Investigating how environmental vitality influences mental health: A large-scale study among patients with schizophrenia on the mediating role of functional capacity

With the accelerating pace of urbanization, the influence of urban environmental factors on the severity of schizophrenia and patients' individual functional capacity has increasingly attracted attention. However, existing literature has rarely examined patient functional capacity as a mediating factor between environment and illness severity. This study addresses environmental vitality factors, investigating their role in the mechanism linking patients' functional capacity and schizophrenia severity. Using clinical data from 38,036 patients diagnosed with schizophrenia, the study employs Structural Equation Modeling (SEM) to comprehensively analyze schizophrenia severity, functional capacity, and community environmental vitality across different social groups. The findings demonstrate that high environmental vitality exhibits a significant “empowering” effect on impoverished patients, reducing illness severity by enhancing their functional capacity (standardized indirect effect [Std. IE] = 0.129, 95 % confidence interval [CI] [0.104, 0.159]). Conversely, for non-impoverished patients, excessive environmental stimulation tends to weaken functional capacity, thus exacerbating illness risk (Std. IE = −0.026, 95 % CI [−0.032, −0.020]). Additionally, female patients are more susceptible to adverse effects in high-vitality environments (Std. IE = −0.023, 95 % CI [−0.032, −0.016]) compared to male patients (Std. IE = −0.011, 95 % CI [−0.018, −0.005]). These conclusions highlight the necessity for future urban community renewal planning to carefully consider the diverse social backgrounds and needs of different patient groups. Integrating indicators of “psychological resilience” and “mental health” into urban design and evaluation standards will help maximize rehabilitation and social integration outcomes for patients with schizophrenia across various groups. • Based on clinical data from 38,036 schizophrenia patients, this study systematically explores the complex relationship between high-vitality environments and schizophrenia severity. • The study incorporates patients' functional capacity into the core mediating mechanism, clarifying the critical path through which environmental vitality influences disease progression via functional capacity. • It is found that high-vitality environments have an “empowering” effect on impoverished patients, whereas for non-impoverished groups, excessive stimulation may worsen the condition. • From a gender perspective, female patients are more sensitive to high-vitality environments, making them prone to negative impacts that weaken their social functioning. • Findings inform urban planning and community renewal, emphasizing group differences and mental health in policy design.