Debate: Urban-rural environments - which is better for mental health? Moving beyond urban-rural dichotomies in psychosis risk for young people.

Abstract

While urban-rural gradients exist for common mental disorders (Wiers et al., 2025), observations from the Global North suggest these are strongest for psychotic disorders, which typically emerge during adolescence. Despite well-documented urban-rural variation in risk, recent research suggests a more nuanced relationship between place and these severe mental illnesses exists. Traditional urban-rural dichotomies cannot account for social gradients in psychosis globally for young people. Instead, a framework centred on social identity, inclusion and belonging may provide a more comprehensive approach to understanding psychosis risk as a result of the environments in which people are born, raised and live. Future research should integrate traditional epidemiological designs with causal inference methods and new technologies to capture momentary responses to diverse environmental stimuli that are both place-based and placeless. This approach could uncover novel avenues for prevention and intervention, tailored to the digital age, ultimately improving outcomes for young people and families affected by psychosis.