Mapping Mental Health in Municipalities: Comparing Random Sampling and Setting-Based Approaches to Generate Inclusive Data and Actionable Evidence

This research is supported by the SNSF under its project funding scheme. The project will start in January 2027.

The World Health Organization reported in September 2025 that over a billion people live with mental health conditions and that services require urgent scale-up. The consequences extend far beyond individual suffering, with profound social and economic costs (exceeding CHF 20 billion annually in Switzerland alone). Yet how should public mental health, care, prevention and promotion be implemented and expanded at the local and regional levels where they matter most?  Existing data from authorities and academic research face critical limitations, including insufficient depth in assessing mental health and its determinants, low participation rates, the exclusion of vulnerable and hard-to-reach groups, and failure to address the key interplay between individual, interpersonal, municipal, and societal factors. Our project addresses these shortcomings in the canton of Zurich with two main objectives: (A) to test and refine three different sampling and recruitment strategies, including a setting-based and participatory approach, to better reach underrepresented populations; and (B) to generate actionable, municipality-level evidence on mental health and wellbeing that supports researchers, practitioners, and policymakers. This dual focus provides scientific value by advancing more inclusive population research and policy value by generating locally relevant and actionable evidence. Zurich, Switzerland’s largest and most heterogeneous canton, brings together urban, peri-urban, and rural contexts with wide internal variation in size, resources, and foreign residents, making it a microcosm of the country. At the same time, challenges of urban density, social inequalities, ageing, and migration connect Zurich to urban and peri-urban regions worldwide, ensuring findings are locally actionable, nationally relevant, and globally comparable.

We will conduct three parallel large-scale cross-sectional surveys on mental health, wellbeing, and associated factors across individual, interpersonal, and municipal levels, while keeping broader state-level factors constant. Three recruitment strategies will be systematically compared: (1) a cantonal random sample as baseline (today’s state-of-art approach); (2) municipality-stratified samples in seven municipalities using matrix-based case selection; and (3) a full enumeration of all adults in four municipalities chosen through a most-different systems design. Municipalities are categorized by population size, fiscal capacity (as proxy for wealth), and share of foreign residents to maximize diversity in context and composition. In total, approximately 83’000 individuals will be invited, making this one of the largest recent population-based mental health studies in Switzerland. The survey will include validated instruments on mental health and wellbeing, key secondary outcomes, and measures of associated factors across the multiple levels of influence. 

This project moves clearly beyond state-of-art population studies that typically describe the big picture burden of mental health disorders but rarely produce actionable community-level results. Bridging psychology, epidemiology, and political science, the project addresses cross-cutting challenges of recruitment, selection bias, and representation, generating insights relevant across disciplines. By linking municipal contexts to mental health, we deliver evidence to guide public health and local policy, strengthen social cohesion and inclusion, and address structural drivers of distress. Based in the canton of Zurich, this project offers a model for more inclusive and context-sensitive mental health assessment, with lessons applicable to urban and peri-urban settings worldwide.

PIs: Anja Frei & Seraina Rüegger

Project partners: Karsten Donnay, Milo Puhan, Lilly Shanahan, Markus Wolf