Sociology, biology and mechanisms in urban mental health

The place of the social in psychiatry: from structural determinants to the ecology of mind

PURPOSE

Social psychiatry considers the ways in which mental disorders are shaped by particular social environments. This paper outlines a cultural-ecosocial approach that emphasizes the ways in which cultural meaning and practices mediate the effects of the social determinants of mental health on the mechanisms of illness, disorder, and disease.

METHODS

Selective review of literature and conceptual synthesis.

RESULTS

"The social" in psychiatry stands for the structures and dynamics of groups of people interacting on multiple scales from the intimate sphere of couple and family to neighbourhoods, communities, societies, nations, and transnational or global networks. These interactions create social contexts, niches, forms of belonging, identities, institutions, and larger systems that influence the causes, expression, course, and outcome of mental disorders. Characterizing these systems requires theory that considers the ways in which social systems constitute dynamical systems that configure material, energetic, and informational flows that give rise to human experience. Unpacking the health consequences of these local and extended systems requires an interdisciplinary approach that considers: (1) the social psychological, psychophysiological, and sociophysiological processes that mediate the impact of the environment on body, mind, and person; (2) the interactional dynamics of social systems that give rise to structural adversity and inequity as well as resilience; and (3) the recursive effects of self-understanding, agency and subjectivity.

CONCLUSIONS

In the cultural-ecosocial view, "the social" is shorthand for interactional processes that constitute material and symbolic structures that provide cultural affordances, constraints, and challenges as well as resources for healing, recovery, and adaptation.

Making un/equal: reassessing inequality and mental health through a praxeographic approach on welfare categorization processes

PURPOSE

In recent decades, Europe has seen a steady increase in psychiatric diagnoses, which, besides affecting the population in many ways, also challenges the organization of welfare. This paper explores how welfare classification processes impact the contemporary production of mental (ill) health and social inequality in the German welfare state.

METHODS

Based on comprehensive ethnographic research in the public mental healthcare landscape in Berlin between 2011 and 2017, this paper discusses in detail the case of a mandatory prescription of a psychosocial rehabilitation measure for Ms Reisch, a psychiatric service user and ethnographic research partner. The analysis draws on the methodological approach of praxeography to examine how this case challenges the social determinants of mental health framework and the conceptual work of the sociology of inequality on which the categories of welfare are largely built.

RESULTS

The paper highlights the essentializing properties of social categories, whether in the sociology of inequality or in social and mental health policy. It also demonstrates the strength of praxeography to expose how multiple welfare categorization processes shape experiences and events of dis/ability in practice, potentially contradicting the stated intentions of social policy.

CONCLUSION

The results suggest that the attachment of categories to people in public welfare needs to be changed to make public administration more flexible to responding to the situated processes that bring about differentiations of equal and unequal in practice. The paper, therefore, encourages social inquiry into the potentialities of a post-categorical social policy framework.

Investigating the effects of rurality on stress, subjective well-being, and weight-related outcomes

Purpose

Rates of obesity are significantly higher for those living in a rural versus urban setting. High levels of stress and low levels of subjective well-being (SWB) have been linked to poor weight-related behaviors and outcomes, but it is unclear if these relationships differ as a function of rurality. This study investigated the extent to which living in a rural versus urban county ("rurality") moderated associations between stress / subjective wellbeing (predictors) and diet quality, dietary intake of added sugars, physical activity, and BMI (outcomes).

Methods

Participants were recruited from urban (n = 355) and rural (n = 347) counties in Washington State and self-reported psychological, demographic, and food frequency questionnaires while physical activity behavior was measured objectively.

Findings

After controlling for relevant covariates, levels of stress were positively associated with added sugar intake for those living in the urban county while this relationship was non-significant for those residing in the rural county. Similarly, SWB was negatively associated with added sugar intake, but only for urban residents. County of residence was also found to moderate the relationship between SWB and BMI. Higher SWB was inversely associated with BMI for those living in the urban county while no relationship was observed for rural county residents.

Conclusions

These findings support the hypothesis that the relationships between stress / SWB and weight function differentially based on the rurality of the residing county. This work adds to the growing body of literature highlighting the role stress and SWB play in the rural obesity disparity.

Neurobiological effects of urban built and natural environment on mental health: systematic review

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.

Urban precarity and youth mental health: An interpretive scoping review of emerging approaches

Circumstances of living are key to shaping emotional and affective experiences, long term health, wellbeing and opportunities. In an era characterised by rapid urbanisation across the majority of the world, there is increasing interest in the interaction between mental health and urban environments, but insufficient attention is paid to how mental health is situated in space and time. Socio-economic inequalities are prevalent in many urban environments globally, making conditions of living highly precarious for some social groups including young people. There remains a large volume of unmet mental health service needs, and young people are impacted by uncertain economic futures. The purpose of this scoping review is to develop an interdisciplinary and globally-informed understanding of the urban conditions which affect youth mental health across a range of scales, and to identify protective factors which can promote better youth mental health. We seek to broaden the scope of urban mental health research beyond the physical features of urban environments to develop an interpretive framework based on perspectives shared by young people. We illustrate how concepts from social theory can be used as an integrative framework to emphasise both young people's lived experiences and the wider cultural and political dynamics of urban mental health.

Cities and neuroscience research: A systematic literature review

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.

Stress and emotional arousal in urban environments: A biosocial study with persons having experienced a first-episode of psychosis and persons at risk

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.

Urban green spaces and stress during COVID-19 lockdown: A case study for the city of Madrid

Due to the unexpected emergence of COVID-19, different cities improvised responses to prevent the virus from spreading and infecting the population. Madrid, capital of Spain and one of the most affected cities in Europe, confined everyone home and closed most public and private spaces, including public parks. The whole situation was surely to be responsible for stress-levels to peak. We developed an online survey to better understand the relationship between people and Urban Green Spaces prior to the COVID-19 pandemic, and the new bond that may have emerged from this interruption. We recruited participants, without gender or age preference, excluding underage children and teenagers, using a combination of convenience sample and a snowball approach. A total of 132 responses were logged. The study was limited to mental health inferences, specifically related to stress and its most frequent manifestations among the urban population. These indicators included physical, mood or behavioral changes and were studied on those participants who had access to UGS before and during confinement. Among the most important findings, we confirmed that when people are confronted with stressful situations, indoor plant interaction is not a substitute for different outdoor green experiences; those who interacted with green spaces in a daily manner managed stress levels better than people who didn't (but their effects might lose strength over time); and turning to green spaces for comfort during stressful times when you don't usually do so helps overcome difficult situations. This article contributes to the growing study of green spaces as a means towards improved mental well-being in urban areas.

Investigating the mental health implications of urban environments with neuroscientific methods and mobile technologies: A systematic literature review

Urbanization is an ongoing global process that is influencing and shaping individual mental health and well-being. This paper aims to provide an overview of the current literature containing state-of-the-art neuroscientific and mobile technologies that have been used to investigate the mental health implications of urban environments. Searches for peer-reviewed primary research articles were conducted in PubMed and SCOPUS, returning 33,443 papers; 90 empirical articles published from 1981 to 2021 were included in the final synthesis. Central findings suggest virtual reality and mobile electroencephalography to be the most commonly used methods, and demanding mood, affect, and health phenomena or states to be the most common concepts of study in both physical built settings and natural urban spaces. Recommendations for both future practice and study noting particular opportunities for future methodological contributions are discussed.

How Do Urban Environments Affect Young People's Mental Health? A Novel Conceptual Framework to Bridge Public Health, Planning, and Neurourbanism

Childhood and adolescence are crucial periods for mental and social development. Currently, mental illness among young people is a global epidemic, and rates of disorders such as depression and anxiety are rising. Urban living, compared with rural living, is linked with a higher risk of serious mental illness, which is important because the world is urbanizing faster than ever before. Urban environments and their landscapes, designs, and features influence mental health and well-being. However, no conceptual frameworks to date have detailed the effect of urban environments on young people's mental health, and few studies have considered the growing role of digital and social media in this relationship, leading to calls for the development of holistic approaches to describe this relationship. This article synthesizes existing knowledge on urban places (both built and natural environments) and mental health in the public health and urban planning literature and examines the emerging field of neurourbanism (a multidisciplinary study of the effect of urban environments on mental health and brain activity) to enhance current practice and research. We developed 2 novel conceptual frameworks (1 research-oriented, 1 practice-oriented), adapted from Bronfenbrenner's socioecological model, that focus on the relationship between urban environments and young people's mental health. We added a digital and social media contextual level to the socioecological model, and we applied a multilayer concept to highlight potential cross-field interactions and collaborations. The proposed frameworks can help to guide future practice and research in this area.

Toxoplasma gondii and Psychopathology: Latent Infection Is Associated with Interpersonal Sensitivity, Psychoticism, and Higher Testosterone Levels in Men, but Not in Women

Objective

The ability of parasites to hijack the nervous system, manipulating the host’s physiology and behavior in ways that enhance the parasite’s fitness while damaging host fitness, is a topic of ongoing research interest in evolutionary biology, but is largely overlooked in mental health research. Nevertheless, recent evidence has shown that Toxoplasma gondii infection can change host testosterone levels and influence the development of some psychiatric disorders. Here, we tested this hypothesis in a mixed sample of 213 non-clinical subjects.

Methods

Participants (nmales = 108, nfemales = 105) provided 5 ml of blood to quantify testosterone levels and Toxoplasma gondii antibodies. The Symptom Checklist-90-Revised was used to assess psychopathological symptoms.

Results

The results showed that Toxoplasma-infected men had higher testosterone levels and scored higher in Interpersonal Sensitivity and Psychoticism symptoms than non-infected men. Toxoplasma-infected women did not differ from control women.

Conclusions

Framed in an evolutionary framework, the findings suggest that the elevated testosterone levels and the expression of psychopathological symptoms can be seen as the result of the manipulation exerted by Toxoplasma gondii either to reach its definitive host or to increase its spread. Future research can benefit from integrating insights from evolutionary biology and parasite-host interactions with physiology, immunology, and mental health to develop a better understanding of mental health etiology.

Urban Emotion Sensing Beyond 'Affective Capture': Advancing Critical Interdisciplinary Methods

The use of mobile sensor methodologies in urban analytics to study 'urban emotions' is currently outpacing the science required to rigorously interpret the data generated. Interdisciplinary research on 'urban stress' could help inform urban wellbeing policies relating to healthier commuting and alleviation of work stress. The purpose of this paper is to address-through methodological experimentation-ethical, political and conceptual issues identified by critical social scientists with regards to emotion tracking, wearables and data analytics. We aim to encourage more dialogue between the critical approach and applied environmental health research. The definition of stress is not unambiguous or neutral and is mediated by the very technologies we use for research. We outline an integrative methodology in which we combine pilot field research using biosensing technologies, a novel method for identifying 'moments of stress' in a laboratory setting, psychometric surveys and narrative interviews on workplace and commuter stress in urban environments.

Anti-aging technoscience & the biologization of cumulative inequality: Affinities in the biopolitics of successful aging

This paper charts the emergence of under-remarked affinities between contemporary anti-aging technoscience and some social scientific work on biological aging. Both have recently sought to develop increasingly sophisticated operationalizations of age, aging and agedness as biological phenomena, in response to traditional notions of normal and chronological aging. Rather than being an interesting coincidence, these affinities indicate the influence of a biopolitics of successful aging on government, industry and social science. This biopolitics construes aging as a personal project that is mastered through specific forms of entrepreneurial individual action, especially consumption practices. Social scientists must remain alert to this biopolitics and its influence on their own work, because the individualization of cumulative inequalities provides intellectual and moral justifications for anti-aging interventions that exploit those inequalities.

Mental health, subjectivity and the city: an ethnography of migrant stress in Shanghai

Ethnography, with its focus on everyday experience, can yield significant insights into understanding migrant mental health in contexts where signs of severe mental distress remain largely imperceptible, and more generally, into how stresses and strains are lived through the spaces, times and affective atmospheres of the city. Migrant ethnography can help us reconsider the oft-made connection between everyday stress and mental ill health. In this contribution, drawing on field evidence in central and peripheral Shanghai, we highlight the importance of attending to the forms of spatial and temporal agency through which migrants actively manage the ways in which the city affects their subjectivity. These everyday subjective practices serve to problematize the very concept of ‘mental health’. The paper engages in a critical dialogue with sociological and epidemiological research that assesses migrant mental health states through the lens of the vulnerability or resilience of this social group, often reducing citiness to a series of environmental ‘stressors’. Distinct from methods ascertaining or arguing against the prevalence of mental disorders among urban migrants, the insight of urban ethnography is to open up a space to explore the mediations that operate dialogically between the city as lived by migrants through particular places and situations and forms of distress.

Digging deeper in Shanghai: towards a 'mechanism-rich' epidemiology

Background

There are very few close-up sociological or anthropological data informing epidemiological and psychiatric research design and/or contributing to our understanding of the relationship between mental health and specific forms of urban life. Furthermore, research on the relationships between urbanicity and mental disorder has paid little attention to the global diversity of urban experience, such as in cities in China, India and Brazil.

Methods

Two innovative methods can be employed to unveil the diversified urban experience of migrants in China, i.e. an ethnography-informed sociological deep surveying instrument and an ecological momentary assessment with a smartphone app. This article introduces the design and pilot survey of these new instruments towards a ‘mechanism-rich’ epidemiology.

Results

The ethnography-informed survey instrument enabled us to include some of the issues from the ethnography and successfully ‘dig deeper’ into respondents’ social experience. The pilot of the smartphone app serves as ‘proof of principle’ that we can recruit respondents in Shanghai, and that we can receive and use the data.

Conclusions

Both of these pilots have demonstrated good feasibility for studying mobility, urban life and mental health. Our next steps will be to extend the Shanghai sample, to use the app in Sao Paulo and Toronto and then hopefully in India and Africa.