage of research design should be a baseline requirement.
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Affiliation(s)
- Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- UTokyo Center for Integrative Science of Human Behavior (CiSHuB), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Diversity in Medical Education and Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin-Ichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yusuke Takahashi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- St Luke's International Hospital, Tokyo, Japan
| | - Yutaka Sawai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akito Uno
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Kumakura
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mika Yamagishi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiko Kanehara
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kentaro Morita
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mariko Tada
- Center for Research on Counseling and Support Services, The University of Tokyo, Tokyo, Japan
| | - Yoshihiro Satomura
- Center for Diversity in Medical Education and Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naohiro Okada
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
| | - Shinsuke Koike
- The International Research Center for Neurointelligence (WPI-IRCN) at The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo, Japan
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), Tokyo, Japan
- UTokyo Center for Integrative Science of Human Behavior (CiSHuB), Graduate School of Art and Sciences, The University of Tokyo, Tokyo, Japan
- Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Sho Yagishita
- Department of Structural Physiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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12
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Corcoran R. Poverty, ACEs and stigmatised places: The application of psychology to the challenges of disadvantage. Psychol Psychother 2023; 96:577-589. [PMID: 36866430 DOI: 10.1111/papt.12457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/28/2022] [Accepted: 02/10/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Our life circumstances present continual challenges to our mental health and well-being. For most of us, the politics of economy and society determine our prospects of living a good life. The fact that the ability to control and change things that happen to us is largely vested in the power of remote others has inevitable, mostly negative consequences. METHOD The following opinion piece illustrates the challenge our discipline faces in locating a complimentary contribution alongside those of public health, sociology and other sister disciplines with particular reference to the intractable concerns of poverty, ACES and stigmatised places. FINDINGS The piece presents an examination of what psychology as a discipline can do in the context of adversity and challenges that individuals face but over which they have little sense of control. The discipline of psychology needs to play a meaningful part in understanding and addressing the impacts of societal matters, moving from a dominant position of individualised understandings of distress to embrace more fully the context in which people are expected to feel good and function well. CONCLUSION Community psychology offers a useful, established philosophy from which to advance our practices. However, a more sophisticated, discipline-wide narrative and grounded understanding that empathically represents real lives and captures individual functioning within a complex and distant societal system is urgently required.
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Affiliation(s)
- Rhiannon Corcoran
- Psychology and Public Mental Health, Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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13
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Wolf ID, Waitt G. Towards liveable cities: A review of ethnicity, public urban nature space and wellbeing. AMBIO 2023; 52:1505-1518. [PMID: 37160553 PMCID: PMC10169147 DOI: 10.1007/s13280-023-01871-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/27/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
In this review, we synthesise the results of studies that examine how the relationships between public urban nature spaces and wellbeing vary by ethnicity in cities of the Global North. We searched for articles that reported on the relationships between public urban nature spaces, ethnicity and wellbeing. We found 65 articles that met our inclusion criteria. From our review, we found positive and negative relationships between public urban nature spaces, ethnicity and wellbeing in four interrelated domains: integration/relationship building, therapy, safety and capabilities/competency building. The findings of this review inform park management by offering twelve wellbeing pathways to design urban nature spaces that are more inclusive to all residents.
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Affiliation(s)
- Isabelle D. Wolf
- Australian Centre for Culture, Environment, Society and Space, School of Geography and Sustainable Communities, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
- Centre for Ecosystem Science, University of New South Wales, Sydney, NSW 2052 Australia
| | - Gordon Waitt
- Australian Centre for Culture, Environment, Society and Space, School of Geography and Sustainable Communities, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
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14
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Tomasso LP, Spengler JD, Catalano PJ, Chen JT, Laurent JGC. In situ psycho-cognitive assessments support self-determined urban green exercise time. URBAN FORESTRY & URBAN GREENING 2023; 86:128005. [PMID: 37483383 PMCID: PMC10358366 DOI: 10.1016/j.ufug.2023.128005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Prescribed nature walks frequently yield improvements to mood and cognition as observed in experimental studies. Research that uses real life settings such as self-determined time exercising outdoors for restorative health benefits may more accurately elicit effects than time-specified study protocols. This study examined in situ psycho-cognitive outcomes of routine walks in urban greenspace to test the concept that self-set exposure duration and not context alone is related to magnitude of psycho-cognitive benefit. Pre-post measurements taken on a diverse participant pool of individuals walking in urban parks and recruited on random days over a two-week period found significant associations between outdoor activity duration and cognitive and mood improvements. Greater outdoor walking duration linearly predicted stronger processing speeds but non-linearly in tests of other cognitive domains. Results of fixed effects model for mean mood change following green exercise show outdoor walking influenced mood change at highest levels of significance, even after accounting for individual level variability in duration. Mood improved for all durations of outdoor walking under a random effects model with high significance. Untethering fixed intervals of outdoor exercise from formal study design revealed briefer but more frequent nature engagement aligned with nature affinity. The influence of unmeasured factors, e.g., nature affinity or restorative conditioning, for prescriptive durations of urban green exercise merits further investigation toward designing wellbeing interventions directed at specific urban populations.
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Affiliation(s)
- Linda Powers Tomasso
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Dr, Boston, MA 02215, United States
- Population Health Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
| | - John D. Spengler
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Dr, Boston, MA 02215, United States
| | - Paul J. Catalano
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
- Department of Data Science, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, United States
| | - Jarvis T. Chen
- Population Health Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, United States
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, United States
| | - Jose Guillermo Cedeño Laurent
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 401 Park Dr, Boston, MA 02215, United States
- Department of Environmental and Occupational Health and Justice, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, United States
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15
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Lai KY, Kumari S, Webster C, Gallacher JEJ, Sarkar C. Neighbourhood residential density, urbanicity and incident dementia and Alzheimer's disease: A 12-year prospective cohort study from the UK Biobank. ENVIRONMENTAL RESEARCH 2023; 226:115627. [PMID: 36894118 DOI: 10.1016/j.envres.2023.115627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION An increasing proportion of global population is exposed to urban densification in an aging society. However, little is known of the role of residential density and urbanicity on the risk of developing dementia including Alzheimer's disease. We examined long-term associations between residential density and urbanicity and risks of incident dementia and Alzheimer's disease. METHODS This prospective cohort study included participants from the UK Biobank who lived at the same residential address, had no self-reported neurological conditions and without dementia at baseline. Residential density was measured as the number of dwelling units within 1-km street neighbourhood of participant's home address. A composite index of urbanicity was developed from neighbourhood-level z-standardized densities of housing, retail, public transport and street centrality. Hazard ratios were derived from Cox proportional hazard models adjusted for known risk factors. RESULTS The analytic sample included 239,629 participants aged 38-72 years. During a median follow-up of 12.3 years (interquartile range 11.5-13.0 years), 2,176 participants developed dementia and 1,004 Alzheimer's disease. After adjustments for potential risk factors, each 1,000 units/Km2 increment in residential density was associated with higher risks of dementia (hazard ratio [HR]=1.10, 95% confidence interval [CI]: 1.06-1.15) and Alzheimer's disease (HR=1.10, 95% CI: 1.04-1.16). Consistently, categorical models showed that living in neighbourhoods of higher residential density and urbanicity were associated with higher risks of dementia (HR = 1.30, 95% CI: 1.12-1.51 for the highest density quintile compared to the lowest and HR = 1.21, 95% CI: 1.05-1.39 for the highest urbanicity quintile relative to the lowest). The associations were more pronounced in female, age >65 years, and among participants of the low income and those being frail and having shorter leucocyte telomere length (LTL). CONCLUSIONS Higher residential density and urbanicity was found to be positively associated with elevated risks of dementia and Alzheimer's disease. Optimizing neighbourhood residential density maybe one of the upstream considerations for mitigating against neurodegenerative diseases.
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Affiliation(s)
- Ka Yan Lai
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China; Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Sarika Kumari
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Chris Webster
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China; Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - John E J Gallacher
- UK Dementias Platform, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China; Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China; UK Dementias Platform, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
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16
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Motoc I, Hoogendijk EO, Timmermans EJ, Deeg D, Penninx BWJH, Huisman M. Social and physical neighbourhood characteristics and 10-year incidence of depression and anxiety in older adults: Results from the Longitudinal Aging Study Amsterdam. Soc Sci Med 2023; 327:115963. [PMID: 37207380 DOI: 10.1016/j.socscimed.2023.115963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE A growing literature suggests that neighbourhood characteristics are associated with mental health outcomes, but the evidence in older adults is inconsistent. We investigated the association of neighbourhood characteristics, pertaining to demographic, socio-economic, social and physical environment domains, with the subsequent 10-year incidence of depression and anxiety, in Dutch older adults. METHODS In the Longitudinal Aging Study Amsterdam depressive and anxiety symptoms were assessed four times between 2005/2006 and 2015/2016, using the Center for Epidemiological Studies Depression Scale (n = 1365) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (n = 1420). Neighbourhood-level data on urban density, percent population over 65 years of age, percent immigrants, average house price, average income, percent low-income earners, social security beneficiaries, social cohesion, safety, proximity to retail facilities, housing quality, percent green space, percent water coverage, air pollution (particulate matter (PM2.5)), and traffic noise, were obtained for study baseline years 2005/2006. Cox proportional hazard regression models, clustered within neighbourhood, were used to estimate the association between each neighbourhood-level characteristic and the incidence of depression and anxiety. RESULTS The incidence of depression and anxiety was 19.9 and 13.2 per 1000 person-years, respectively. Neighbourhood characteristics were not associated with the incidence of depression. However, various neighbourhood characteristics were associated with an increased incidence of anxiety, including: higher urban density level, higher percent immigrants, greater proximity to retail facilities, lower housing quality score, lower safety score, higher PM2.5 levels and less green space. CONCLUSION Our results indicate that several neighbourhood characteristics are associated with anxiety but not with depression incidence in older age. Several of these characteristics have the potential to be modifiable and thus could serve as a target for interventions at the neighbourhood-level in improving anxiety, provided that future studies replicate our findings and provide further evidence for a causal effect.
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Affiliation(s)
- Irina Motoc
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands.
| | - Emiel O Hoogendijk
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands
| | - Erik J Timmermans
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dorly Deeg
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Martijn Huisman
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life and Mental Health Programs, Amsterdam, the Netherlands; Department of Sociology, VU University, Amsterdam, the Netherlands
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17
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Bolouki A. Neurobiological effects of urban built and natural environment on mental health: systematic review. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:169-179. [PMID: 35112526 DOI: 10.1515/reveh-2021-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
Although rapid global urbanization improves people in many ways, it also increases the prevalence of major mental disorders in urban communities. Exposure to natural surroundings, whether real or virtual, on the other hand, has been found to reduce arousal and stress. The purpose of this study is to provide an overview of the existing literature on how brain function changes when exposed to natural and urban settings. As a highly effective technique for determining human brain activity, this review considers literature using neuroimaging techniques, i.e., electroencephalography (EEG), functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). SCOPUS and PubMed were searched for peer-reviewed literature published prior to September 2021. Twenty-six sources were included, returning 263 papers; 18 empirical articles published from 1991 to 2021 were included in the final synthesis. EEG findings were generally consistent with those obtained from fMRI/NIRS data. Natural settings were linked to greater alpha EEG values and fewer demands on information processing and stronger functional connectivity in fMRI/NIRS studies, which indicate feelings of relaxation and restoration. These findings offer a better understanding of the functional activities during environmental exposures and also imply that nature exposure improves cognitive functions and mental health.
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18
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Senkler B, Freymueller J, Lopez Lumbi S, Hornberg C, Schmid HL, Hennig-Fast K, Horstmann G, Mc Call T. Urbanicity-Perspectives from Neuroscience and Public Health: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:688. [PMID: 36613008 PMCID: PMC9819040 DOI: 10.3390/ijerph20010688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Urban residency is associated with exposure to environmental factors, which can influence health in many ways. Neuroscientific research, as well as Public Health research, aim towards broadening evidence in the field of Urban Health. However, it is unclear whether the association between urban living and mental illnesses is causal rather than explainable by other selective effects. This review seeks to gather information on the current evidence regarding urban living and neurological outcomes to demonstrate how Public Health and Neuroscience could complement each other in the field of Urban Health. A scoping review was conducted in four electronic databases according to the PRISMA-statement guidelines. 25 empirical studies were included. Outcomes such as schizophrenia and psychotic disorders, social and cognitive functioning were scrutinised. Evidence was found for alteration of brain functioning and brain structure. Most studies researching cognitive functioning or cognitive decline displayed possible protective effects of urban living compared to rural living. The different study designs in Public Health and Neuroscience could profit from each other. Although the comparability of studies is limited by the inconsistent assessments of urbanity. Synergies and potentials to combine aspects of Public Health and Neuroscience in the field of Urban Health to improve population health became apparent.
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Affiliation(s)
- Ben Senkler
- Sustainable Environmental Health Sciences, Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany
| | - Julius Freymueller
- Sustainable Environmental Health Sciences, Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany
| | - Susanne Lopez Lumbi
- Sustainable Environmental Health Sciences, Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany
| | - Claudia Hornberg
- Sustainable Environmental Health Sciences, Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany
| | - Hannah-Lea Schmid
- Sustainable Environmental Health Sciences, Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany
| | - Kristina Hennig-Fast
- Psychotherapy and Psychosomatics, Department Psychiatry, Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany
| | - Gernot Horstmann
- Neurocognitive Psychology, Department Psychology, Faculty of Psychology and Sport Science, Bielefeld University, 33615 Bielefeld, Germany
| | - Timothy Mc Call
- Sustainable Environmental Health Sciences, Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany
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Qiu Q, Yang L, He M, Gao W, Mar H, Li J, Wang G. The Effects of Forest Therapy on the Blood Pressure and Salivary Cortisol Levels of Urban Residents: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:458. [PMID: 36612777 PMCID: PMC9819785 DOI: 10.3390/ijerph20010458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
Urban residents have a higher risk of hypertension and psychological stress than rural residents. Aside from medical interventions, understanding how to control hypertension and alleviate the stress of urban populations has become a public concern. As an alternative medical measure, forest therapy has shown the effects of normalizing blood pressure (BP) and reducing stress increasingly in recent literature, but this is still inconclusive. In order to systematically verify forest therapy’s effects on the BP and mental stress of urban residents, we conducted meta-analyses to assess the changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and salivary cortisol concentration (SCC; a stress biomarker) between the forest therapy group and urban control group. We searched 4 online databases, and 21 studies on BP involving 2270 participants and 13 studies on SCC involving 1786 participants were included. Through the meta-analysis, the mean difference and confidence interval (CI) estimates indicated that forest therapy significantly reduced participants’ SBP −3.44 (95% CI −5.74, −1.14), DBP −3.07 (95% CI −5.59, −0.54), and SCC −0.07 (95% CI −0.10, −0.04), as compared with urban control. Yet, there was substantial heterogeneity (I2 = 72.87−88.59%) among these studies. We also found that each prediction interval (PI) for SBP (95% PI −13.30, 6.42), DBP (95% PI −15.54, 9.41), and SCC (95% PI −0.18, 0.05) were all much wider than the CIs and contained values above 0. This means that forest therapy may reduce SBP, DBP, and SCC on average, but may not exclude adverse results. Meta-regression analyses showed that participants’ age and baseline SBP levels determined the heterogeneity among SBP studies. After forest therapy, older participants and those with higher baseline SBP levels had greater SBP-lowering effects. Among DBP studies, the primary source of heterogeneity was participants’ baseline DBP levels; participants with higher baseline DBP levels had greater DBP reduction. In subgroup analyses, we discovered that longer-term forest therapy programs (≥20 min) resulted in a greater reduction in BP and SCC than shorter-term forest therapy programs (<20 min). Additionally, seated viewing, walking, or multi-session programs in forests were observed to have similar effects on reducing BP and SCC. Despite extensive analyses, the study did not identify any sources of heterogeneity among forest therapy programs for lowering SCC levels. Overall, we conclude that forest therapy programs have beneficial therapeutic effects on urban residents’ physio-psychological health through lowering BP and relieving stress (reducing SCC). This finding provides solid evidence of the contribution of forest therapy to urban residents’ health and wellbeing.
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Affiliation(s)
- Quan Qiu
- Guangdong Key Laboratory for Innovative Development and Utilization of Forest Plant Germplasm, College of Forestry and Landscape Architecture, South China Agricultural University, Guangzhou 510642, China
- Faculty of Forestry, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Ling Yang
- Guangdong Key Laboratory for Innovative Development and Utilization of Forest Plant Germplasm, College of Forestry and Landscape Architecture, South China Agricultural University, Guangzhou 510642, China
| | - Mei He
- Faculty of Forestry, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Jiangxi Academy of Forestry, Nanchang 330013, China
| | - Wen Gao
- Faculty of Forestry, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Co-Innovation Center for Sustainable Forestry in Southern China, Nanjing Forestry University, Nanjing 210037, China
| | - Harrison Mar
- Faculty of Forestry, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Jiyue Li
- Guangdong Key Laboratory for Innovative Development and Utilization of Forest Plant Germplasm, College of Forestry and Landscape Architecture, South China Agricultural University, Guangzhou 510642, China
| | - Guangyu Wang
- Faculty of Forestry, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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20
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Xie M, Zhao Z, Dai M, Wu Y, Huang Y, Liu Y, Tang Y, Xiao L, Wei W, Zhang G, Du X, Li C, Guo W, Ma X, Deng W, Wang Q, Li T. Associations between urban birth or childhood trauma and first-episode schizophrenia mediated by low IQ. SCHIZOPHRENIA 2022; 8:89. [PMID: 36309513 PMCID: PMC9617944 DOI: 10.1038/s41537-022-00289-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/17/2022] [Indexed: 11/09/2022]
Abstract
Exposure to urban birth, childhood trauma, and lower Intelligence Quotient (IQ) were the most well-established risk factors for schizophrenia in developed countries. In developing countries, whether urban birth is a risk factor for schizophrenia and how these factors are related to one another remain unclear. This study aimed to investigate whether IQ mediates the relationship between urban birth or childhood trauma and first-episode schizophrenia (FES) in China. Birthplace, childhood trauma questionnaire (CTQ), and IQ were collected from 144 patients with FES and 256 healthy controls (HCs). Hierarchical logistic regression analysis was conducted to investigate the associations between birthplace, childhood trauma, IQ, and FES. Furthermore, mediation analysis was used to explore the mediation of IQ in the relationship between birthplace or childhood trauma and FES. After adjusting for age, sex and educational attainment, the final model identified urban birth (odds ratio (OR) = 3.15, 95% CI = 1.54, 6.44) and childhood trauma (OR = 2.79, 95% CI = 1.92, 4.06) were associated an elevated risk for FES. The 52.94% total effect of birthplace on the risk of FES could be offset by IQ (indirect effect/direct effect). The association between childhood trauma and FES could be partly explained by IQ (22.5%). In total, the mediation model explained 70.5% of the total variance in FES. Our study provides evidence that urban birth and childhood trauma are associated with an increased risk of FES. Furthermore, IQ mediates the relationship between urban birth or childhood trauma and FES.
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Affiliation(s)
- Min Xie
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Zhengyang Zhao
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Minhan Dai
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Yulu Wu
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Yunqi Huang
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Yunjia Liu
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Yiguo Tang
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Liling Xiao
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Wei Wei
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Guangya Zhang
- grid.263761.70000 0001 0198 0694Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Xiangdong Du
- grid.263761.70000 0001 0198 0694Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Chuanwei Li
- grid.263761.70000 0001 0198 0694Department of Psychiatry, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Wanjun Guo
- grid.13402.340000 0004 1759 700XAffiliated Mental Health Centre & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, 310013 Hangzhou, Zhejiang China
| | - Xiaohong Ma
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Wei Deng
- grid.13402.340000 0004 1759 700XAffiliated Mental Health Centre & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, 310013 Hangzhou, Zhejiang China
| | - Qiang Wang
- grid.412901.f0000 0004 1770 1022Mental Health Center, West China Hospital, Sichuan University, 610041 Chengdu, Sichuan China
| | - Tao Li
- grid.13402.340000 0004 1759 700XAffiliated Mental Health Centre & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, 310013 Hangzhou, Zhejiang China
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21
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Valladares A, Bornstein L, Botero N, Gold I, Sayanvala F, Weinstock D. From scary places to therapeutic landscapes: Voices from the community of people living with schizophrenia. Health Place 2022; 78:102903. [PMID: 36174464 DOI: 10.1016/j.healthplace.2022.102903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/19/2022]
Abstract
This article discusses how people living with schizophrenia experience, understand, and respond to their urban environment. Our study relies on experiential photo-voice data gathered with a sample of six people diagnosed with schizophrenia and living in non-institutional settings in Montréal, Canada, to identify how individuals in this community perceive the urban landscape. We adopt a therapeutic landscapes' framework that explores the urban fabric at three levels: physical, social, and symbolic. Research participants identified both health-denying and health-enhancing places within ordinary urban landscapes. Landscapes identified as health-denying are characterized by environmental stressors and loss of control, with construction sites an example highlighted by participants. Healing and restorative landscapes, as identified by participants, were physically attractive or quiet, socially safe and welcoming, and symbolically affirmative of one's identity, all factors worthy of further study. The findings are also policy-relevant: they suggest that people living with schizophrenia and their clinicians can develop strategies to make health-enhancing uses of urban landscapes; and that urban policies and practices can foster urban environments conducive to enhanced health and well-being, both for the community of people living with schizophrenia and the wider population of urban dwellers.
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Affiliation(s)
| | | | - Nicolás Botero
- McGill University, Department of Cognitive Science, Canada
| | - Ian Gold
- McGill University, Department of Philosophy, Canada
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22
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Huang H, Li Y, Zhao Y, Zhai W. Analysis of the impact of urban summer high temperatures and outdoor activity duration on residents' emotional health: Taking hostility as an example. Front Public Health 2022; 10:955077. [PMID: 35958864 PMCID: PMC9358219 DOI: 10.3389/fpubh.2022.955077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/06/2022] [Indexed: 11/27/2022] Open
Abstract
The combined effect of global warming and the heat island effect keeps the temperature of cities rising in the summer, seriously threatening the physical and mental health of urban residents. Taking the area within the Sixth Ring Road of Beijing as an example, based on Landsat remote sensing images, meteorological stations, and questionnaires, this study established a relational model between temperature and hostility and then analyzed the changes in the emotional health risk (hostility) in the study area and the mechanism of how outdoor activity duration influences hostility. Results show that: (1) the area within the Sixth Ring Road of Beijing had a higher and higher temperature from 1991 to 2020. Low-temperature areas gradually shrank, and medium- and high-temperature areas extended outwards from the center. (2) The threat of high temperature to residents' hostility gradually intensified—the sphere of influence expanded, low-risk areas quickly turned into medium-high-risk areas, and the level of hostility risk increased. Level 1 risk areas of hostility had the most obvious reduction—a 74.33% reduction in area proportion; meanwhile, Level 3 risk areas had the most significant growth—a 50.41% increase in area proportion. (3) In the first 120 min of outdoor activities under high temperature, residents' hostility was negatively correlated with outdoor activity duration; after more than 120 min, hostility became positively correlated with duration. Therefore, figuring out how temperature changes influence human emotions is of great significance to improving the living environment and health level of residents. This study attempts to (1) explore the impact of temperature changes and outdoor activity duration on hostility, (2) evaluate residents' emotional health risk levels affected by high temperature, and (3) provide a theoretical basis for the early warning mechanism of emotional health risk and the planning of healthy cities.
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Affiliation(s)
- Huanchun Huang
- College of Landscape Architecture, Nanjing Forestry University, Nanjing, China
| | - Yang Li
- College of Landscape Architecture, Nanjing Forestry University, Nanjing, China
| | - Yimin Zhao
- College of Landscape Architecture, Nanjing Forestry University, Nanjing, China
| | - Wei Zhai
- School of Architecture and Planning, The University of Texas at San Antonio, San Antonio, TX, United States
- *Correspondence: Wei Zhai
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23
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Stress and emotional arousal in urban environments: A biosocial study with persons having experienced a first-episode of psychosis and persons at risk. Health Place 2022; 75:102762. [PMID: 35286900 DOI: 10.1016/j.healthplace.2022.102762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
This article examines the entanglement between feelings of stress and discomfort, physiological arousal and urban experiences of persons living with early psychosis. It adopts a biosocial approach, using mixed methods combining ambulatory skin conductance monitoring, mobile interviews and contextual data, collected through GPS and video recordings. The study draws on and strives to cross-fertilize two recent strands of research. The first relates to the use of digital phenotyping in mental health research. The second explores stress and emotional arousal in cities using ambulatory physiological measures. Empirically, the paper is based on fieldwork in Basel, Switzerland, with nine participants recruited within the Basel Early Treatment Service (BEATS), and four controls. We focus on three salient elements in our results: visual perception of moving bodies, spatial transitions and openness and enclosure of the built environment. The analysis shows how these elements elicit physiological responses of arousal and expressed feelings of discomfort. In the concluding section we discuss the methodological implications of these results and suggest the notion of regime of attention as a focus for future biosocial research on urban mental health.
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24
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Hsueh YC, Batchelor R, Liebmann M, Dhanani A, Vaughan L, Fett AK, Mann F, Pitman A. A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4766. [PMID: 35457637 PMCID: PMC9029472 DOI: 10.3390/ijerph19084766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 12/02/2022]
Abstract
Given the links between the built environment and loneliness, there is interest in using place-based approaches (addressing built environment characteristics and related socio-spatial factors) in local communities to tackle loneliness and mental health problems. However, few studies have described the effectiveness, acceptability, or potential harms of such interventions. This review aimed to synthesize the literature describing local community-based interventions that target place-based factors to address loneliness and mental health problems, informing the development of future public health approaches. We searched PsycINFO, Medline, and Embase using a structured search strategy to identify English-language studies evaluating the effectiveness, acceptability, and potential harms of place-based community interventions in addressing loneliness and mental health problems, both in general and clinical populations. Seven studies met the inclusion criteria, classified as evaluating provision of community facilities (such as clubhouses), active engagement in local green spaces, and housing regeneration. None were randomised trials. Quantitative and qualitative findings suggested promising effects and/or acceptability of six interventions, with minimal potential harms. There is a clear need for randomised trials or quasi-experimental studies of place-based interventions to describe their effectiveness in addressing loneliness and mental health problems, as well as complementary qualitative work investigating acceptability. This will inform future policy development.
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Affiliation(s)
- Yung-Chia Hsueh
- Division of Psychiatry, University College London (UCL), London W1T 7NF, UK; (Y.-C.H.); (M.L.); (F.M.)
| | | | - Margaux Liebmann
- Division of Psychiatry, University College London (UCL), London W1T 7NF, UK; (Y.-C.H.); (M.L.); (F.M.)
| | - Ashley Dhanani
- Bartlett School of Architecture, University College London (UCL), London WC1H 0AY, UK; (A.D.); (L.V.)
| | - Laura Vaughan
- Bartlett School of Architecture, University College London (UCL), London WC1H 0AY, UK; (A.D.); (L.V.)
| | - Anne-Kathrin Fett
- Department of Psychology, City, University of London, London EC1V 0HB, UK;
| | - Farhana Mann
- Division of Psychiatry, University College London (UCL), London W1T 7NF, UK; (Y.-C.H.); (M.L.); (F.M.)
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London (UCL), London W1T 7NF, UK; (Y.-C.H.); (M.L.); (F.M.)
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
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25
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Saxena A, Dodell-Feder D. Explaining the Association Between Urbanicity and Psychotic-Like Experiences in Pre-Adolescence: The Indirect Effect of Urban Exposures. Front Psychiatry 2022; 13:831089. [PMID: 35360125 PMCID: PMC8962621 DOI: 10.3389/fpsyt.2022.831089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/27/2022] [Indexed: 11/30/2022] Open
Abstract
Urban living is a growing worldwide phenomenon with more than two-thirds of people expected to live in cities by 2050. Although there are many benefits to living in an urban environment, urbanicity has also been associated with deleterious health outcomes, including increased risk for psychotic outcomes particularly when the urban exposure occurs in pre-adolescence. However, the mechanisms underlying this association is unclear. Here, we utilize one-year follow-up data from a large (N=7,979), nationwide study of pre-adolescence in the United States to clarify why urbanicity (i.e., census-tract population density) might impact psychotic-like experiences (PLE) by looking at the indirect effect of eight candidate urbanicity-related physical (e.g., pollution) and social (e.g., poverty) exposures. Consistent with other work, we found that of the evaluated exposures related to urbanicity, several were also related to increased number of PLE: PM2.5, proximity to roads, census-level homes at-risk for exposure to lead paint, census-level poverty, and census-level income-disparity. These same urban-related exposures were also related to the persistence of PLE after 1 year, but not new onset of PLE. Mediation analysis revealed that a substantial proportion the urbanicity-PLE association (number and persistence) could be explained by PM2.5 (23-44%), families in poverty (68-93%), and income disparity (67-80%). Together, these findings suggest that specific urban-related exposures contribute to the existence and maintenance, but not onset of PLE, which might help to explain why those in urban environments are disproportionately at-risk for psychosis and point toward areas for public health intervention.
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Affiliation(s)
- Abhishek Saxena
- Department of Psychology, University of Rochester, Rochester, NY, United States
| | - David Dodell-Feder
- Department of Psychology, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States
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26
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Abarca Brown C, Szabzon F, Bruhn L, Ravelli Cabrini D, Miranda E, Gnoatto J, de Vries Albertin P, Santana GL, Andrade LH. (Re) thinking urban mental health from the periphery of São Paulo in times of the COVID-19 pandemic. Int Rev Psychiatry 2022; 34:78-88. [PMID: 35584018 DOI: 10.1080/09540261.2022.2027349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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'.
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Affiliation(s)
- Cristobal Abarca Brown
- Section of Psychiatric Epidemiology, Institute of Psychiatry School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Felipe Szabzon
- Section of Psychiatric Epidemiology, Institute of Psychiatry School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lenora Bruhn
- Section of Psychiatric Epidemiology, Institute of Psychiatry School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniela Ravelli Cabrini
- Section of Psychiatric Epidemiology, Institute of Psychiatry School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Elisangela Miranda
- Section of Psychiatric Epidemiology, Institute of Psychiatry School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jacqueline Gnoatto
- Human Rights Centre Pablo Gonzales Olalla (Centro de Direitos Humanos Pablo Gonzales Olalla), São Paulo, Brazil
| | - Paula de Vries Albertin
- Department of Global Health & Social Medicine, Faculty of Social Science & Public Policy, King's College London, London, UK
| | - Geilson Lima Santana
- Section of Psychiatric Epidemiology, Institute of Psychiatry School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology, Institute of Psychiatry School of Medicine, University of São Paulo, São Paulo, Brazil
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27
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Ancora LA, Blanco-Mora DA, Alves I, Bonifácio A, Morgado P, Miranda B. Cities and neuroscience research: A systematic literature review. Front Psychiatry 2022; 13:983352. [PMID: 36440407 PMCID: PMC9684645 DOI: 10.3389/fpsyt.2022.983352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/21/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cities are becoming the socio-economic hubs for most of the world's population. Understanding how our surroundings can mentally affect everyday life has become crucial to integrate environmental sustainability into urban development. The present review aims to explore the empirical studies investigating neural mechanisms underlying cognitive and emotional processes elicited by the exposure to different urban built and natural spaces. It also tries to identify new research questions and to leverage neurourbanism as a framework to achieve healthier and sustainable cities. METHODS By following the PRISMA framework, we conducted a structured search on PubMed, ProQuest, Web of Science, and Scopus databases. Only articles related to how urban environment-built or natural-affects brain activity through objective measurement (with either imaging or electrophysiological techniques) were considered. Further inclusion criteria were studies on human adult populations, peer-reviewed, and in English language. RESULTS Sixty-two articles met the inclusion criteria. They were qualitatively assessed and analyzed to determine the main findings and emerging concepts. Overall, the results suggest that urban built exposure (when compared to natural spaces) elicit activations in brain regions or networks strongly related to perceptual, attentional, and (spatial) cognitive demands. The city's-built environment also triggers neural circuits linked to stress and negative affect. Convergence of these findings was observed across neuroscience techniques, and for both laboratory and real-life settings. Additionally, evidence also showed associations between neural social stress processing with urban upbringing or current city living-suggesting a mechanistic link to certain mood and anxiety disorders. Finally, environmental diversity was found to be critical for positive affect and individual well-being. CONCLUSION Contemporary human-environment interactions and planetary challenges imply greater understanding of the neurological underpinnings on how the urban space affects cognition and emotion. This review provides scientific evidence that could be applied for policy making on improved urban mental health. Several studies showed that high-quality green or blue spaces, and bio-diverse urban areas, are important allies for positive neural, cognitive, and emotional processes. Nonetheless, the spatial perception in social contexts (e.g., city overcrowding) deserves further attention by urban planners and scientists. The implications of these observations for some theories in environmental psychology and research are discussed. Future work should take advantage of technological advancements to better characterize behavior, brain physiology, and environmental factors and apply them to the remaining complexity of contemporary cities.
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Affiliation(s)
- Leonardo A Ancora
- Institute of Physiology, Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal
| | | | - Inês Alves
- Institute of Molecular Medicine, Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ana Bonifácio
- Centre of Geographical Studies, Institute of Geography and Spatial Planning, University of Lisbon, Lisbon, Portugal
| | - Paulo Morgado
- Centre of Geographical Studies, Institute of Geography and Spatial Planning, University of Lisbon, Lisbon, Portugal
| | - Bruno Miranda
- Institute of Physiology, Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal.,Institute of Molecular Medicine, Lisbon School of Medicine, University of Lisbon, Lisbon, Portugal
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28
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Baumann PS, Söderström O, Abrahamyan Empson L, Duc Marwood A, Conus P. Mapping Personal Geographies in Psychosis: From Space to Place. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgab051. [PMID: 39144800 PMCID: PMC11206046 DOI: 10.1093/schizbullopen/sgab051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Recently, there has been a growing interest in the interaction between the urban milieu and the development of psychosis. While growing up in an urban environment constitutes a risk factor for developing psychosis, patients who develop a first episode of psychosis tend to avoid city centers and suffer from isolation. These observations have fostered emerging interest in ways of developing contexts in cities that are favorable to mental health and that may help service users in their paths to recovery. Building on work on place attachment as well as systemic therapy, we present a new approach to map the urban spaces experienced by service users. We propose two tools, the "place attachment diagram" and "life space network," to situate emotional bond and spatial dimension respectively at their center and help service users to map meaningful places in the city. We also suggest that different facets of the illness such as epidemiological risk factors (residential mobility, migration, urban living, trauma), early place attachment and abnormal space experience, may shape individual space and place experience in psychosis. Psychotherapeutic process with patients should aim at turning urban "spaces" into "places" characterized by a sense of familiarity, security and opportunity. Finally, we argue that the "spatial" is a forgotten dimension in psychotherapy and should be taken into account when treating individuals with psychosis.
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Affiliation(s)
- Philipp S Baumann
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Prilly, Lausanne, Switzerland
- Psychiatrist, Rue du Pont-Neuf 2, 1110 Morges, Switzerland
| | - Ola Söderström
- Institute of Geography, University of Neuchâtel, Espace Louis-Agassiz, Neuchâtel, Switzerland
| | - Lilith Abrahamyan Empson
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Prilly, Lausanne, Switzerland
| | - Alessandra Duc Marwood
- Centre de consultation les Boréales and Unité d’Enseignement du Centre d’Etude de la famille, Institut Universitaire de Psychothérapie, Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), Prilly, Lausanne, Switzerland
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29
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van der Wal JM, van Borkulo CD, Deserno MK, Breedvelt JJF, Lees M, Lokman JC, Borsboom D, Denys D, van Holst RJ, Smidt MP, Stronks K, Lucassen PJ, van Weert JCM, Sloot PMA, Bockting CL, Wiers RW. Advancing urban mental health research: from complexity science to actionable targets for intervention. Lancet Psychiatry 2021; 8:991-1000. [PMID: 34627532 DOI: 10.1016/s2215-0366(21)00047-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/30/2022]
Abstract
Urbanisation and common mental disorders (CMDs; ie, depressive, anxiety, and substance use disorders) are increasing worldwide. In this Review, we discuss how urbanicity and risk of CMDs relate to each other and call for a complexity science approach to advance understanding of this interrelationship. We did an ecological analysis using data on urbanicity and CMD burden in 191 countries. We found a positive, non-linear relationship with a higher CMD prevalence in more urbanised countries, particularly for anxiety disorders. We also did a review of meta-analytic studies on the association between urban factors and CMD risk. We identified factors relating to the ambient, physical, and social urban environment and showed differences per diagnosis of CMDs. We argue that factors in the urban environment are likely to operate as a complex system and interact with each other and with individual city inhabitants (including their psychological and neurobiological characteristics) to shape mental health in an urban context. These interactions operate on various timescales and show feedback loop mechanisms, rendering system behaviour characterised by non-linearity that is hard to predict over time. We present a conceptual framework for future urban mental health research that uses a complexity science approach. We conclude by discussing how complexity science methodology (eg, network analyses, system-dynamic modelling, and agent-based modelling) could enable identification of actionable targets for treatment and policy, aimed at decreasing CMD burdens in an urban context.
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Affiliation(s)
- Junus M van der Wal
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands; Department of Public Health, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Claudia D van Borkulo
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Marie K Deserno
- Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands; Centre for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Josefien J F Breedvelt
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; National Centre for Social Research, London, UK; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mike Lees
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Informatics Institute, University of Amsterdam, Amsterdam, Netherlands
| | - John C Lokman
- Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Denny Borsboom
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Damiaan Denys
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ruth J van Holst
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marten P Smidt
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Public Health, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Paul J Lucassen
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Julia C M van Weert
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, Netherlands
| | - Peter M A Sloot
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Institute for Advanced Study, University of Amsterdam, Amsterdam, Netherlands; National Centre for Cognitive Science, ITMO University, St Petersburg, Russia
| | - Claudi L Bockting
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Reinout W Wiers
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
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The Environment of Birthplace and Self-Reported Mental Health Conditions: Findings from the American Panel of Life. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2021; 2:256-261. [PMID: 36417224 PMCID: PMC9620909 DOI: 10.3390/epidemiologia2030019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 12/14/2022]
Abstract
Studies from around the globe have found that urbanicity is associated with greater risk for certain psychiatric disorders, though the association has been less evident in the United States. We analyzed data collected in 2019 from the RAND American Life Panel (n = 2554), which were representative of the general adult population of the United States. Using multivariable logistic regression, we examined the associations between environment of birthplace (large urban, small urban, suburban, rural) and psychiatric disorders, adjusting for sociodemographic characteristics. We found that being born in a large urban area was associated with greater odds of having any psychiatric disorder when compared with being born in a rural area. However, when looking at specific disorders, we found that being born in a large urban area was only significantly associated greater odds of anxiety disorder and post-traumatic stress disorder (PTSD), but was not associated with bipolar disorder, major depressive disorder, attention deficit/hyperactivity disorder, or alcohol/substance use disorder. Being born in a small urban area was marginally associated with anxiety disorder. Future studies should examine why urban birthplace has only been associated with anxiety disorders and PTSD in the United States, and why urbanicity is associated with mood disorders in other parts of the world but not in the United States.
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Attademo L, Bernardini F. Air Pollution as Risk Factor for Mental Disorders: In Search for a Possible Link with Alzheimer's Disease and Schizophrenia. J Alzheimers Dis 2021; 76:825-830. [PMID: 32568207 DOI: 10.3233/jad-200289] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
As a global problem that has increasingly been causing worldwide concern, air pollution poses a significant and serious environmental risk to health. Risks of cardiovascular and respiratory diseases, as well as various types of cancer, have been consistently associated with the exposure to air pollutants. More recently, various studies have also shown that the central nervous system is also attacked by air pollution. Air pollution appears to be strongly associated with a higher risk of cognitive defects, neurodevelopmental (e.g., schizophrenia) and neurodegenerative (e.g., Alzheimer's disease) disorders. Subjects with schizophrenia, as well as subjects with Alzheimer's disease, experience a variety of neuropsychological deficits and cognitive impairments. This determines an adverse effect on social and professional functioning, and it contributes to the long-term disease burden. However, no final conclusions have been drawn on the matter of the direct relationship between schizophrenia and Alzheimer's disease. In recent years, the topic of urbanicity and mental health has become increasingly important. Urban exposure to environmental toxins and pollution is currently described as a reliable risk factor for schizophrenia and other psychoses, and it has been demonstrated more and more how exposure to air pollutants is associated with increased risk of dementia. Pathways by which air pollution can target and damage the brain, leading to an increased risk for developing schizophrenia and Alzheimer's disease, are multiple and complex. Results from epidemiological studies suggest potential associations, but are still insufficient to confirm causality. Further studies are needed in order to verify this hypothesis. And if confirmed, the clinical implications could be of substantial relevance for both public and mental health.
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Affiliation(s)
- Luigi Attademo
- Department of Mental Health, ASP Basilicata, Potenza, Italy.,Planetary Health Lab, University of Edinburgh, Edinburgh, UK
| | - Francesco Bernardini
- Planetary Health Lab, University of Edinburgh, Edinburgh, UK.,Department of Mental Health, ASFO Friuli Occidentale, Pordenone, Italy
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Menculini G, Bernardini F, Attademo L, Balducci PM, Sciarma T, Moretti P, Tortorella A. The Influence of the Urban Environment on Mental Health during the COVID-19 Pandemic: Focus on Air Pollution and Migration-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3920. [PMID: 33917942 PMCID: PMC8068323 DOI: 10.3390/ijerph18083920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused a crisis worldwide, due to both its public health impact and socio-economic consequences. Mental health was consistently affected by the pandemic, with the emergence of newly diagnosed psychiatric disorders and the exacerbation of pre-existing ones. Urban areas were particularly affected by the virus spread. In this review, we analyze how the urban environment may influence mental health during the COVID-19 pandemic, considering two factors that profoundly characterize urbanization: air pollution and migration. Air pollution serves as a possibly risk factor for higher viral spread and infection severity in the context of urban areas and it has also been demonstrated to play a role in the development of serious mental illnesses and their relapses. The urban environment also represents a complex social context where minorities such as migrants may live in poor hygienic conditions and lack access to adequate mental health care. A global rethinking of the urban environment is thus required to reduce the impact of these factors on mental health. This should include actions aimed at reducing air pollution and combating climate change, promoting at the same time a more inclusive society in a sustainable development perspective.
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Affiliation(s)
- Giulia Menculini
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
| | - Francesco Bernardini
- CSM 24 ore Area delle Dolomiti Friulane, Department of Mental Health, AsFO Friuli Occidentale, 33170 Pordenone, Italy;
- Planetary Health Lab, Old Medical School, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Luigi Attademo
- Planetary Health Lab, Old Medical School, University of Edinburgh, Edinburgh EH8 9AG, UK;
- SPDC Potenza, Department of Mental Health, ASP Basilicata, Italian National Health Service, 85100 Potenza, Italy
| | - Pierfrancesco Maria Balducci
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
- CSM Terni, Department of Mental Health, 05100 Terni, Italy
| | - Tiziana Sciarma
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
| | - Patrizia Moretti
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
| | - Alfonso Tortorella
- Department of Psychiatry, University of Perugia, 06132 Perugia, Italy; (G.M.); (P.M.B.); (T.S.); (P.M.)
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Abstract
We examine epidemiological evidence for the central role of inequalities (principally economic) in driving the onset of mental disorders, physical ill health and premature mortality. We locate the search for solutions in current UK contexts, and include known and likely effects of the COVID-19 pandemic. Prevention of mental disorders and adverse outcomes such as premature mortality must begin with efforts to mitigate rising poverty-inequality.
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