When disaster strikes home: a scoping review linking the built environment to mental health outcomes following extreme environmental events.

Extreme environmental events (EEEs) are escalating globally, heightening risks of adverse mental health outcomes among affected populations. A robust body of evidence demonstrates the importance of neighbourhood built environments for mental health. Yet, the impact of built environments on mental health in the context of EEEs remains underexplored. This scoping review synthesised peer-reviewed studies examining associations between built environment attributes and mental health outcomes, following individuals' exposure to EEEs. Fourteen studies were identified and mapped according to the 3Ds framework (density, design, diversity), natural features, and disaster-related domains. Overall, the evidence was limited and heterogeneous. Area and housing damage were the most frequently examined attributes, followed by neighbourhood greenspace. Area and housing damage were consistently associated with higher risks of anxiety and trauma-related disorders, while neighbourhood greenspace yielded mixed associations. Other features, including population density, safety, accessibility to healthcare, neighbourhood vacancy and urbanicity, were examined infrequently with inconsistent evidence. Most studies were cross-sectional and focused on the general population aged 18 years and older. Perceived built environment measures often yielded stronger associations with mental health than objective measures. Although evidence is still emerging, this review highlights the substantial scope for advancing our understanding of the relationships between the built environment and mental health in the context of EEEs. Future research should prioritise longitudinal studies that integrate objective spatial data with subjective lived experiences, analytical approaches considering multiple factors operating at individual, neighbourhood, and city scales, and explicitly examine vulnerable population groups to inform health-promoting, equitable and climate-adaptive urban planning.