Urbanization and psychiatric illness in southern countries around the world
Urban life is not for everyone. It’s loud and crowded, your neighbor upstairs decided that Saturday 8am is the perfect time for a vacuum cleaner. The last one may be me. This city is not for the faint of heart, but have you ever wondered if it would harm your mental health?
Many researchers have. Urbanization has long been a keen area of interest. Research shows a link between exposure to urban environments and increased psychiatric morbidity (Kirkbride et al., 2024).
One popular explanation of this trend is social drift, the idea that psychopaths tend to convene in urban areas. However, recent longitudinal evidence suggests that social drift is not the whole story (March et al., 2008). Urban population is increasing, and by 2050, two-thirds of us are expected to live in urban environments (Ritchie et al., 2018), it makes sense that we want to figure out what causes this association.
The vast majority of research on urbanity was conducted in the northern part of the world (this trend is reliably found in the northern part, but not in southern Europe). Studies conducted in the south of the world have found contradictory results. This article (Roberts et al., 2023) begins to study this change.
Will urban life harm our mental health? Researchers are exploring how to correlate urban environments with increased psychiatric rates.
method
This is a cross-sectional study conducted in India, Nigeria and Trinidad using a network of local health and community providers. It analyzes how psychiatric levels classify urban or rural areas as urban or rural areas as population density and construction area level.
The researchers identified possible cases using local terms used to describe psychosis, which were collected among early qualitative pilots of the program. Suspicious cases were screened and researchers interviewed individuals whose cases met certain criteria. The case investigation period began in May 2018 and stopped after 24 to 27 months.
To be included in the study, an individual must be not previously diagnosed, which means never received a diagnosis or antipsychotic medication. The number of untreated psychiatric disorders was calculated and population estimates were used to calculate the relative rate of undiagnosed psychiatric disorders in each area.
result
Final samples were found; India: 268, Nigeria: 196 and Trinidad: 574 cases.
Trinidad
More and more urban areas have higher psychiatric rates (IRR: 3.24, 95% CI 2.68 to 3.91). In most urban areas, the rates are three times higher than those in the smallest cities. This trend has been found in all cases and when looking at recent onsets only.
India
There was no difference between more and fewer cities (IRR: 1.18, 95% CI 0.93–1.52) when all cases were included. When restricted to excluding long-term untreated cases, they found that more urban areas had higher psychiatric rates.
Nigeria
Lower psychiatric rates were found in more urban areas (IRR: 0.68, 95% CI 0.51 to 0.91). This trend has been found in recent episodes and in all cases.
The study shows that cities and psychiatric links vary widely – rising in Trinidad, changing in India, and falling in Nigeria.
in conclusion
The authors say these findings are “tentative” to suggest that the link between urbanization and mental disorders is context-specific. The strong evidence of their findings of connection between Trinidad is in stark contrast to earlier studies (Morgan et al., 2024). However, due to the cross-sectional nature of the study, they cannot rule out social drift.
The findings suggest that urban psychiatric links may be context-specific, although questions about social drift are still unanswered.
Advantages and limitations
This study is the first to show the link between urbanization and psychiatric disorders in Trinidad. The authors try to explain this finding, suggesting that this is due to an increase in risk factors such as violence since the last study. Focusing on Nigeria, India and Trinidad, the author provides a broad understanding of southern countries around the world. Nigeria and India will consider a lot of urbanization, making it particularly interesting. Trinidad has recently been classified as a high-income country, making possible comparisons with the impact of Nordics. Another advantage of the study is that in its broad limitations, the authors demonstrate their commitment to transparency.
However, as with all studies, there are limitations. This study included only three locations in larger countries. Especially in India and Nigeria, these findings are more extensive for these countries. As a cross-sectional study, researchers cannot rule out social drift because there is no attempt to record childhood history and thus are exposed to cities during development. In addition, they used two categories of urbanization systems: rural or urban. No consideration is given to areas like Ona Ara in Nigeria, which is a mixture of rural and urban areas. Inclusion of urban areas in this rural category may distort the unexpected results found.
Due to the case investigation method, there are some accurate problems. First, due to limited data, they cannot explain factors such as family history of psychiatric disorders. Furthermore, they show that case investigation is challenging in urban areas. But instead, they noted that in urban areas, services may be more accessible, which may drive some of the differences. These methodological weaknesses are particularly evident in the Nigerian data.
In cultural and historical contexts, mental diagnosis needs to be carefully considered, especially mental illness. Psychiasis is diagnosed among black people because of institutionalized racism that historically and currently maintains psychiatry (Van der Ven and Susser, 2023).
I think the author missed an opportunity to clearly acknowledge structural inequality, how to make the persistence of urban life. Our environment is built by people of power, i.e. infrastructure, pollution, green space, all of which are not determined by the factors they affect. Whether urban life brings risks or rural life can provide protection, and having the freedom to change the environment is a privilege. Exposure to health risks is rarely arbitrarily determined and can have a disproportionate impact on socially marginalized groups.
These findings provide insights into urbanization and psychosis in the global South, but also highlight how structural inequality and imbalances of power affect exposure and outcomes.
Impact on practice
The most important thing in this article is the need to conduct research from the global south. The relationship between urbanization and psychiatric disorders cannot be neatly transformed into countries outside the northern part of the world. It is a reminder that mental health has always been in dialogue with cultural, political and environmental landscapes.
The authors correctly point out that urbanization is complex and requires work to understand how it affects psychosis. Identifying such factors will allow for effective prevention strategies. This, in turn, can help improve physical and mental health by making our environment effective for us.
This study highlights the urgent need for global South research, reminding us that mental health is shaped by location, environment, and complexity.
MSC students at the University of Glasgow
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Statement of interests
As the founder of LGBTQ+ NGO, my perspective is consistent with my experience of the power of community well-being. I think community care is infinitely valuable, which undoubtedly influences my interpretation of the above paper. Furthermore, as someone from northern Ireland, I don’t think mental health is relevant to the impact of history, especially the oppression, violence and systemic instability of global powers. Research cannot and should not avoid naming these perpetrators. Finally, as someone growing up in the global North, I want to admit that my ability to understand conceptualization of global mental health is limited. My kind colleagues and peers should continue to expand my understanding by continuing to share their knowledge, perspectives and experiences.
Link
Main paper
Roberts, T., Susser, E., Lee Pow, J., Donald, C., John, S., Raghavan, V. ,…Morgan, C. (2023). Urbanization and untreated psychiatric rates in three different environments across the globe. Psychology,,,,, 53(14), 6459–6467. doi: 10.1017/s0033291722003749
Other references
Abi-Dargham, A., Moeller, SJ, Ali, F., Delorenzo, C., Domschke, K. Field. World Psychiatry, 22:236-262.
Ritchie, R., Samborska, V., Roser, M. (February 2024). Urbanization.
Kirkbride, JB, Anglin, DM, Colman, I., Dykxhoorn, J., Jones, PB, Patalay, P., Pitman, A. Social determinants of mental health and disorder: evidence, prevention, and advice. World Psychiatry: Official Journal of the World Psychiatry Association (WPA),,,,, twenty three(1), 58-90.
March, D., Hatch, SL, Morgan, C., Kirkbride, JB, Bresnahan, M., Fearon, P. , & Susser, E. (2008). Mental illness and place. Epidemiological Review,,,,, 3084-100.
Masten, AS, Lucke, CM, Nelson, KM, & Stallworthy, IC. (2021). Developmental and resilience in psychopathology: a multi-system perspective. Annual Review of Clinical Psychology,,,,, 17(1), 521–549.
Morgan, C., Cohen, A. and Roberts, T. (2024). Psychiatric: A global perspective. Oxford University Press.
Summerfield D. Postscript: Oppose “global mental health”. Intercultural psychiatry. 2012; 49 (3-4): 519-530.
doi: 10.1177/1363461512454701
E. Van der Ven, E. (2023). Risks of structural racism and schizophrenia. American Journal of Psychiatry,,,,, 180(11), 782–784.
