Leah Alkalay (author) and Ashley Chen (mentor)

Some of us spent our childhood building forts in the woods with our siblings and knowing the full history of everyone in our town. We took countless walks by rivers with our dogs, hearing birds chirp at our passing. Others spent their early days with endless activities to choose from and the constant sound of police cars and ambulances whizzing by. These very different environments shape the world we know, but how much do they also shape us? 

Perhaps understanding such effects of these contrasting upbringings can give us insight into how they impact mental health and wellbeing. It turns out these early environments can have a large influence on factors such as how we cope with stress, our social development, access to resources, and the level of psychological and behavioral risk. In other words, our childhood environments may shape psychological baselines that persist into adulthood.

Rural Upbringing

Research on rural children consistently demonstrates that they are more likely to report positive childhood experiences (PCEs), including volunteering, having a guiding mentor, and living in safe and supportive neighborhoods (Crouch et al., 2022). Growing up in a place where “everyone knows everyone” has further been linked to stronger social capital and overall wellbeing. Given that social capital encompasses the networks of relationships between people in a community, it follows that strong community connections may enhance it. Having many  social ties increases the likelihood of children having reliable adult figures in their lives, creating informal support they can rely on for emotional security and belonging. 

Yet, rural communities have and continue to face impactful healthcare challenges. Mental illness occurs at similar rates in rural and urban areas, but rural residents have worse outcomes due to shortages in care (Morales et al., 2020). Morales et al. (2020) found that 65% of non-metropolitan U.S. counties have no psychiatrists and more than 60% of rural Americans live in designated mental health provider shortage areas. These risks are further increased by residents needing to travel far for treatment, there being less resources for early support, and little education regarding mental illness. As a result, symptoms may go unnoticed or untreated. Families in rural communities might also rely more heavily on schools or family physicians, who often lack specialized mental health training, for care.

Because of these struggles, rural children may have higher rates of untreated mental and behavioral health conditions and some areas have reported rising youth suicide rates (Edwards et al., 2023). Interventions, such as mental health education in schools, community awareness, and increasing access to online mental resources, may address some of these concerns (Graham et al., 2021). Moreover, telepsychiatry and mental health programs may also lower rural shortages and gaps.

To judge the psychological effects of a rural childhood, we need to consider its strengths and weaknesses. Rural communities can offer meaningful social support and safety to its residents, but without certain resources, children and teenagers might struggle to manage their mental health needs. Even if a young rural resident expresses distress, they may not know how or where to get the proper help. Hence, rural environments may protect and endanger mental health, depending on the resources available and the specific community environment.

Urban Upbringing

Conversely, urban childhoods have many resources, but are characterized by numerous environmental stressors. Adults who were born in densely populated areas report higher rates of psychiatric conditions, especially anxiety disorders and PTSD (Oh et al., 2021). Environmental stressors such as crowding, noise, pollution, and increased social competition have been linked to these risks (Kelleher & Gardner, 2017). These kinds of stressors can impact children’s coping strategies, which may strengthen adaptability but increase stress.

Cities allow for easier access to better mental health care, specialized services, education, extracurricular activities, and community events (Kelleher & Gardner, 2017). Even though urban environments may strain mental health, they also offer protective factors that mitigate these risks. For a lot of children, exposure to more diverse social experiences and increased academic opportunities may increase resilience and creativity.

In the future, urban areas may benefit from efforts aimed at reducing environmental stress. This may include adding more parks and trees for residents to relax in, minimizing traffic and construction noises, and promoting stronger community connections. Even small exposures to urban green areas, such as tree covered areas and parks, can reduce stress in adolescents, which may also improve long-term wellbeing among urban youth (Mennis et al., 2018).

Rural and Urban Comparison

Rural environments can offer an easy going, stable lifestyle, accompanied by close-knit community ties. Urban environments have no shortage of stimulation, diversity, and opportunity, but can create isolation, even in populated areas. Generally, most rural research focuses on children, while most urban mental-health research focuses on adults, which may explain some differences in the data. These differences make it challenging to directly compare the two environments. To make better conclusions, studies could be done that track children from both types of areas throughout development. 

Both environments share common issues like barriers to care, environmental stressors, and stigma surrounding mental-health treatment. Additionally, the socioeconomic status of an individual may greatly impact mental health outcomes as higher-income individuals often have greater access to mental health resources than lower-income individuals, regardless of environment. Equitable access to care in both places may help resolve these shared issues. Overall, more research is needed to understand how childhood settings shape psychological development across the lifespan. Understanding prevalent challenges may help communities work together to support healthy development. Moreover, the best setting for individuals may vary with age, with young adults possibly benefitting from the diversity and exposure of urban settings and older adults preferring the peace and reduced stress of rural settings.

Conclusion

All in all, childhood environments may shape our identities, changing how we cope, connect, and interact with the world. Understanding and experiencing both perspectives may build empathy, expand problem-solving skills, and generate ideas for future mental health research. Being aware of the distinct strengths of both environments may help communities make better decisions, improve mental health care and its delivery, and support healthier lives for all children, no matter where they grow up.

References

Crouch, E., Probst, J. C., Shi, S., McLain, A., Eberth, J. M., Brown, M. J., Merrell, M., & Bennett, K. J. (2022). Examining the association between rurality and positive childhood experiences among a national sample. The Journal of Rural Health, 39(1), 105–112. https://doi.org/10.1111/jrh.12708 

Crouch, E., Radcliff, E., Merrell, M. A., & Bennett, K. J. (2020). Rural‐urban differences in positive childhood experiences across a national sample. The Journal of Rural Health, 37(3), 495–503. https://doi.org/10.1111/jrh.12493 

Edwards, A. M., Hung, R., Levin, J. B., Forthun, L., Sajatovic, M., & McVoy, M. (2023). Health disparities among rural individuals with mental health conditions: A systematic literature review. Journal of Rural Mental Health, 47(3), 163–178. https://doi.org/10.1037/rmh0000228 

Graham, A. K., Weissman, R. S., & Mohr, D. C. (2021). Resolving key barriers to advancing mental health equity in rural communities using Digital Mental Health Interventions. JAMA Health Forum, 2(6). https://doi.org/10.1001/jamahealthforum.2021.1149 

Kelleher, K. J., & Gardner, W. (2017). Out of sight, out of mind — behavioral and developmental care for rural children. New England Journal of Medicine, 376(14), 1301–1303. https://doi.org/10.1056/nejmp1700713

Mennis, J., Mason, M., & Ambrus, A. (2018). Urban greenspace is associated with reduced psychological stress among adolescents: A Geographic Ecological Momentary Assessment (GEMA) analysis of activity space. Landscape and Urban Planning, 174, 1–9. https://doi.org/10.1016/j.landurbplan.2018.02.008 

Morales, D. A., Barksdale, C. L., & Beckel-Mitchener, A. C. (2020). A call to action to address rural mental health disparities. Journal of Clinical and Translational Science, 4(5), 463–467. https://doi.org/10.1017/cts.2020.42 

Oh, H., Goehring, J., Jacob, L., & Smith, L. (2021). The environment of birthplace and self-reported mental health conditions: Findings from the American Panel of Life. Epidemiologia, 2(3), 256–261. https://doi.org/10.3390/epidemiologia2030019