Mental health facility visits before and after the outbreak of COVID-19: The role of walkable built environment

Before the COVID-19 pandemic, walkability was linked to improved mental health . However, walkable areas can be more vulnerable to outbreaks of infectious diseases due to increased interaction and proximity between individuals, potentially leading to adverse effects on mental health. Whether walkability maintains its positive association with better mental health during the pandemic remains unclear, especially given mixed findings on whether walkability increases COVID-19 cases. This study integrates Walk Score®, mental health facility visit frequencies from mobile phone GPS trajectories, and COVID-19 case rates to explore how the relationship between walkability and mental health evolves across three periods: before the pandemic, during its early stages, and in the later stages. Additionally, it examines the role of COVID-19 case rates in this dynamic using mediation analysis . Our findings indicate that Walk Score® consistently associates with reduced frequency of mental health facility visits at all three time points, despite a reversal in the relationship between walkability and COVID-19 case rates from the early to later stages of the pandemic. Mediation analysis revealed that walkability has only direct effects on mental health in the early stages of the pandemic when walkability was found to be correlated with increased COVID-19 case rate. However, both indirect and direct effects were observed when walkability was associated with reduced COVID-19 case rate in the later stages. The study demonstrates that walkable environments consistently offer mental health benefits throughout different pandemic stages. These findings underscore the importance of integrating walkability into urban planning strategies. • Walkability’s link to COVID-19 case rates shifts from positive early in the pandemic to negative later. • Walkability consistently correlates with fewer mental health facility visits before and during different pandemic stages. • Walkability indirectly affects mental health visits via COVID-19 case rates, but this shows only in the later pandemic stage. • Walkability’s direct effect on reducing mental health visits remains greater than its indirect effect via COVID-19 case rates.