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Assessing the impact of urban environment and green infrastructure on mental health: results from the São Paulo Megacity Mental Health Survey



Different land cover types in cities, including green areas, have impacts on mental health. Few studies, however, have been conducted in megacities in low-/middle-income countries, which have extremely complex urban arrangements.


We analyzed land cover using the population database of the São Paulo Megacity Mental Health Survey (n = 4287) and the associations with the diagnosis of depression/anxiety.


Automatic classification of the orthophotos of the metropolitan area was performed using the random forest algorithm to provide land cover variables. The association of mental health data with land cover was determined with logistic regression and multilevel regression models.


The percentage of different green spaces, mainly grassed areas, within districts was negatively associated with the presence of anxiety (OR 0.994, 0.968, 0.994, respectively), while roofs, asphalt and shadow (OR 1.007, 1.021, 1.085, 1.021, 1.014, respectively) were positively associated with the presence of anxiety. These results were more significant in green areas within the fourth quartile [−0.352 (0.158) and −0.347 (0.155), respectively] and in the roofs in the fourth quartile [0.321 (0.159)]. No significant results were found for depression.


Our data indicate the need for intensive greenery in spaces with different vegetation compositions in urban environments, especially megacities, to improve the mental health of urban dwellers.

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Fig. 1: Exposure assessment metrics of the participant’s survey.
Fig. 2: Satellite image of the area and respective classification of the roof class and its different colors.
Fig. 3: Satellite image of the studied area and the maps of the district and municipalities of SPMA colored according to their land cover quartiles.
Fig. 4: Odds ratios of the associations of anxiety with land cover variables at the district level in the São Paulo Metropolitan Area.


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We thank the Institute of Geosciences and Cartography of the State of São Paulo for providing the orthophotography. We also liked to thank Charles Ribas and Caue Peres for the help with geocoding the participants’ addresses.


The author TCLM thanks the São Paulo Research Foundation for a fellowship (Grants: 2016/15989-6 and 2013/21728-2 – São Paulo Research Foundation - FAPESP). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP): thematic project grant 03/00204-3). Laura Helena Andrade is supported/funded by the Brazilian Council for Scientific and Technological Development (CNPq Grant 307933/2019-9) and FAPESP project grant 16/50307-3. Thais Mauad is funded by the Brazilian Council for Scientific and Technological Development (CNPq grant #2019-3/304277).

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Correspondence to Tiana C. L. Moreira.

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Moreira, T.C.L., Polize, J.L., Brito, M. et al. Assessing the impact of urban environment and green infrastructure on mental health: results from the São Paulo Megacity Mental Health Survey. J Expo Sci Environ Epidemiol 32, 205–212 (2022).

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  • Urbanization
  • Public health
  • Green urban areas
  • Land cover
  • Mental health


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