The urban environment and mental disorders: Epigenetic links

For the first time in human history, more than half of the world''s population lives in urban areas and this is projected to increase to two-thirds by 2030. This increased urbanity of the world''s population has substantial public health implications. Nearly a century of research has shown higher risk of mental disorder among persons living in urban versus rural areas. Epidemiologic research has documented that associations between particular features of the urban environment, such as concentrated disadvantage, residential segregation and social norms, contribute to the risk of mental illness. We propose that changes in DNA methylation may be one potential mechanism through which features of the urban environment contribute to psychopathology. Recent advances in animal models and human correlation studies suggest DNA methylation as a promising mechanism that can explain how the environment “gets under the skin.” Aberrant DNA methylation signatures characterize mental disorders in community settings. Emerging evidence of associations between exposure to features of the environment and methylation patterns may lead toward the identification of mechanisms that explain the link between urban environments and mental disorders. Importantly, evidence that epigenetic changes are reversible offers new opportunities for ameliorating the impact of adverse urban environments on human health.Key words: urban environment, mental disorders, DNA methylation, epigenetics, posttraumatic stress disorder, depressionThe 20th century has been characterized by the world-wide movement of populations from rural to urban areas. For the first time in human history, more than half of the world''s population lives in urban areas and this is projected to increase to two-thirds by 2030. The movement of populations to urban environments is probably the most important demographic shift in the past century. In particular, the increased urbanity of the world''s population has substantial public health implications. A body of research has long shown that there are different burdens of disease and disability in urban vs. non-urban areas and more recent work has linked specific features of the urban environment to particular health indicators (for reviews of the literature about urban health see refs. ¹ and ²).Some of the more promising work in this area concerns research that has shown relations between urbanity and mental disorders. There is more than a century of work that has shown higher risk of most mental disorders among persons living in urban versus rural areas.^3–8 Early research proposed several factors that may explain this association including selective migration and social disorganization.³ For example, it has been proposed that persons within disadvantaged areas may have a more difficult time building and sustaining supportive social relationships, therefore increasing susceptibility to mental illness. Subsequent work has shown associations between particular features of the urban environment and risk of mental illness. Living in poorer urban neighborhoods is associated with greater risk of new episodes of depression compared to living in richer neighborhoods, even when accounting for individual income or exposure to stressful or adverse circumstances.^6,9,10 Living in neighborhoods characterized by residential racial segregation is associated with a greater risk of depression and anxiety, compared to living in less segregated neighborhoods.¹¹ Other evidence suggests that neighborhood collective efficacy and norms are associated with the risk of substance use disorders12 and suicide attempts,¹³ again when taking into account individual experiences.Coincident with the growing number of studies that have demonstrated links between features of the urban environment and mental health, there has been an increase in work that has sought to understand the mechanisms underlying these epidemiologic observations. In particular, there is an emerging interest in identifying biologic explanations that may clarify the link between features of the urban environment and individual mental health. Existing research has documented a role for changes in immune function,¹⁴ gene-environment interactions¹⁵ and psychological mechanisms,¹⁶ among others, that may explain the links between the urban environment and mental health. This paper adds to this growing field and proposes that changes in DNA methylation may be one potential mechanism through which features of the urban environment contribute to psychopathology.