The mental health of urban populations is not merely shaped by biology or circumstance, it is embedded in the rhythms, structures and spatial logic of the cities they inhabit. As urbanization rises, it is increasingly clear that the design, governance and management of urban environments are not solely infrastructural concerns but matters of public health. Among the most urgent challenges is depression, now a leading global cause of ill health. While therapeutic interventions remain vital, the spaces in which people live, move and relate play a quiet, yet profound, role in shaping psychological wellbeing. The evidence is growing: city design is not neutral, it influences how we feel, connect, cope and flourish.
How urban design can lead to ‘anxious cities’
This recognition has led to the emergence of a new understanding of what may be termed ‘anxious cities’, a concept that captures the subtle, yet cumulative, ways in which urban design can intensify psychological strain.
‘Anxious cities’ is a term introduced in this work to describe urban environments where the cumulative effects of spatial design, infrastructure and social conditions contribute, often unintentionally, to chronic psychological strain. This concept provides a lens for examining how noise, mobility, spatial fragmentation and a lack of equitable access to green or social infrastructure intersect to shape emotional wellbeing. It is not meant as a diagnostic category, but as a framework to support more inclusive, preventive and emotionally sustainable approaches to urban planning and policy.
Urban form as a determinant of psychological wellbeing
Cities can nurture the mind or wear it down. Urban environments expose residents to a cascade of stressors: relentless noise, overcrowding, insufficient transport and a scarcity of green or communal spaces. When cities are designed without regard for human experience, they risk embedding distress into the daily lives of their inhabitants. In Mexico City, research has shown that neighbourhoods marked by high urban stress correlate with increased depressive symptoms, especially among women, who report disrupted sleep and persistent fatigue. Yet, global data shows that men are disproportionately affected with more severe outcomes, such as suicide, highlighting a concerning trend of unaddressed psychological distress.
This is not merely a matter of aesthetics or comfort. The placement of services, the structure of streets, the fragmentation of land use and the absence of gathering spaces all shape the emotional terrain of urban life. Planning decisions are, at their core, decisions about public health. A city’s layout can burden the psyche or gently sustain it.
This pattern manifests distinctly across diverse global urban contexts. In Delhi, India, research reveals significant mental health disparities between slum-dwelling adolescents and their counterparts in more affluent areas, with environmental stressors, such as overcrowding, inadequate infrastructure and limited privacy, intensifying symptoms of depression and anxiety. Similar challenges emerge in rapidly urbanizing Chinese cities, where longitudinal studies indicate widening rural-urban mental health inequalities, particularly among older adults.
Despite technological advances, urban residents consistently demonstrate better mental health outcomes than their rural counterparts, partly attributable to differential access to community resources. In Southeast Asian megacities, LGBTQ individuals face compounded mental health vulnerabilities when navigating urban environments that offer limited safe communal spaces. These disparities reflect how urban form, regardless of location, consistently influences psychological wellbeing through interconnected pathways of spatial design, infrastructure quality and access to restorative environments. The universality of this relationship underscores the need for context-sensitive, yet globally informed, approaches to urban mental-health planning.
The power of green infrastructure to restore emotional balance
Urban nature is more than ornamental, it is a quiet force for healing. Among the most consistent findings in public health research is the protective role of green spaces in supporting mental wellbeing. Trees, parks, gardens and even modest corridors of vegetation offer psychological restoration, as well as ecological benefits. In Canadian cities, a study on urban forests revealed that residents living near biodiverse, high-quality green areas reported significantly fewer mental health complaints, independent of income or background.
Yet, access to such spaces remains uneven. In many cities, lower-income neighbourhoods are the least likely to have nearby nature, compounding risks of stress and depression. This disparity is systemic, rooted in historical patterns of spatial exclusion and uneven investment. Green infrastructure must be recognized as a fundamental component of urban resilience. Expanding it equitably, especially in historically underserved communities, offers a clear and evidence-based path to a more emotionally balanced and inclusive urban future. A large-scale study in Denmark found that children who grew up with access to green spaces had a significantly lower risk of developing mental health disorders later in life, reinforcing the long-term protective power of nature. As cities reimagine their futures, integrating natural elements not as amenities but as rights, particularly for children and vulnerable populations, may be one of the most humane and preventive investments in collective mental health.
Mobility, noise and the psychological cost of movement
The way we move through a city is not neutral. It shapes how we feel, how we relate and how we endure. Yet, mobility remains a largely overlooked element of mental health. Long and stressful commutes on fragmented or overcrowded systems drain psychological resilience, eroding opportunities for rest, social connection and psychological recovery. In Mexico City, researchers found that transport-related stress contributed significantly to depressive symptoms, with women particularly affected. These findings reveal how the structure of urban movement can intensify emotional strain.
Cities that support gentler forms of mobility, where walking, cycling and public transit are safe, accessible and inviting, do more than reduce pollution. They ease the pressure of daily life. Movement evolves from a functional necessity to a potential source of psychological restoration.
Noise, too, carries a psychological cost. Chronic exposure to elevated sound levels has been linked to sleep disruption, anxiety and depression. When acoustic sensitivity informs urban design through zoning, vegetation and architectural awareness, cities can become quieter. In that quiet, mental wellbeing is given space to grow.
More than a matter of transit, mobility is a question of urban dignity. It reflects how cities value time, accessibility and the inner life of their residents. The emotional geography of a place is traced not only in its buildings but in how one moves between them. When movement feels safe, dignified and humane, the city itself begins to feel more like a home and less like an obstacle. Planning for mental wellbeing is, therefore, inseparable from the right to move freely, calmly and without fear.
Planning cities for emotional sustainability
A city is more than a collection of structures. It is an emotional ecosystem, a container for memory, movement and meaning. Depression, both as a personal affliction and a public challenge, reflects not only what happens within individuals but what happens around them. While medical care remains indispensable, prevention begins long before diagnosis. It begins in the quiet choices made by planners and policymakers, in how neighbourhoods are shaped, where trees are planted and how spaces invite connection, rather than concealment.
Designing for emotional sustainability requires cities to integrate mental wellbeing into every layer of urban life. Green infrastructure, equitable mobility and inclusive social spaces are not ornamental, they are essential. They determine whether the city becomes a setting for flourishing or a stage for chronic stress. Each zoning decision, each park bench, each stretch of pavement carries the weight of this responsibility.
Urban mental health must be recognized as a foundational concern for the twenty-first century. The choices we make today in housing, transport, land use and governance will echo across generations. With foresight and compassion, cities can shift from being quiet contributors to distress to becoming active protectors of the human spirit.
This vision lies at the heart of what I define as anxious cities: a framework for recognizing and redesigning the emotional impact of urban environments in pursuit of healthier, more inclusive futures.
Luis Antonio Ramirez Garcia
This article is republished from the World Economic Forum under a Creative Commons license. Read the original article.