Professor Reinout Wiers Hello, my name is  Reinout Wiers. I'm a Professor of Developmental   Psychopathology at the University of Amsterdam,  and one of the three Co-Directors of the   interdisciplinary Centre for Urban Mental Health,  and I was the first author on this debate paper,   “Urban Versus Rural Environments -  Which is Better for Mental Health?”   with subtitle from Lou Reed, “The  One Good Thing About a Small Town.” Professor Harm Krugers Hello, my name is  Harm Krugers. I'm an Associate Professor at   the Swammerdam Institute for Life Sciences, at the  Faculty of Science at the University of Amsterdam.   My research interest is in how stress and also  stressors early in life affect mental health later   in life, and I'm one of the Co-Directors  of the Centre for Urban Mental Health. Professor Reinout Wiers Thanks for this  invitation, and we're happy to tell you something   about the Centre for Urban Mental Health, and  then specifically in this little paper that we   did and the debate about mental health in youth,  and then specifically regarding the question,   “Is it better to grow up in a small town or in  the city?” But let us give us some background.   We're here – we’re two of the three Co-Directors  of this interdisciplinary centre. It's the biggest   research priority area of the University of  Amsterdam, and it runs ten years. We’re in year   six now. And I'm in the Faculty of Social  and Behavioural Sciences, in Psychology,   and the two other faculties involved are  Medicine, this is where Claudi Bockting is,   who you’ll see on a picture later, and in the  movie. And the third faculty is the Natural   Sciences, Harm Krugers, who also joined the  management team as the third Co-Director. Maybe I can start with giving a little bit of  background on why urban mental health? So, I'll   share a couple of slides for that. So, when we  started the centre, we first worked on a position   paper, which was published in Lancet Psychiatry  in 2021. And one of the things we looked at is to   actually substantiate this relationship between  living in an urban context and mental health   problems. Three conditions are the most prevalent  mental health problems, they’re varieties of   anxiety, depression and substance use disorders.  And also when you look at costs, for example,   at European level, these three are in the top  five of most costly and frequent of all mental and   brain problems. It depends a little bit on how  you define it exactly which comes out first. So,   here we see substance use disorders as the lowest  of these three, but if you include cigarette   smoking and problem drinking, it's actually  number one. Anyway, these three are the big three. So, this is also what we focus on, and in  this picture, it’s related – it's based on   United Nations data, so what you see here is the  percentage of urbanisation in different countries,   and what we see is, basically, that as  soon as you get up from 50% – until 50%,   there's really not a relationship, but from there  on you see that the higher the urbanisation,   the more mental – common mental disorders you  see. And the bad thing is that already more   than half of the people live in urban areas, but  this is by all prospects, expected to grow to,   like, two-third, or even 70%, in the next  decades. So, there is an urgent problem. Here's some research, also from the Centre,  Adam Finnemann, who actually did his defence   of his PhD last week, and he looked in UK  Biobank bank data with all sorts of measures   and different cities and different ways to  calculate the distance to the city centre,   controlling for all sorts of other  variables. And what you see is,   basically, that all the positive things go down  if you're closer to the city centre, happiness,   meaning, etc., but addictions and other mental  health problems go up. So, you would say,   “Why would anyone ever want to live in a city?”  Well, there is a clear reason here, and that is   the yellow-orangey line in the left figure, and  that is because you earn more money. However,   the financial satisfaction is actually  lower, you can imagine, because things   are more expensive. You can look at the details  in this recent Science Advance paper. So, again,   there is a clear relationship between living  in an urban setting and mental health problems. In the same paper, we also proposed, so this is  The Lancet Psychiatry paper again, a, kind of,   a framework, because, you know, there are  clearly individual factors and, of course,   there are also all sorts of urban factors  people think of, like, lack of green, or   traffic, noise pollution, etc., but there's  also very important social factors that play   a role. And these three levels of explanation  are interrelated and influence how people feel,   and they do so in, also, different timescales. So,  on the individual level, you can see effects in   a matter of days and hours. Social factors are  typically more in a longer timeframe, and some   urban factors can – you know, the city is very  different now from when I was a student here,   and even in a longer period. And some cities,  especially in China, other Asian countries,   show a very rapid growth, which  also comes with specific problems. On the right, you see mental disorders. So, you  could say here the three big ones, varieties of   anxiety, mental addictions and mood disorders,  and this is the symptom network perspective.   We do a lot of work on that. So, the idea is  there's not some latent brain or genetic factor   that explains everything. No symptoms cause each  other which are influenced by the environment.   And that can be the environment at different  levels and of course, also individual factors,   like, genetics do moderate the expression of  these mental health problems, but always in   interaction with the urban environment. So, this  is a little bit of our general model. I will now   show you a little one minute movie clip, and then  the specific paper we did here focuses more on   what it means to grow up in the city, versus  coming in later. So, here's the little movie. [Video commences] Dr Junus van der Wal The majority of the  world population lives in cities. Common   mental disorders are becoming  more prevalent. In the Centre   for Mental Health will aim to see if  these two are somehow interrelated. Professor Claudi Bockting So, as  a Centre for Urban Mental Health,   we try to unravel new pathways for intervention,   as well as policymaking, to improve  mental health in urban settings. Professor Rixt van der Veen We analyse large  datasets and we look at factors, genetic factors,   but also environmental factors, like socioeconomic  status, pollution, perceived stressors. Professor Reinout Wiers In  our interdisciplinary study,   we get these data and start modelling  these with complexity science,   to better understand mental health  in the city and how we can change it. Professor Rixt van der Veen There is an  opportunity to develop interventions on   individual, on group level and  on the societal level [pause]. [Video ends] Professor Reinout Wiers   So, mechanisms, we now outlined general  mechanisms. What is also important to realise   that you can't really say that the enhanced –  or that the relationship between stronger mental   health problems in urban areas is due to the  city only, right? So, it's not a one-way street,   that's also what we emphasised in the model that  we briefly showed. It can – there ca – there are   also other mechanisms playing a role, for example,  there is selection. So, we know that people with   an enhanced risk to develop mental health problems  more often go to the city, and that's related   to being poor, for example, to have a migrant  background. All of these are factors that enhance   the risk to develop mental health problems, in  general. So, that part is also interesting to   study, and of course, and we study all of these to  also help people to mitigate these risk factors. But it's not always about, you know, the pollution  and that's the first thing that people think of.   Of course, these also do play a role. Being in a  grey environment versus a more green environment,   there's research showing effects of that. There's  also social factors that play a role, and again,   these hit harder to people to – who already  are at enhanced risk to develop a problem. So,   we know that, for example – and also, some of our  own studies showed that people who perceive that   they're discriminated have more mental health  problems. This was found especially in girls   in Amsterdam with a migrant background.  So, you know, the city is more than just   the cars with the noise and the smells,  but there is really a lot going on there. But as we also saw, there's also attractive  things. So, this is, of course, why people come   there. This is the place where you can get – where  you can earn money, where you can have the fun,   where you go out, you know, all of the  entertainment, and of course, education.   It's also typically the centre where you get  the higher education, including universities,   other higher and middle education. So, the two  factors that I highlighted are “selection” and   then “the environment,” which is not only the  physical, but also the social. And the third is   that stress is higher in the city and that has  effects on the brain, and this is a nice moment   for Harm Krugers to come into the conversation,  also, because that's actually his specialty. Professor Harm Krugers Thank you so much,  Reinout. Yeah, and I'm happy to say something   about the “effects of stress.” And stress is an  important risk factor for mental disorders that   also Reinout mentioned, and the good thing is that  most people can cope well with stressors. Still,   it is an important risk factor. An important  question is why is it such an important risk   factor? Well, we are regularly exposed to  stressful experience. It can vary from small   daily insults to major events. As I mentioned,  people can cope relatively well. Most people can   cope relatively well with these events.  But for example, stress, when it becomes   too harsh or too prolonged, too chronic, it  can definitely be an important risk factors. And the sensitivities to stress, that  is dynamic, that's a dynamic process,   and the sensitivity to stressors can be  determined and can be modulated by earlier   experiences. And that's why I think the youth  is an important factor, because early in life,   when individuals grow up, the  stress system is still developing,   and there's good evidence from very fundamental  basic rodent studies, but also from human studies,   that the stress system can be sensitised by  events early in life. So, one of the axis that   is important for coping and dealing with stress is  the hypothalamic-pituitary-adrenal axis, and that   ultimately, results in the release of cortisol  from the adrenal glands. And that's important,   these hormones are important to  cope and deal with stressors. But negative experiences early in life, impov  – growing up in an impoverished environment,   at least that's what we know from rodent studies,  can synthesise this axis, and that will result   in a higher stress responsiveness and higher  stress hormone levels, and that at the end,   can be detrimental. So, it is good and important  you understand how individuals grow up,   how the stress system is being modified, and  ultimately, also, how that can relate to mental   disorders. Understand – and understanding  these mechanisms is important, potentially,   to find novel interventions to  improve mental health [pause]. Professor Reinout Wiers   So, when it comes to the development in the  urban context, and explaining mental health   problems in young people and especially in  youth, the point that we make in this paper   is that it's crucial to differentiate between  two groups. So, on the one hand, you have the   people who grow up in the city. So, basically,  during their whole youth they had the, you know,   positive, potentially positive, in terms of  opportunities, but also clearly negative effects,   of the urban environment. And then you have  the young adults who come into the city,   typically for education, students. So, what  we see is that over the past decade or so,   mental health problems in young adults have  increased, and this got worse during COVID,   and some of it actually also remained high after.  So, there is a continuous problem of mental health   in youth, but when thinking about the development,  these are really very, very different subgroups. So, on the one hand, you have the people  who grew up here, where some of these   developmental factors may have played a role  and related to the sensitised stress system,   that Harm just talked about. Maybe also the –  a higher percentage with migrant background,   who may often end up in education below their  actual possibilities, experience discrimination,   stuff like that. And then you have students  who maybe grew up in nice suburbs, with lots   of green. So, they come here with, say, a better  background in terms of resilience, potentially,   but then they suddenly may be alone in a big city,  where they don’t know the way, where there may be   overwhelmed with all the noises, etc. So, it's  really very, very different subgroups. And as a   whole, we know they're at increased risk for  mental health problems, but yeah, basically,   the suggestion we make in this paper is you should  not put these together, because most likely,   there are very, very different mechanisms  that play a role in these subgroups. Professor Harm Krugers To add to that, as I  mentioned, the stress system is an important   system to cope and to deal with stress-related  mental disorders, which is also what we are   talking about here. So, in general, what is  found is that the mental wellbeing in the   city centre is worse than the mental wellbeing  outside of the – out of the city centre. Still,   it's important, of course, to realise that  there are large individual differences,   and that comes when you – that  has to do, of course, for example,   with the stress sensitivity and also, the  exposure to the stressors and what has been   – or what have been earlier experiences  and how have people been dealing with it? So, the individual differences are also  extremely important to take into account,   and it's difficult to predict at a personal  level how people will deal with stressors and   whether and how exactly people will develop mental  disorders. So, that is also why this complexity   science is so important. It is important to  understand which factors bring some people at   risk. And it can be completely different between  individuals, and also when people move, let’s say,   from one place to another place. And that is,  I think, an important point, also, for future   research, to get an idea of this whole complexity  of factors, which can be highly individual,   but result in, let's say, some general patterns of  mental wellbeing inside and outside of the city. Professor Reinout Wiers Yes, and I did not  mention that before explicitly, but indeed,   complexity we chose to use as a backbone in  our multi-level interdisciplinary project,   because complexity science is basically,  skill-free method to describe changes and   processes between different  levels of explanation [pause]. When it comes to development and interventions,  in the first five years, we mostly looked at   mechanisms playing a role in urban mental health  and established the phenomena, like, the research   of Adam Finnemann and others, the relationship  between an urban setting and increased mental   health problems. The second period, in which  we're now, the emphasis is on intervention. So,   what did we learn from the mechanism research  to develop interventions and test these? There's   a lot of projects going on, and I would  really invite listeners, also, to go to our   website. I’ll show the website, where it is, and  maybe we can do that in the end, again, also. But it's really too much to explain  everything, but we'll give a couple of   examples. So, this also has the website. Here  we are. I hope you can see it highlighted,   centreforurbanmentalhealth.com, as one word. So,  we now in the second period, do team science,   and we have three teams. One team works on  personalising interventions, based on individual   networks, other things that we just explained  in terms of general mechanisms, and also,   a lot going on with digital interventions,  including AI chatbots, stuff like that. So, the question is, how can we optimally  personalise interventions so that they're   more meaningful for people, and  help them? And to some extent,   maybe AI can also help there. And that is  important not only for applications, say, here,   in Amsterdam, or Europe more general, but also,  for the possibility to scale up interventions   for lower and middle income countries where  basically, there is much less capacity for   person intervention, so with actual Counsellors.  So, if you develop AI applications that are   actually supervised by, say, Therapists, but  maybe also by trained laypeople, and actually   Claudi had the third – Claudi Bockting, the  third Co-Director, did a nice study training   laypeople in Indonesia to work on helping people  with depression, with very positive results.   And we're also working on our project,  prevention project, in India in that way. So, this is also another thing in the centre,  it's not only about helping people in our own   quasi-urban environment. I mean, if you  compare it to some of the big metropoles,   Amsterdam is not really the extreme urban  example. But also to develop things that can   be used in different places. The second  one is really on – the second group,   on multilevel interventions. There's some  evidence that if you only target the individual,   chances are the system will bounce back  to where it was. Whereas if you combine   an intervention for the individual and  for the system, you get better effects.   And the third line of intervention research  is really looking at more neural mechanisms in   relation to specific environments, and Harm, maybe  you want to say something on that line, also. Professor Harm Krugers Yes, so the centre  also investigates, let's say, more in general,   lifestyle factors, and whether they can be used  as intervention for mental disorders. And in   the centre there is research, for example,  on the microbiome, and then in particular,   also the relationship between the brain and  the gut. And there's evidence more and more   that this is an important relationship that  can contribute to changes in mental health,   and potentially, also can be used as an  intervention to improve mental health. Another line of investigation is exercise,  physical exercise. It can be running, it   can be leisure, all kinds of leisure activities.  And there's evidence, also from the literature,   that running, exercise, anaerobic, aerobic  exercise, can increase and improve the brain   health and also mental health. For example, it has  been investigated over time that people that show   exercise, that have regular exercise, have brain  changes. And one of the areas – the brain areas   that's often investigated, is the hippocampus. And  there is some evidence that physical exercise can   improve function of the hippocampal formation. And  hippocampus is important for learning and memory,   and it is, of course, important to have a  good memory over lifespan, and it's important   to investigate this relationship between running,  exercise and brain function and mental wellbeing. And that's what is also being investigated in  the Centre for Urban Mental Health. For example,   it is investigated under and among students, how  physical exercise and whether and how physical   exercise can improve mental wellbeing. And also  in another study, some people relapse from mental   disorders, for example, from depression. You know,  when they are depressed, they get better and there   can be relapse. And it is important to investigate  whether and how that relates to changes in   physical activity, but also whether changing  physical activity and improving physical activity,   for example, can increase mental wellbeing  again. So, these are two important factors   that are under investigation in order to see how  and whether they can contribute to mental health. Professor Reinout Wiers Yeah, and maybe to add,  because we really range from brain level genetics,   there's also a project now on how  genetics can help to tailor prevention,   but also very – more social projects. And I  already mentioned the chatbots that can help   people with mental health problems, and  some have been developed also for migrant,   elderly people who have above average mental  health problems. As you can imagine, you're in   a different country and maybe not everything goes  the way you always wanted it. But the problem is,   they're basically – even when there is  an application that's proven effective,   chances are they won't use it, because  of distrust of government, for, you know,   good reasons or maybe less good reasons. But then  anyway, so the uptake is really a major problem. So, one of the current projects – and we also  have people from social science, sociology and   anthropology involved here. So, they really  investigate, what are barriers in – you know,   for the vulnerable, specific vulnerable groups in  the city, in actually taking up interventions that   might help? So, this is really a different way  to, kind of, reach out. And also Claudi’s – in   Claudi’s group with the Academic Mental Health  Centre, they also try to find people who   typically would not go for help for mental health  problems, but they do go to the Hairdressers. So,   what if you train Hairdressers to address some of  these mental health problems and maybe help them   with taking a first step? So, those are, kind of,  out of the box ways to try to help people in an   urban environment to improve their mental health  problems that, you know, otherwise are missed,   even though they're actually the people who  might benefit from these interventions most. Professor Harm Krugers Yeah, so  these interventions really range from,   let's say, lifestyle factors, such  as exercise, being investigated by,   you know, Reinout, but also social coherence  and see how that affects mental wellbeing. Professor Reinout Wiers Yeah [pause].   I think what we try to do in the Centre for  Urban Mental Health is to really look in an   interdisciplinary way at the big challenges  on mental health in an urban context,   and from a developmental perspective,  growing up in an urban context. And I   think the big challenge here is that, on the  one hand, we get very deep understanding from,   say, some of the neural mechanisms, say,  for example, a project on the effects on   brain and development of smoking cannabis  during pregnancy, and how that relates,   also, to a more busy urban environment. But  then – and then, as I me – also mentioned,   these AI-driven chatbots. So, there's  tonnes of new knowledge input possibilities. But then there's the other side of the coin, and  that is, do we develop something that are – tools   that are actually used, especially by the people  who may benefit from them most? And there,   the key thing is really co-creation, also.  So, if it’s about children in the city,   adolescents in the city, talk with them about  what could be a good way to help them. And so,   on the one hand, it’s more and more  technical knowledge, with the modelling,   brain stuff. On the other hand, make – creating  very simple tools and maybe suggestions also,   for the built environment, that actually have  an effect in the city. That's our big challenge,   and that's also what makes it  very exciting to work on this. Professor Harm Krugers Yeah. Yes,  and to add a little bit to that,   I think these are big questions, mental health  issues are big complex questions. So, it requires,   let's say, also a complex approach with people  from different disciplines, different approach,   different ideas. Even Mathematicians that can  model why some people thrive, whereas some other   people are much more vulnerable than others.  And I think now, we are now at the stage where   we can do things that were not possible, let’s  say, ten years ago, as, you know, Reinout was   think – was telling. For example, these digital  tools to improve mental wellbeing, also for the   younger generation, adolescents, I think that is  a really an opportunity, and also a challenge, to   see whether that can work and how we had better –  how we can implement those kinds of approaches to   improve mental health, for the younger generation,  which is the capital, I would say, of our society.