Spatial clustering of anxiety and depression and determinants of high-risk areas in a Swiss urban population, 2023-2025.

Abstract

Background: Anxiety and depression are leading contributors to the global mental health burden, often clustering in urban areas where sociodemographic vulnerabilities and environmental stressors accumulate. Evidence on their joint and distinct spatial patterns in high-income urban contexts remains limited.

Methods: We analyzed longitudinal data from 2023 to 2025 collected in the population-based Specchio study in Geneva (N = 6057), Switzerland. Prevalence and distribution of anxiety (GAD-2 ≥ 3) and depression (PHQ-2 ≥ 3) were assessed. Spatial clustering was examined using Spatial and Spatiotemporal Relative Risk (sparr). Generalized estimating equations evaluated sociodemographic, psychosocial, and environmental determinants.

Results: Overall, 6057 participants were included, 59% female, mean age (51.8 ± 14.0). The prevalence of anxiety was 13.5%, 14.1%, 12.1% and depression 9.9%, 9.4%, 8.1% in 2023, 2024 and 2025 respectively. Spatial high-risk clusters for anxiety and depression were identified and overlapped in central Geneva. These clusters persisted between 2023 and 2025. Depression clusters decreased slightly after adjustment for age, sex, and education, and anxiety clusters remained the same. High-risk clusters were associated with lower income, more one-person households, higher levels of air pollution, urban heat, and reduced greenness compared with the rest of the canton. Findings were consistent when restricting analyses to individuals who participated in all three years.

Conclusion: Areas with greater socioeconomic disadvantage and higher environmental stress were characterized by higher prevalence of anxiety and depressive symptoms in an urban area in Switzerland. These findings underscore the need for targeted public health interventions that integrate social and environmental approaches for mental health issues in urban settings.