Spatial Associations Between the Neighborhood Built Environment and Mental Health: Evidence from Tehran

Abstract Built environments influence mental health, yet evidence on how different dimensions of urban form relate to specific mental health outcomes remains mixed, particularly in high-density cities. This study examined these relationships in Tehran, Iran, while accounting for spatial dependence and exploring spatial heterogeneity. Using secondary neighborhood-level data from 356 neighborhoods, five mental health outcomes—anxiety, depression, social dysfunction, somatic symptoms, and overall psychological distress—were analyzed in relation to the built environment. Ordinary Least Squares (OLS), Spatial Durbin Models (SDM), and Geographically Weighted Regression (GWR) were employed to assess global associations, spatial spillover effects, and localized spatial variation. The findings indicate that residential density emerged as the built-environment characteristic most consistently associated with poorer mental health, whereas population density showed no significant direct association with any mental health outcome. Access to daily services were associated with lower somatic symptoms and social dysfunction. Anxiety and depression were explained mainly by neighborhood socio-demographic characteristics, particularly unemployment and neighborhood age structure. Spatial spillover effects were identified only for social dysfunction, while exploratory GWR analyses indicated that neighborhood–mental health associations were predominantly global across Tehran, with only modest evidence of localized spatial variation. These findings demonstrate that different dimensions of urban density have distinct implications for mental health and that different mental health outcomes respond to different neighborhood characteristics. Overall, the results suggest that improving the quality of high-density residential environments, alongside addressing neighborhood socioeconomic inequalities, may be more effective than focusing on urban density alone when promoting mental health in high-density cities.