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This study characterized climate change perspectives in Switzerland, examined their associations with mental health indicators, and investigated their geographic distribution. We analyzed data from 3136 participants in Geneva’s Specchio cohort, assessing climate change perspectives with the Six Americas Survey and mental health using PHQ-2 and GAD-2 screening tools. Results revealed exceptionally high climate concern, with 76% of participants categorized as “Alarmed” or “Concerned”, substantially exceeding rates in recent national surveys. Depression symptoms were significantly associated with overall climate concern (OR = 1.071, 95% CI: 1.014–1.132), while anxiety showed stronger associations with climate worry (OR = 1.178, 95% CI: 1.121–1.238). Women demonstrated higher odds of concerned climate perspectives and climate worry compared to men. Hot spot analysis revealed distinct urban-peripheral patterns, with 11.7% of participants residing in joint hot spots of both climate worry and anxiety concentrated in urban centers. These findings advance understanding of climate-mental health relationships and identify potential targets for community-level interventions.