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Is the prevalence of psychiatric disorders associated with urbanization?

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In many countries, the total rate of psychiatric disorders tends to be higher in urban areas than in rural areas. The relevance of this phenomenon is that it may help in identifying environmental factors that are important in the pathogenesis of mental disorders. Moreover, urban preponderance suggests that the allocation of funds and services should take urbanization levels into account.


The Netherlands Mental Health Survey and Incidence Study (NEMESIS) used the Composite International Diagnostic Interview (CIDI) to determine the prevalence of DSM-III-R disorders in a sample of 7,076 people aged 18–64. The sample was representative of the population as a whole. The study population was assigned to five urbanization categories defined at the level of municipalities. The association between urbanization and 12-month prevalence rates of psychiatric disorders was studied using logistic regression taking several confounders into account.


The prevalence of psychiatric disorders gradually increased over five levels of urbanization. This pattern remained after adjustment for a range of confounders. Comorbidity rates also increased with level of urbanization.


This study confirms that psychiatric disorders are more common and more complex in more urbanized areas. This should be reflected in service allocation and may help in identifying environmental factors of importance for the aetiology of mental disorders.

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  1. Dohrenwend BP, Dohrenwend BS (1974) Psychiatric disorders in urban settings. In: Caplan G (ed) American handbook of psychiatry. Basic Books, New York, pp 424–447

    Google Scholar 

  2. Marsella AJ (1998) Urbanization, mental health, and social deviancy. A review of issues and research. Am Psychologist 53(6):624–634

    Article  CAS  Google Scholar 

  3. Mueller DP (1981) The current status of urban-rural differences in psychiatric disorder. An emerging trend for depression. J Nerv Ment Disease 169(1):18–27

    Article  CAS  Google Scholar 

  4. Neff JA (1983) Urbanicity and depression reconsidered. The evidence regarding depressive symptomatology. J Nerv Ment Disease 171:546–552

    CAS  Google Scholar 

  5. Peen J, Schoevers RA, Beekman AT, Dekker J (2007) The current status of urban-rural differences in psychiatric disorders (Submitted)

  6. Verheij RA (1996) Explaining urban-rural variations in health: a review of interactions between individual and environment. Soc Sci Med 42(6):923–935

    Article  PubMed  CAS  Google Scholar 

  7. Webb SD (1984) Rural-urban differences in mental health. In: Freeman H (ed.) Mental health and the environment. Churchill Livingstone, London, pp 227–249

    Google Scholar 

  8. Blazer D, George LK, Landerman R, Pennybacker M, Melville ML, Woodbury M, Manton KG, Jordan K, Locke BZ (1985) Psychiatric disorders: A rural/urban comparison. Arch Gen Psychiatry 42:651–656

    PubMed  CAS  Google Scholar 

  9. Kessler RC, McGonagle KA, Zhao B, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the national comorbidity survey. Arch Gen Psychiatry 51:8–19

    PubMed  CAS  Google Scholar 

  10. Kessler RC, Chiu WTA, Demler OM, Walters EEM (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62:617–627

    Article  PubMed  Google Scholar 

  11. Kovess-Masfety V, Alonso J, de Graaf R, Demyttenaere K (2005) A European approach to rural-urban differences in mental health: the ESEMeD 2000 comparative study. Can J Psychiatry 50(14):926–936

    PubMed  Google Scholar 

  12. den Dulk CJ, Stadt H van den, Vliegen JM (1992) Een nieuwe maatstaf voor stedelijkheid: de omgevingsadressendichtheid (A new criterion for degree of urbanization: the local address density). Maandstatistiek van de Bevolking 7:14–27

    Google Scholar 

  13. Paykel ES, Abbott R, Jenkins R, Brugha TS, Meltzer H (2000) Urban-rural mental health differences in great Britain: findings from the national morbidity survey. Psychol Med 30(2):269–80

    Article  PubMed  CAS  Google Scholar 

  14. Weich S, Twigg L, Lewis G (2006) Rural/non-rural differences in rates of common mental disorders in Britain: prospective multilevel cohort study. Br J Psychiatry 188:51–57

    Article  PubMed  Google Scholar 

  15. Bijl RV, Ravelli A, Zessen G van (1998) Prevalence of psychiatric disorder in the general population: results of The Netherlands mental health survey and incidence study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol 33:587–595

    Article  PubMed  CAS  Google Scholar 

  16. Bijl RV, Zessen G van, Ravelli A, de Rijk C, Langendoen Y (1998) The Netherlands mental health survey and incidence study (NEMESIS): objectives and design. Soc Psychiatry Psychiatr Epidemiol 33:581–586

    Article  PubMed  CAS  Google Scholar 

  17. Robins LN, Wing J, Wittchen H-U, Helzer JE, Baber TB, Burke J, Farmer A, Towle LJ (1988) The composite international diagnostic interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1019–1077

    Google Scholar 

  18. Smeets RMW, Dingemans PMAJ (1993) Composite international diagnostic interview (CIDI), Version 1.1. World Health Organization, Amsterdam

    Google Scholar 

  19. Wittchen HU (1994) Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatric Res 28(1):57–84

    Article  CAS  Google Scholar 

  20. Altman DG (1991) Practical statistics for medical research. Chapman & Hall/CRC, Boca Raton

    Google Scholar 

  21. StataCorp (2003) Stata Statistical Software, release 8.1. Stata, College Station, Texas

    Google Scholar 

  22. Rothman KJ, Greenland S (1998) Modern epidemiology. Lippincott-Raven, Philadephia, pp 255–257

    Google Scholar 

  23. Bijl RV, Ravelli A (2000) Psychiatric morbidity, service use, and need for care in the general population: results of The Netherlands Mental Health Survey and Incidence Study. Am J Public Health 90:602–607

    PubMed  CAS  Google Scholar 

  24. Dekker J, Peen J, Smit F, Schoevers RA (2006) Prevalence of psychiatric disorders in relation with urbanization in Germany (Submitted)

  25. Verheij RA, Mheen HD van de, Bakker DH de, Groenewegen PP, Mackenbach JP (1998) Urban-rural variations in health in the Netherlands: does selective migration play a part? J Epidemiol Commun Health 52:487–493

    Article  CAS  Google Scholar 

  26. Dalgard OS, Tambs K (1997) Urban environment and mental health. A longitudinal study. Br J Psychiatry 171:530–536

    PubMed  CAS  Google Scholar 

  27. Halpern D (1995) Mental health and the built environment. Taylor & Francis, London

    Google Scholar 

  28. Pedersen CB, Mortensen PB (2001) Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Arch Gen Psychiatry 58:1039–1046

    Article  PubMed  CAS  Google Scholar 

  29. Faris R, Dunham H (1939) Mental disorders in urban areas. University of Chicago Press, Chicago

    Google Scholar 

  30. Giggs JA, Cooper JE (1987) Ecological structure and the distribution of schizophrenia and affective psychoses in Nottingham. Br J Psychiatry 151:627–633

    Article  PubMed  CAS  Google Scholar 

  31. Dauncey K, Giggs J, Baker K, Harrison G (1993) Schizophrenia in Nottingham: lifelong residential mobility of a cohort. Br J Psychiatry 163:613–619

    PubMed  CAS  Google Scholar 

  32. Moorin RE, Holman CDJ, Garfield C, Brameld KJ (2006) Health related migration: Evidence of reduced ‘urban-drift’. Health Place 12(2):131–140

    Article  PubMed  CAS  Google Scholar 

  33. Pedersen CB, Mortensen PB (2006) Are the cause(s) responsible for urban-rural differences in schizophrenia rooted in families or in individuals? Am J of Epidemiol 163(11):971–978

    Article  Google Scholar 

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Correspondence to Jaap Peen MS.

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Peen, J., Dekker, J., Schoevers, R.A. et al. Is the prevalence of psychiatric disorders associated with urbanization?. Soc Psychiat Epidemiol 42, 984–989 (2007).

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