Urbanization and emerging mental health problems: the role of the WPA Section on Urban Mental Health

During the past century, there has been a constant tendency worldwide for people to move into urban areas and megacities, aiming to better living, working and health conditions, including easier access to social and health services. Out of a total world population of 8.1 billion, the urban population will rise to more than 5.5 billion by 20501. Urbanization brings with it a unique set of advantages and disadvantages. While new values and novel lifestyles are more easily spread in urban society, urbanization has also initiated a dissolution of social relations and a decrease of social control, with traditional family dynamics, human bonds and schooling/working styles being disrupted. Overcrowding forces urban residents into excessive competition and continually causes tremendous stress. These factors contribute to the development of mental health problems. The majority of novel-emerging mental disorders first appeared in urban areas. Historically, eating disorders are a clear example. A survey revealed that the incidence of bulimia nervosa shows a dose-response relation with degree of urbanization, being five times higher in cities than in rural areas2. Both man-made and natural disasters – such as terrorism, wars, pandemics and climate change – can bring catastrophic damage to urban dwellers. Megacities are now frequent targets of terrorism. After disasters, weak social control in cities increases criminality. Isolation, financial difficulties and loss of dignity of elderly are commonplace in megacities, leading to an increased incidence of physical as well as mental diseases. In this context, novel mental health problems that transcend existing concepts are emerging in urban areas. We psychiatrists should be more sensitive to the risks of urbanization, and should discuss how to respond to them to as great an extent as possible. The WPA Section on Urban Mental Health was established in the year 2000 to provide a global platform to discuss urban mental health problems and their solutions among psychiatrists, epidemiologists and other experts. In 2015, the Section set up four subsections: a) global impact of demographic changes due to urbanization on mental health; b) mental health of slum dwellers (conduct problems, early pregnancies, drug abuse and traffic, comorbidity of mental and physical disorders); c) urban lifestyle and stress-related mental health; d) impact of terrorism and disasters on mental health in urban areas. Since 2021, the renovated Section has shared the aim to establish a global platform on emerging mental health problems in urban areas, by collaborating with other WPA Sections, scientific societies, and organizations such as the World Health Organization (WHO) and the Asian Federation of Psychiatric Associations. Based on the values of collegiality, diversity, inclusion and transparency, we are planning to propose innovative guidelines to deal with such unfamiliar problems, intended for clinicians and practitioners in real-world clinical settings globally. To fulfill our aims and tasks, we organize regular online meetings every four months, webinars (e.g., covering social isolation, aging society, youth mental health, digital mental health), and Section Symposia during all World Congresses of Psychiatry. We also aim to produce expert consensus surveys to better define priorities for action within urban mental health care domains. Since the insights of young generations are important in urban life, we are actively welcoming young members to our Section. Social isolation is one of the crucial mental health problems of the 21st century. Since the late 1990s, in Japan – especially in urban areas – pathological social withdrawal in youth, called hikikomori, has been emerging, and now it is spreading globally3. Our Section has contributed to enhance the awareness of this condition internationally3-5. We are currently promoting a novel method of hikikomori diagnostic evaluation (HiDE), through webinars and symposia, so that it can be utilized around the world5. In July 2024, the WHO Regional Office for the Western Pacific (WPRO) organized the Technical Consultation on Loneliness in Cities, where our Section members had a leading role6. Urbanization is a crucial risk factor for social isolation and loneliness7, and digital technology has been regarded as a possible solution, but also a possible risk factor to induce novel psychopathologies8. The government of Japan has used the expression “digital garden city” for a metaverse-based platform which combines the urban and rural, and is promoting its utility9. Such digital innovations are expected to be applied as therapeutic tools to achieve early intervention for patients who have traditionally been difficult to reach with mental health care. The digital world enables every human being to meet anyone in a virtual space, transcending the limitations of physical space and time. On the other hand, these new virtual worlds may promote a dissociation of body and mind, and give rise to novel psychopathologies that have never been imagined10. In addition, maladaptive usages of digital tools for self-care behaviors may induce mental health problems such as Internet/smartphone addiction and gaming disorder. Thus, our Section has started to collaborate with the WPA Working Group on Digitalization10 to monitor and respond to mental health problems due to the novel digital city. As urban mental health will stay at the forefront of psychiatry for the foreseeable future, the WPA Section on Urban Mental Health will continue to address the mental health problems that arise as a result of urbanization, in collaboration with other WPA Sections and other relevant international organizations, aiming to better define the many factors that contribute to urban mental health, and to formulate specific solutions and intervention programs.