Utilizing Smartphone Technology to Examine the Relationship Between Environment and Mental Wellbeing in Early Psychosis and Healthy Individuals

Abstract

More than half of the global population currently resides in urban environments—a figure projected to rise to nearly 70% by 2050 (United Nations, 2019). While urban settings offer numerous benefits, such as improved access to healthcare and education, they also pose significant risks to mental wellbeing (Bloemsma et al., 2022). Much of the existing literature examining this association focuses on the general population. However, it is equally important to examine the association between the urban environment and mental wellbeing in clinical populations, particularly individuals with psychosis, given the well-established link between urban living and psychosis (Abrahamyan Empson et al., 2019; Bouter et al., 2023; Saxena & Dodell-Feder, 2022). Recent studies increasingly focus on the early stages of psychosis, especially individuals at Clinical High Risk (CHR) and those who have experienced a First Episode of Psychosis (FEP), aiming to enhance long-term outcomes through early intervention. Despite growing interest in this area, no study to date comprehensively examines diverse urban environmental factors and mental wellbeing in individuals with early psychosis. The primary aim of this thesis is to examine the associations between various aspects of the social and built environment and mental wellbeing in individuals with early psychosis and healthy individuals. The secondary aim is to examine whether these associations differ between individuals with early psychosis (CHR and FEP) and healthy controls (HCs). This research employs the Urban Mind smartphone application, which uses Ecological Momentary Assessment (EMA) to capture real-time experiences in naturalistic settings (Shiffman et al., 2008). Over a three-year period, 80 participants (n= 51 Early Psychosis [n=30 CHR; n=21 FEP]; n=29 HC) aged between 16 and 60, were enrolled in the study. Chapter 1 provides a comprehensive review of the literature on the relationships between urban environmental factors and mental wellbeing in both general and clinical populations. It also discusses the application of smartphone-based methods in mental health research. Chapter 2 outlines the methodological framework, including a detailed description of the Urban Mind application and other research tools used. Chapter 3 presents an experimental study examining natural aspects of the environment. It investigates the immediate and lasting associations between exposure to natural elements—such as trees, water, plants, or birds—and mental wellbeing. It also examines whether these associations differ between individuals with early psychosis and healthy controls. Chapter 4 investigates additional urban environmental factors, specifically perceived overcrowding and perceived noise. This chapter examine their immediate and sustained associations with mental wellbeing, and whether these associations differ between clinical and non-clinical groups. Chapter 5 focuses on the role of adaptive and maladaptive coping strategies. This Chapter examines the association between maladaptive and adaptive coping strategies and mental wellbeing, and whether this association is different between individuals with early psychosis in comparison to HCs. This Chapter also examines the moderating role of maladaptive and adaptive coping strategies in the associations between nature, perceived overcrowding, perceived noise and mental wellbeing in individuals with early psychosis and healthy individuals. Finally, Chapter 6 summarizes the key findings, discusses their broader implications, evaluates the thesis's strengths and limitations, and presents concluding remarks.