Built environment determinants of mental health in Mashhad metropolis, Iran

Source abstract

While the built environment’s relationship with mental health is well-documented in high-income countries (HICs), evidence from low- and middle-income countries (LMICs), especially Islamic and Middle Eastern contexts, remains scarce. This study examines this association in Mashhad, Iran. A cross-sectional survey of 950 residents aged 25+ across 13 neighborhoods was conducted. Mental health was assessed using the validated GHQ-28 questionnaire. Built environment variables included residential density, land-use diversity, green space, and destination accessibility. Stepwise regression and path analysis were used. Results showed that only 19.7% of participants were mentally healthy. Regression models explained 23.1% of mental health variance, with key predictors being perceived accessibility to grocery stores, commercial areas, and green space. Net and gross residential density negatively impacted mental health, especially anxiety and somatic symptoms. Path analysis confirmed a strong direct effect of green space and significant indirect effects of commercial space and density. Contrary to HIC findings, increased density and per capita green space were negatively associated with mental health in Mashhad, revealing an “intensification paradox” where growth outpaces infrastructure and design quality. Commercial land use and destination accessibility emerged as protective factors. These findings underscore how local context shapes built environment mental health links.