van der Wal, J. M., (2021). Advancing urban mental health research: From complexity science to actionable targets for intervention. Flashcards
background
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.
cmd =
common mental disorder
relatie tussen CMD and urbization
they found a positive, non-linear relationship with a higher CMD prevalence in more urbanised countries, particularly for anxiety disorders.
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
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two major events at the beginning of the 21st century that affect human society
- unprecedented increase in urbanization
- burden of mental disorders has increased
By contrast, a meta-analysis of population surveys done in the USA22 between 2009 and 2011 found no urban–rural differences
for major depression in adolescents (n=55 583) and the
highest risk of major depression in adults (n=116 459) in small metropolitan and semi-rural areas.
Results for substance use disorders are mixed, partly because of the wide variety of substances and differences in availability or legal status.
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hoe kan het dat bv. crime leidt tot meer internalising disorders
frequent exposure to negative circumstances such as inequality or crime in disadvantaged urban areas can lead to maladaptive appraisal in the form of negative selfevaluation or heightened perceived threats, increasing the risk of internalising disorders.
This weighted perception can further increase maladaptive behaviours, such as social isolation or illicit substance use, which will feed back to the urban environment (eg, by affecting neighbourhood social cohesion or crime).
cities and stress
Cities are generally associated with prolonged exposure to social stress, which can alter the stress response. Accumulation of stressors has a negative effect on
neurobiological stress resilience (ie, allostasis), modifying the risk to develop CMDs throughout life
Complex system behaviour in CMDs can be found in the occurrence of sudden deterioration of symptoms, characterised as sudden transitions around tipping points from a healthy to a pathological state.
Underlying dynamics could consist of reinforcing symptom feedback loops (eg, rumination and sleep) or
contributors to mental disorders (eg, poor diet and insufficient physical exercise)
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the conceptual framework is based on 4 principles:
(1) the factors and outcomes involved operate as dynamically interacting elements within a complex system,
(2) factors are affected by metafactors such as changes in city size, urbanisation, migration, and stage of economic development,
(3) interactions between explanatory factors and CMD symptoms occur over different timescales, and
(4) CMD outcomes can affect explanatory factors (feedback loops).
meta factors
- city size
- population growth
- urbanisation
- migration
- economic development
factors
- urban
- social
- individual
temporal scale
- years to throughout life
- weeks to months
- hours to days
Our example concerns Jane, an inhabitant of a neighbourhood with little green space (urban factor), in her country’s largest city (meta factor). Her apartment
is located close to a busy road. Jane has a low income, which often causes financial distress (individual factor). The constant traffic noise (urban factor) disturbs her sleep, causing insomnia.78 Chronic exposure to air pollutants (urban factor) could negatively affect brain structures and functioning,48 increasing her risk of developing a CMD. Insomnia could increase financial distress by negatively affecting work performance, creating a reinforcing feedback loop.79 Depending on Jane’s psychological coping and neurobiological susceptibility, these factors could trigger, for example, a depressive disorder.79 However, her municipality is investing in sustainable urban development (meta factor) and building a park (protective urban factor) between her apartment building and the busy road. This intervention could improve Jane’s mental health by reducing stress (individual factor)63 and mitigating traffic noise (urban factors) in the short term,80 and eventually by increasing neighbourhood social cohesion (social factor)81 or perhaps even by mitigating air pollution (urban factor).82 This
hypothetical example shows how multiple interactions, from the urban to the individual level, can trigger CMD symptoms, create feedback loops, and reinforce distress. It also exemplifies how interventions can affect multiple
pathways over different timescales
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The global population is increasingly living in urban environments. This demographic shift means there is
an increase in exposure to urban stressors that have been associated with higher risk of CMDs.
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