Sometimes a single thought can completely transform how we see familiar things—you just have to read to the end. Practicing Gestalt therapist Igor Martynenko explores an idea that seems simple at first glance but unexpectedly upends conventional logic.
8 min read
Share:
AI summary
A megacity affects mental health through a complex of factors: noise, pollution, sleep deprivation, social isolation, and stress. The most convincing data links the urban environment with an increased risk of depression and psychotic disorders, while the connection with anxiety is less clear-cut. Mental health in the city is not only a medical but also an economic problem, requiring systemic changes in urban policy.
A megacity isn't some kind of "psychological poison" in and of itself. Rather, in a large city, a person simultaneously faces a whole set of stressors—noise, air pollution, crowding, nighttime light, constant rushing, an unsafe environment, and often a sense of social isolation. Each of these factors individually may seem tolerable, but combined they increase the risk of mental disorders.
But we shouldn't view the city exclusively as a source of harm. The urban environment has advantages too: access to doctors and psychotherapy, more opportunities for education and work, a better chance of finding the right community or support. So the question shouldn't be framed as: is the city itself harmful, but rather: which specific properties of the urban environment amplify stress, and which help the psyche maintain resilience.
What the City Does to the Psyche
For depression, the data looks fairly consistent. In major reviews and meta-analyses, urban living is often associated with a higher prevalence of depressive conditions compared to rural environments. This doesn't mean every megacity resident is automatically in a high-risk zone. But even a moderate increase in probability at the level of entire urban populations translates into a serious burden on the mental health system.
With anxiety disorders, the situation is less clear-cut. In some studies, the link between urban environments and anxiety is fairly evident; in others, the results are weaker or depend on which specific type of anxiety we're talking about. For generalized anxiety, there's a signal, but it's not uniform. For panic disorders, there's even less data than we'd like: they're often lumped together with a broader set of anxiety symptoms, making conclusions vague. So here it's more accurate to speak not of a direct and universal causal link between cities and anxiety, but rather that the urban environment can amplify existing anxiety vulnerability or some specific type of anxiety.
The most convincing data has been accumulated regarding the psychotic spectrum. In large registry studies, people who grew up or have lived long-term in the most urbanized environments show a higher risk of schizophrenia and certain other psychotic disorders than residents of more rural areas. What's particularly important here is that it's not about the mere fact of living "among large numbers of people," but about the social context: deprivation, neighborhood disadvantage, crime, breakdown of social connections, chronic stress.
In recent years, researchers have increasingly moved away from the crude "city versus countryside" dichotomy and are looking at the specific environmental profile. This shift is important: the focus now is not on the mere fact of living in a city, but on specific environmental properties. It turns out that what matters isn't simply population density, but a combination of factors: air quality, noise levels, presence of green spaces, distance from industrial facilities, neighborhood safety, length of daily commute, sleep quality. In other words, not every city is equally harmful and not every dense environment is equally hard on the psyche.
Who Is in a More Vulnerable Position
Urban stressors don't affect everyone equally. There are groups for whom the environment can indeed play a particularly significant role.
First, children and adolescents. Their nervous systems are still developing, and early chronic exposures—such as noise, air pollution, lack of green spaces, unsafe conditions—can influence their future mental health trajectory. That's why the environmental question matters more for them than it might seem at first glance.
Second, people living in socially disadvantaged neighborhoods are more vulnerable. When urban noise and overload are compounded by poverty, unstable employment, poor housing, and constant financial anxiety, the psychological burden becomes much heavier. In this case, environmental factors are hard to separate from purely socioeconomic ones.
Third, migrants, refugees, and people experiencing social exclusion find themselves in the at-risk group. A big city does indeed offer more opportunities, but at the same time it can amplify feelings of anonymity, disconnection, and chronic tension, especially if a person faces discrimination or lacks stable social support.
Finally, the impact of the urban environment is felt more acutely by those who already have anxiety, affective, or psychotic disorders, as well as people who are sensitive to sleep deprivation and sensory overload. For them, a noisy street outside the window, poor sleep, and constant hyperstimulation aren't just everyday inconveniences—they're real factors that worsen their condition.
What this means in practice
For the individual, the main takeaway isn't that you need to urgently leave the city. That's often unrealistic, and not always necessary. It's far more useful to view your environment as part of everyday prevention and, when needed, treatment. In practice, several things are especially important.
First and foremost, sleep matters. For megacity residents, this is one of the most vulnerable areas. Nighttime noise, street light, late-night screens, long commutes, and sensory overload gradually destroy sleep patterns. That's why even simple measures—darkening the room, reducing screen time in the evening, earplugs, more stable sleep and wake times, morning light—can produce noticeable effects.
The second important point is regular contact with green spaces. You don't necessarily have to live near a forest or large park. Sometimes it works to make a habit of walking part of your route through a quieter, greener area, spending 20–30 minutes outside without your phone, building in at least a few moments during the week where your attention isn't in constant defensive mode.
The third practical measure is reducing overall sensory overload. For one person, this means choosing a less noisy route to work; for another, skipping workouts along highways; for a third, cutting down on places and situations where they're constantly in a state of irritation or vigilance.
But it's important not to romanticize environmental changes. If anxiety, panic attacks, insomnia, depression, or suspiciousness persist for weeks and are already starting to limit your life, "lifestyle ecology" alone isn't enough. These measures don't replace psychotherapy, and they certainly don't replace psychiatric care when it's needed. Environment is an important factor, but not the only one.
The economics of the problem and demand for care in the megacity
But this issue has not only a clinical dimension, but a material one as well. Depression and anxiety lead to the loss of about 12 billion working days worldwide each year and cost the global economy roughly $1 trillion due to reduced productivity. At the same time, investments in treatment are economically justified: according to WHO estimates, every dollar invested in expanding care for depression and anxiety can yield about four dollars in return through improved health and work capacity. For megacities, this is especially important because mental health here is directly linked to quality of work, income stability, and overall burden on the care system.
Looking at Moscow's open data, it's clear that urban demand for psychiatric and psychotherapeutic care can hardly be called episodic. In the first six months of operation, the capital's mental health centers received nearly 12,000 visitors, with specialists conducting over 42,000 appointments in total. This gives a rough estimate of about 3.5 appointments per visitor and indirectly shows that a significant portion of cases don't end with a single consultation. A year after launch, the number of visits to these centers exceeded 25,000. Nearly three-quarters of visitors were women, and more than half were people under 50—that is, the most socially active segment of the population.
The nature of these visits is also important from an economic standpoint. According to Moscow's health service, in 70% of cases, mental health center visitors come with psychosomatic complaints—intestinal pain, heart issues, headaches, and other symptoms without identified organic pathology. Additionally, common reasons for visits include anxiety, constant fatigue, irritability, sleep problems, and reduced work capacity. On Moscow's official portal, the centers themselves are described as institutions working with psychosomatic disorders, neuroses, fears, phobias, and stress. This matters because we're talking not only about severe psychiatric conditions, but also about states that directly impact a person's daily effectiveness, their ability to work and maintain their usual rhythm of life.
The financial burden on patients in the megacity can also be significant. According to publicly available price lists from Moscow clinics, even basic entry into treatment costs noticeably: at Gannushkin Psychiatric Hospital No. 4, an initial psychiatric appointment costs from 2,800 rubles, a follow-up from 2,000 rubles; at SM-Clinic, an initial psychiatric appointment costs 2,900 rubles for 30 minutes and 5,200 rubles for 60 minutes, a follow-up
— 2,700 and 4,700 rubles respectively; one of the MEDSI clinics lists prices on its website starting at 3,300 rubles for an initial and follow-up appointment with a psychiatrist, while individual psychotherapy starts at 6,300 rubles per session. So the cost of treatment in a major city is measured not only by the severity of one's condition, but also by very concrete expenses. And the faster a one-time visit turns into regular therapy or monitoring, the more noticeable this burden becomes for the patient.
Why this matters for both therapists and urban policy
In clinical practice, questions about environment are still often undervalued. Yet they should be asked as frequently as questions about family, work, or relationships. Where does the person live? How much time does commuting take? Is there noise at night? How safe is the neighborhood? Can they walk to a park? Do they have a living social network outside the internet? Such details sometimes explain a person's condition just as well as formal diagnostic categories.
At the city level, this leads to an even more important conclusion. Mental health isn't just about a specialist's office and it isn't just about medication. It's also about transportation policy, housing quality, green spaces, street lighting, fighting poverty, reducing air pollution, access to care, and a sense of basic security. In other words, mental health in a megacity is also a question of how the urban environment itself is designed.
Conclusion
A megacity affects mental health not simply because there are "too many people" in it. Its impact is built from multiple factors: chronic stress, sleep deprivation, overload, social isolation, neighborhood disadvantage, lack of greenery, noise, and pollution. The most robust evidence today concerns depression and the psychotic spectrum. For anxiety disorders the link also exists, but it's less uniform and depends more heavily on the type of anxiety, age, individual vulnerability, and social circumstances.
That's why one's living environment shouldn't be considered secondary background. In many cases it doesn't explain everything, but it explains enough to influence both the course of a disorder and its prognosis, as well as which interventions will actually work.
