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City Living and Mental Well-being

  • February 26, 2021
  • Anxiety, Depression, Patients and Families

More than half the world’s population lives in cities, and the number is expected to continue to increase in the coming decades. Living in urban areas has been associated with increased risk for mental disorders, including anxiety, depression and schizophrenia. Research using functional magnetic resonance imaging has identified changes in the brain indicating that urban upbringing and city living are linked to social stress processing.

Among the potentially contributing factors to poorer mental health in urban areas are air pollution and other exposure to toxins, increased noise, lack of open space, crime and social inequalities, and the stress of sensory overload. On the other hand, cities can provide advantages, such as better access to health care and education, and potential for social interaction. Urban environments vary greatly and many factors can play a role. For example, one study found that neighborhood characteristics, including social cohesion, pleasantness and safety, were associated with lower levels of depression.

A few of the features of urban environments that research has found can have a positive impact on mental health are:1

  • Green spaces, including small city parks and streets lined with trees.
  • Active spaces, including walkable neighborhoods and areas for recreation and leisure that promote both physical and mental health.
  • Social spaces, that encourage people to gather, such as with benches.
  • Safe spaces, where people have less concern about safety (crime, traffic, etc.).

In recognition of the impact of urban environment on mental health, the Center for Architecture and Design in Philadelphia recently awarded its annual Edmund Bacon Award for urban design psychiatry to psychiatrist Mindy Fullilove, M.D. The award recognizes Dr. Fullilove’s work at the intersection of space and cities and how it affects people on a very personal level. Fullilove, professor of urban policy and health at the New School in New York, has been studying and writing about the impact of urban design and urban disinvestment and revitalization on low-income communities for many years. Her latest book is “Main Street: How a City’s Heart Connects Us All.”

While her work has been ongoing for many years, Rebecca Johnson, executive director of the Center, observed it is particularly relevant and timely today. In accepting the award, Fullilove noted that the social and economic fallout of the coronavirus pandemic, and the recent protests for racial equity, have highlighted social fractures that make American cities fragile.2

While factors related to urban living may only make a small difference in mental health, on a population level with billions of people living in cities, making environments as supportive and positive as possible can be have an impact. Psychiatrist Lyla McCay, founder of the Center for Urban Design and Mental Health, and colleagues, suggest there are many opportunities for city planners to use “smart urban design to help promote good mental health, prevent illness, and support people who have mental health challenges.”3


  1. Kirk, Mimi. How to Support Mental Health Through Urban Planning. Bloomberg. December 2016.
  2. Crimmins, P. Center for Architecture gives awards for urban design psychiatry, ideas for PES site renewal. WHYY. February 10, 2021.
  3. McCay, L. et al. Urban Design and Mental Health in Mental Health and Illness in the City. Springer Nature, Singapore. 2017.
  4. Lederbogen, Florian, et al. City living and urban upbringing affect neural social stress processing in humans. Nature. 2011.
  5. Mechelli, Andrea. Cities increase your risk of depression, anxiety and psychosis – but bring mental health benefits too. The Conversation. December 18, 2019
  6. Baggaley, Kate. City life damages mental health in ways we’re just starting to understand. Popular Science. May 13, 2019
  7. Helbich, M., et al. Relative importance of perceived physical and social neighborhood characteristics for depression: a machine learning approach. Social Psychiatry and Psychiatric Epidemiology. May 2020

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