# Debate: Urban–rural environments – which is better for mental health? Moving beyond urban–rural dichotomies in psychosis risk for young people

## TL;DR

This paper argues that simplistic urban-rural distinctions are insufficient for understanding psychosis risk in young people and proposes a more nuanced framework based on social identity and inclusion.

## Contribution

The paper introduces a novel framework centered on social identity and belonging to better understand psychosis risk beyond traditional urban-rural dichotomies.

## Key findings

- Urban–rural gradients are strongest for psychotic disorders emerging during adolescence.
- Traditional urban–rural dichotomies fail to capture global social gradients in psychosis risk.
- A framework focusing on social identity and inclusion may offer a more comprehensive understanding of psychosis risk.

## Abstract

While urban–rural gradients exist for common mental disorders (Wiers et al., 2025), observations from the Global North suggest these are strongest for psychotic disorders, which typically emerge during adolescence. Despite well‐documented urban–rural variation in risk, recent research suggests a more nuanced relationship between place and these severe mental illnesses exists. Traditional urban–rural dichotomies cannot account for social gradients in psychosis globally for young people. Instead, a framework centred on social identity, inclusion and belonging may provide a more comprehensive approach to understanding psychosis risk as a result of the environments in which people are born, raised and live. Future research should integrate traditional epidemiological designs with causal inference methods and new technologies to capture momentary responses to diverse environmental stimuli that are both place‐based and placeless. This approach could uncover novel avenues for prevention and intervention, tailored to the digital age, ultimately improving outcomes for young people and families affected by psychosis.