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Studies show that mental disorders are much less common in rural areas.
More and more people live in cities. More than half of the world’s population already lives in cities. It is estimated that by 2050, two-thirds of the people on this planet will live in urban places. From a mental health perspective, this may not be a good trend. Because people in cities suffer from mental disorders more often than people in rural areas. Meta-analyses in which the results of several studies are evaluated show, for example: Anxiety disorders are around 20 percent more common in cities than in the country, and affective disorders such as depression are even around 40 percent more common.
It is not yet entirely clear why people living in cities are more susceptible to mental disorders than those living in rural areas. “But we have evidence that stress plays a role,” says psychiatrist and stress researcher Mazda Adli, medical director of the Fliedner Clinic Berlin and head of the affective disorders research area at the Clinic for Psychiatry and Psychotherapy at the Berlin Charité. “The greater social stress of city life could be one of the central reasons.”
Social stress arises from living together with other people and can occur in different ways in everyday urban life. For example, as density stress, i.e. when people live together in a small space and have no room to retreat. But there is also isolation stress when you feel lonely and socially isolated even though there are many people around you. Or when people with a migration background are socially excluded. According to Adli, things become particularly toxic when both – density stress and isolation stress – come together. “Social stress is particularly damaging to your health when it becomes chronic and you feel like you have no control over it.”
It is easy to understand that social stress can take its toll on the psyche. More surprising: thick air in cities can also damage the psyche. What is meant is not the thick atmosphere that prevails when the mood is not good. But the bad air that comes from the exhausts of cars or the chimneys of factories.
In a large-scale study from Great Britain and China, almost 400,000 people were followed over a period of more than ten years. Results: The concentration of air pollution where the participants lived was associated with a greater risk of later developing clinical depression or anxiety disorders.
The risk of depression was increased by 16 percent with the highest air pollution compared to the lowest. The way in which air pollutants can affect mental life is now becoming increasingly clear. Particularly small fine dust particles can cross the blood-brain barrier, which normally protects the brain from harmful substances from the bloodstream. This is how air pollutants get into the brain. There they can trigger inflammatory reactions and immune system reactions. Such reactions can in turn impair the function of neurotransmitters in the brain. This fits well into the picture of mental illness. Because nerve cells communicate via messenger substances such as serotonin, which is often referred to, somewhat simply, as the “happiness hormone”. Such messenger substances are impaired in psychological disorders such as depression.
It is possible that levels of air pollution also influence how susceptible people are to stress. This is suggested by a study published in 2023 by Mazda Adli, which was carried out in collaboration with the Federal Environment Agency. Adli and his team found that when there is a higher concentration of particulate matter where you live, the activity of areas of the brain that regulate stress and emotions is weaker. As a result, affected people are probably more susceptible to stress.
Conversely, it was also shown that if the proportion of green spaces in the place of residence is higher, the activity of the stress-regulating areas of the brain is also higher. As a result, you are probably more stress-resistant. The study is not yet proof that the different stress reactions in the brain are really only related to particulate matter pollution or the proportion of green space. But both aspects could have an impact on brain function under stress. In any case, it is becoming increasingly apparent that green spaces are good for mental health. For many people, green spaces in the city offer an opportunity to escape the stress of everyday life.
In addition, city life can outperform country life in many ways when it comes to mental health, says Mazda Adli. Health care is better in urban areas. The city also offers more opportunities for education, cultural activities and development. On average, there is a higher standard of living and more prosperity. “All of this is good for the psyche.”
But city life also has its downside. “Not only is the social stress greater than in the countryside, but stress in general,” says Adli. Things are louder and more hectic in the city. “The vast majority of people can compensate for this additional stress quite well using the city’s resources.” But there are also people who have little access to these resources because they are unevenly distributed. “Not everyone has green spaces nearby or can afford to go to the theater or museum,” says Mazda Adli.
What protects the psyche, according to Mazda Adli, is being socially active and feeling like you belong. “Especially those who feel lonely should try to make contact with other people, such as neighbors or like-minded people,” advises the Berlin psychiatrist. You should get to know your own city or your own district – that is, get familiar with it. In addition, use the city’s cultural resources such as museums or theaters and spend time on your own doorstep, occasionally in the countryside.
From Adli’s perspective, urban planning can help prevent social stress. “It should ensure public spaces that are accessible to everyone, so that people can exchange ideas and feel like they belong socially.” This included green spaces. This doesn’t always have to be parks; it could also be street greening with trees. “And this also includes theaters, museums and cultural centers.”