Impact of Urban Heat Stress on Mental Health Outcomes: A Multivariate Geospatial Analysis of Barisal City Corporation, Bangladesh

Abstract Urban heat stress is an emerging public health challenge in rapidly urbanizing cities, with growing evidence of its impacts on mental health. This study examines the spatial relationship between urban heat stress and mental health outcomes in Barisal City Corporation (BCC), a mid-sized, climate-vulnerable city in southern Bangladesh. A ward-level cross-sectional geospatial analysis was conducted by integrating remotely sensed thermal data with household-level mental health information. Land Surface Temperature (LST) and the Urban Thermal Field Variance Index (UTFVI) were derived from Landsat 8 and 9 imagery using Google Earth Engine. Mental health outcomes—including anxiety and sleep disorder prevalence, mental health outpatient visits, and average household stress scores—were collected via a structured survey of 384 households across 30 wards. Results indicate significant intra-urban variability: anxiety prevalence ranged from 8.3–15.3% (mean 12.2%), sleep disorders from 10.2–18.5% (mean 14.98%), outpatient visits from 13.3–25.3 per 1,000 population (mean 19.94), and household stress scores from 4.7–7.6 (mean 6.34), with higher values in densely built central wards. Bivariate correlations revealed strong positive associations between urban heat and mental health outcomes, with LST explaining over 98% of spatial variation in anxiety and sleep disorders, and UTFVI explaining 97.5% of household stress. Spatial overlays and hierarchical clustering identified high-risk zones in central and eastern wards with overlapping thermal and psychological stress. These findings highlight urban heat stress as a critical environmental determinant of mental health, emphasizing the need for spatially targeted, climate-resilient urban planning and public health interventions. The study provides geospatially explicit evidence to inform integrated climate–health strategies aligned with SDG 3 (health and well-being), SDG 11 (sustainable cities), and SDG 13 (climate action) in mid-sized Global South cities.