title: Cause and context: place-based approaches to investigate how environments affect mental health.
abstract: Our surroundings affect our mood, our recovery from stress, our behavior, and, ultimately, our mental health. Understanding how our surroundings influence mental health is central to creating healthy cities. However, the traditional observational methods now dominant in the psychiatric epidemiology literature are not sufficient to advance such an understanding. In this essay we consider potential alternative strategies, such as randomizing people to places, randomizing places to change, or harnessing natural experiments that mimic randomized experiments.
  
  
  
  We discuss the strengths and weaknesses of these methodological approaches with respect to (1) defining the most relevant scale and characteristics of context, (2) disentangling the effects of context from the effects of individuals' preferences and prior health, and (3) generalizing causal effects beyond the study setting.
  
  
  
  Promising alternative strategies include creating many small-scale randomized place-based trials, using the deployment of place-based changes over time as natural experiments, and using fluctuations in the changes in our surroundings in combination with emerging data collection technologies to better understand how surroundings influence mood, behavior, and mental health.
  
  
  
  Improving existing research strategies will require interdisciplinary partnerships between those specialized in mental health, those advancing new methods for place effects on health, and those who seek to optimize the design of local environments.
authors: Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Urban Health Collaborative, Drexel University, 3600 Market St, Philadelphia, PA, 19104, USA. gsl45@drexel.edu.
authors: Gina S
authors: GS
authors: Lovasi
authors: Department of Epidemiology, School of Public Health, Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA.
authors: Stephen J
authors: SJ
authors: Mooney
authors: Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, USA.
authors: Peter
authors: P
authors: Muennig
authors: Division of Trauma, Emergency Surgery and Surgical Critical Care, New York University School of Medicine, New York, USA.
authors: Charles
authors: C
authors: DiMaggio
mesh_terms: D035843:Biomedical Research; D004777:Environment; D006801:Humans; D008603:Mental Health; D016032:Randomized Controlled Trials as Topic
keywords: Case study; Causal models; Change-point; Place; Spatiotemporal