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The architecture of mental health: identifying the combination of apartment building design requirements for positive mental health outcomes Paula Hooper,a,∗ Alexandra Kleeman,b Nicole Edwards,a Julian Bolleter,a and Sarah Fosterb a

Australian Urban Design Research Centre (AUDRC), School of Design, The University of Western Australia, Australia Centre for Urban Research, School of Global, Urban and Social Studies, RMIT University, Australia

Summary Background Housing quality is a crucial determinant of mental health. While the construction of high-rise buildings is a popular policy strategy for accommodating population growth in cities, there is considerable debate about the health consequences of living in poorly designed apartments. Drawing on three Australian state government apartment design policies introduced to improve apartment design quality, this study aimed to identify the combination of design requirements that were optimally supportive of positive mental health.

The Lancet Regional Health - Western Paciﬁc 2023;37: 100807 Published Online 22 June 2023

https://doi.org/10. 1016/j.lanwpc.2023. 100807

Methods K-means cluster analyses identified groups of buildings (n = 172) that were homogenous in their implementation of a mix of n = 80 measured design requirements. Positive mental health was measured using the Warwick–Edinburgh Mental Well-being Scale (WEMWBS). Linear mixed-effects models controlling for demographic characteristics, self-selection factors and clustering of participants within buildings compared residents in the different clusters. Findings Residents in the "high policy performance buildings", characterised by having a greater implementation of n = 29 design requirements across nine design elements, had significantly higher (+1.96 points) WEMWBS scores compared with residents in the "low policy performance buildings". Interpretation This study is the first to empirically identify a mix of policy-specific architecture design requirements that are associated with positive mental health in apartment residents. These findings provide vital empirical evidence to inform national and international apartment and high-rise housing policies, and design instruments and practices to protect people’s health in apartment dwellings. Funding The High Life project is funded by a Healthway Research Intervention Project grant (#31986) and an Australian Research Council (ARC), Discovery Early Career Researcher Award (DECRA) (DE160100140). NE is supported by an Australian Research Council (ARC) Linkage Project (LP190100558). SF is supported by an Australian Research Council (ARC) Future Fellowship (FT210100899). Copyright © 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Keywords: Housing; Apartments; High rise; Mental health; Policy; Evaluation; Design; Architecture

Introduction Substandard housing is a signiﬁcant public health issue.1 There is a well-developed international evidence base linking inadequate indoor air quality, space, natural ventilation, sunlight, acoustic and visual privacy, insulation, and thermal comfort with various physical health impacts, including asthma, hypertension, upper respiratory tract infections, poor sleep quality, and infectious and chronic diseases.2–5 Moreover, the effects of

prolonged exposure to poor quality housing and associated physical ill health can, in turn, have negative implications for the psychological health of residents.6 A number of cross-sectional studies from highincome countries with a focus on mental health outcomes have found that apartment residents have poorer mental health than residents in other housing typologies,2,6 and emerging evidence indicates that apartment design may play a role in this association. For example,

*Corresponding author. Australian Urban Design Research Centre (AUDRC), School of Design, The University of Western Australia, 35 Stirling Highway, Crawley, 6059, Western Australia E-mail address: paula.hooper@uwa.edu.au (P. Hooper).