Mental health and well-being living in Cities
Mental health and well-being living in CitiesWell-being is referred to feeling content, function well, have positive relationships, some control over one’s life and a sense of purpose, while mental health is defined by the World Health Organization as ‘a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.
Living in cities offers increased access to better healthcare and education, more opportunities for employment as well as for development and expression of personal identities, all supporting better mental health and well-being while maintaining high levels of wellbeing reduces the risk of developing mental health issues. Still, social and environmental factors related to urban living such as air pollution, noise, lack of green spaces, densely populated and deprived neighbourhoods and social inequalities negatively affect the brain development and function as a result the well-being and the mental health of individuals.
Mental health is a result of an interplay of biological, social and environmental factors. Genetics seem to influence mental health by only 30% – 40% while shared and non-shared social and environmental factors influence more. Social factors such as family, friends, neighbourhood, society and culture, factors that change over time influence mental health through complex interrelations. Environmental factors such as the built environment, the natural features, the quality of air, the levels of noise, the infrastructure and the access to services affect the wellbeing and mental health of individuals. Environmental factors are particularly influential during early childhood and adolescence, a period when brain and neurophysiological development is mostly taking place, affecting mental health and wellbeing. In conclusion, the impact of urban social and environmental factors also depends on the individuals’ genes.
Already more than 50% of the global population lives in cities and by 2050 70% of the world’s population will live in cities, making the urban environment of increased importance since both social and environmental aspects of it affect mental health and wellbeing. Although living in cities offers many benefits and opportunities, urban environments are related toincreased air pollution and noise, high land use density, lack of natural features such as green and blue spaces, low traffic safety, overcrowded and deprived neighbourhoods and increased crime, negatively affecting the mental health and wellbeing of individuals living in them compared to living in rural areas.
Urban living particularly to individuals with high genetic risk changes the brain volume and brain regions such as the amygdalae that are related to stress processing leading to poor mental health and the development of mental health conditions.
The existence of adverse environmental and social factors related to urban living but also the perceptions of these, disrupt the biological stress response during developmental years, lead to increased perception of threat, higher levels of stress and as a result lead to poor wellbeing and mental health. Adversity and particularly adversity in early life cause allostatic load and sustained activation of the nervous system and more specifically of the sympathetic branch through the Hypothalamus Pituitary axis.
Children and adolescents brought up and living in urban environments seem to have an increased prevalence for developing schizophrenia, bipolar disorder and autism. Also, adults with urban versus rural upbringing differing in their neurocognitive reactivity to social stress have increased risk of developing psychiatric disorders.
In conclusion, living in cities is related to increased rates of anxiety by 21% and of mood disorders, psychosis and addictive disorders by 39%.
One of the key aspects of urban living that affects most of the people is the air pollution. Urban environments have 78% of global emissions affecting more than 50% of population globally with main sources of air pollution motor vehicles and factories. The air pollution exposure is not only associated with physical health problems such as cardiovascular, respiratory, and metabolic diseases but also with effects on the central nervous system causing neurotoxicity and neuropathology, mental health conditions such as anxiety and depression and mostly neurodevelopmental disorders such as schizophrenia. Individuals growing up or living in urban environments, with a higher level of urbanisation and higher proximity to air pollution sources, are facing increased risks of developing mental health conditions and particularly of psychosis. Furthermore, individuals living closer to motorways experience reduced wellbeing and mental health, in comparison to those living further away, although this could also be related to the increased noise levels. In conclusion, the exposure to air pollution is correlated with changes in brain regions that are involved in stress response and emotional regulation, as seen through neuroimaging studies.
While the exposure to air pollution is one of the most common environmental factors related to urban living, proximity and hours of contact with green spaces, as well as perceived quality of green spaces is also related to increased mental health and wellbeing in children and adults. The green spaces are not only reducing the exposure to air pollutants and noise by converting CO2 to oxygen but also reduce distress and the effect of urban stressors by activating the parasympathetic system. Furthermore, safe, well-maintained green spaces with easy access are related to recreational activities, increased physical activity and socialisation, mediating the positive effects on mental wellbeing and mental health.
In conclusion, the more the exposure to natural features such as green spaces, the lower the anxiety levels of individuals living in urban environments.
There are big differences between cities and between neighbourhoods within the cities, making environmental and social factors unequally distributed and unequally affecting the mental and physical health of individuals. Due to the more intense social inequalities in cities, individuals of lower socio-economic status, of ethnic and gender minorities, and individuals living in deprived and densely populated neighbourhoods with less access to protective resources against stress, perceive exclusion and discrimination and as a result diminished self-esteem, increasing the risk of mental health issues such as depression, anxiety and psychosis.
The perceptions of an adverse neighbourhood in combination with common environmental factors of urban areas such as the poor air quality increase perception of the environment as threatening and as a result the distress, augmenting particularly the risk in developing psychosis until the age of 18 years old in comparison to individuals who perceive their neighbourhoods safer and less threatening. More specifically, an increase in the perception of the immediate neighbourhood as adverse, is associated with increased likelihood of reported psychotic experiences by 60%.
Also, adults with schizophrenia after brief exposure to crowded and unsafe urban environments, their symptoms were immediately exacerbated further establishing the correlation of living in cities with increased rates in poor wellbeing and mental health and particularly psychosis.
Yoga and yoga therapy provides effective protective factors by teaching proper breathing through the nose filtering the air, by deep and slow breathing and meditation balancing the nervous system offering peace of mind, and by asanas/movements giving a sense of empowerment control.
Wellbeing is the balance point between individual’s resources and potential challenges and is a prerequisite for mental health. Although living in cities offers great opportunities for personal and professional development, it is also related to common adverse and unequally distributed environmental and social factors such as exposure to polluted air and noise, lack of natural features, increased social inequalities, perception of lack of safety of isolation and loneliness and overcrowded and deprived neighbourhoods. All these factors, affect the neurophysiological development and function of the brain, increasing the perceived stress levels and allostatic load and negatively affecting the mental health and wellbeing as well as the overall health mostly of children and adolescents that grow up in cities and have a genetic predisposition.
Yoga and yoga therapy establishes a sense of control and safety, enhances the parasympathetic branch of the nervous system and promotes mental and physical well-being and health.
