Integrating ESG indicators and behavioral factors to estimate the mental health index in Italy

This article examines the relationship between behavioral and Environmental, Social, and Governance (ESG) variables and the Mental Health Index (MHI) of Italian regions from 2016 to 2023. The use of descriptive statistics, cluster analysis, and forecasting models is employed for descriptive and exploratory purposes, as well as for forecasting regional disparities in mental health. Relative stability at the state level and persistent territorial variability are evident in the MHI derived from the ISTAT-BES indicators, with the North and Centre performing better than the South, except for notable improvements in disadvantaged regions such as Calabria and Campania. Behavioral factors, particularly sedentariness, smoking, and multimorbidity, are consistently associated with adverse trends for mental health, while adequate nourishment and exposure to urban green spaces are found to be protective. ESG-related factors, including occupational security and judicial efficacy, also contribute to these inequalities, attributing mental health status as part of the more general system effects of institutions and environments. Cluster analysis identifies distinct regional typologies based on aggregated behavioral and ESG patterns, while the predictive model highlights multimorbidity, smoking, and sedentary behavior as the most relevant factors negatively associated with the Mental Health Index (MHI), and urban green availability as a key factor positively associated with it. They point out that Italian mental health disparities are not only associated with behavioral determinants of individuals, but must be addressed from a multi-faceted ESG perspective. Policy reactions also mean that public health responses must attend not only to lifestyle risk factors but also structural determinants and incorporate active living promotion, reduction of smoking prevalence, investment in green infrastructures, and improvement of governance efficiency.