Overview of "Systematic Reviews" of the Built Environment's Effects on Mental Health

Connecting to Community: A Social Identity Approach to Neighborhood Mental Health

ACADEMIC ABSTRACT

Integrative theorizing is needed to advance our understanding of the relationship between where a person lives and their mental health. To this end, we introduce a social identity model that provides an integrated explanation of the ways in which social-psychological processes mediate and moderate the links between neighborhood and mental health. In developing this model, we first review existing models that are derived primarily from a resource-availability perspective informed by research in social epidemiology, health geography, and urban sociology. Building on these, the social identity model implicates neighborhood identification in four key pathways between residents' local environment and their mental health. We review a wealth of recent research that supports this model and which speaks to its capacity to integrate and extend insights from established models. We also explore the implications of the social identity approach for policy and intervention.

PUBLIC ABSTRACT

We need to understand the connection between where people live and their mental health better than we do. This article helps us do this by presenting an integrated model of the way that social and psychological factors affect the relationship between someone's neighborhood and their mental health. This model builds on insights from social epidemiology, health geography, and urban sociology. Its distinct and novel contribution is to point to the importance of four pathways through which neighborhood identification shapes residents' mental health. A large body of recent research supports this model and highlights its potential to integrate and expand upon existing theories. We also discuss how our model can inform policies and interventions that seek to improve mental health outcomes in communities.

Neighborhood walkability, neighborhood social health, and self-selection among U.S. adults

OBJECTIVES

Neighborhood walkability is favorably related to multiple physical health outcomes, but associations with social health are less clear. Present analyses examined how neighborhood walkability was related to neighborhood social health and explored the potential confounding role of neighborhood self-selection.

METHODS

Cross-sectional data were analyzed for 1745 adults, ages 20-66, recruited from two US regions. We created a walkability index around each participant's home (1 km street network buffer) based on residential density, street intersection density, mixed land use, and retail floor area ratio. Neighborhood social health outcomes included reported social interactions with neighbors and sense of community. Two mixed model regressions were conducted for each outcome, with and without adjusting for walkability-related reasons for moving to the neighborhood (self-selection). Covariates included sex, age, socioeconomic status, white/nonwhite race/ethnicity, marital status, and time living in the neighborhood.

RESULTS

Neighborhood walkability was positively related to social interactions with neighbors, both without (b = 0.13, p < .001) and with adjustment for self-selection (b = 0.09, p = .008). Neighborhood walkability was positively associated with sense of community, but only before adjusting for self-selection (b = 0.02, p = .009).

CONCLUSION

Neighborhood walkability may promote specific aspects of neighborhood social health, which together are beneficial for physical and mental health. These findings provide additional impetus for enhancing walkability of US communities.

Analyzing Person-Place Interactions During Walking Episodes: Innovative Ambulatory Assessment Approach of Walking-Triggered e-Diaries

BACKGROUND

Walking behavior is positively associated with physiological and mental health as much evidence has already shown. Walking is also becoming a critical issue for health promotion in urban environments as it is the most often used form of active mobility and helps to replace carbon dioxide emissions from motorized forms of transport. It therefore contributes to mitigate the negative effects of climate change and heat islands within cities. However, to promote walking among urban dwellers and to utilize its health-enhancing potential, we need to know more about the way in which physical and social environments shape individual experiences during walking episodes. Such person-place interactions could not adequately be analyzed in former studies owing to methodological constraints.

OBJECTIVE

This study introduces walking-triggered e-diaries as an innovative ambulatory assessment approach for time-varying associations, and investigates its accuracy with 2 different validation strategies.

METHODS

The walking trigger consists of a combination of movement acceleration via an accelerometer and mobile positioning of the cellphone via GPS and transmission towers to track walking activities. The trigger starts an e-diary whenever a movement acceleration exceeds a predetermined threshold and participants' locations are identified as nonstationary outside a predefined place of residence. Every 420 (±300) seconds, repeated e-diaries were prompted as long as the trigger conditions were met. Data were assessed on 10 consecutive days. First, to investigate accuracy, we reconstructed walking routes and calculated a percentage score for all triggered prompts in relation to all walking routes where a prompt could have been triggered. Then, to provide data about its specificity, we used momentary self-reports and objectively assessed movement behavior to describe activity levels before the trigger prompted an e-diary.

RESULTS

Data of 67 participants could be analyzed and the walking trigger led to 3283 e-diary prompts, from which 2258 (68.8%) were answered. Regarding accuracy, the walking trigger prompted an e-diary on 732 of 842 (86.9%) reconstructed walking routes. Further, in 838 of 1206 (69.5%) triggered e-diaries, participants self-reported that they were currently walking outdoors. Steps and acceleration movement was higher during these self-reported walking episodes than when participants denied walking outdoors (steps: 106 vs 32; acceleration>0.2 g in 58.4% vs 19% of these situations).

CONCLUSIONS

Accuracy analysis revealed that walking-triggered e-diaries are suitable to collect different data of individuals' current experiences in situations in which a person walks outdoors. Combined with environmental data, such an approach increases knowledge about person-place interactions and provides the possibility to gain knowledge about user preferences for health-enhancing urban environments. From a methodological viewpoint, however, specificity analysis showed how changes in trigger conditions (eg, increasing the threshold for movement acceleration) lead to changes in accuracy.

The built environment and mental health among older adults in Dalian: The mediating role of perceived environmental attributes

The basic attributes of the urban built environment are an important factor affecting mental health. However, research has rarely distinguished objective and perceived built environment characteristics to explore the associations with older adults' mental health. Based on data of 879 respondents aged 60 or older in Dalian, China, we explored the mediating roles of perceived built environmental attributes in the relationship between objective built environmental characteristics and mental wellbeing by structural equation modelling. Furthermore, to control for residential self-selection, the model was further tested by excluding the participants who self-selected their residences. The results showed that accessibility to daily living service facilities was positively associated with older adults' mental wellbeing through an indirect role of perceived built environmental attributes. The positive direct effect of aggregation of daily living service facilities on mental wellbeing was offset by the negative indirect effects of perceived built environmental attributes. In addition, the street interface density was negatively related to mental wellbeing through indirect effects. The diverse leisure, exercise and landscape facilities, underground parking and presence of elevators within neighborhoods were all positively associated with older adults' mental wellbeing through direct and/or indirect effects. The results were verified after excluding residential self-selection samples. These findings are helpful for evidence-based planning strategies and can provide guidelines on designing neighborhood landscapes and facilities which can further contribute to aging in place policies.

COVID-19 lockdown impact on familial relationships and mental health in a large representative sample of Italian adults

PURPOSE

Benefits of national-level stay-at-home order imposed in Italy to prevent SARS-CoV-2 transmission need to be carefully weighed against its impact on citizens' health. In a country with a strong familial culture and where welfare relies on households, confinement drastically decreased support provided by elder relatives, which may have resulted in mental health worsening.

METHODS

A web-based cross-sectional study (LOST in Italy) was conducted on a representative sample of Italian adults during lockdown (27th of April-3rd of May 2020). We asked 3156 subjects to report on reduced help in housework and childcare from retired parents to assess the impact of confinement on mental health, through validated scales before and during lockdown.

RESULTS

Overall, 1484 (47.0%) subjects reported reduced housework help from parents, and 769 (64.0%, of the 1202 subjects with children) diminished babysitting support. Subjects reporting reduced housework help had worsened sleep quality (multivariate odds ratio, OR = 1.74, 95% confidence interval, CI 1.49-2.03) and quantity (OR = 1.50, 95% CI 1.28-1.76), depressive (OR = 1.32, 95% CI 1.14-1.53) and anxiety symptoms (OR = 1.53, 95% CI 1.32-1.78), compared to those reporting unreduced help. Worsening in sleep quality (OR = 2.32, 95% CI 1.76-3.05), and quantity (OR = 1.80, 95% CI 1.36-2.37), depressive (OR = 1.79, 95% CI 1.39-2.31) and anxiety symptoms (OR = 1.90, 95% CI 1.48-2.46) was also associated with reduced babysitting help. Mental health outcomes were worse in subjects with poorer housing and teleworking during lockdown.

CONCLUSION

Confinement came along with reduced familial support from parents, negatively impacting household members' mental health. Our findings might inform evidence-based family and welfare policies to promote population health within and beyond pandemic times.

Mental health in urban environments: Uncovering the black box of person-place interactions requires interdisciplinary approaches (Preprint)

Living in urban environments affects individuals' mental health through different pathways. For instance, physical activity and social participation are seen as mediators. However, aiming to understand underlying mechanisms, it is necessary to consider that the individual is interacting with its environment. In this regard, this viewpoint discusses how urban health research benefits from integration of socioecological and interdisciplinary perspectives, combined with innovative ambulatory data assessments that enable researchers to integrate different data sources. It is stated that neither focusing on the objective and accurate assessment of the environment (from the perspective of spatial sciences) nor focusing on subjectively measured individual variables (from the public health as well as a psychosocial perspective) alone is suitable to further develop the field. Addressing person-place interactions requires an interdisciplinary view on the level of theory (eg, which variables should be focused on?), assessment methods (eg, combination of time-varying objective and subjective measures), as well as data analysis and interpretation. Firstly, this viewpoint gives an overview on previous findings addressing the relationship of environmental characteristics to physical activity and mental health outcomes. We emphasize the need for approaches that allow us to appropriately assess the real-time interaction between a person and a specific environment and examine within-subject associations. This requires the assessment of environmental features, the spatial-temporal behavior of the individual, and the subjective experiences of the situation together with other individual factors, such as momentary affective states. Therefore, we finally focused on triggered study designs as an innovative ambulatory data assessment approach that allows us to capture real-time data in predefined situations (eg, while walking through a specific urban area).

A Systematic Review of the Effects of Urban Living on Suicidality and Self-Harm in the UK and Ireland

We conducted a systematic review to answer the following: (a) Is there any evidence to support increased prevalence of suicidality and self-harm (i.e. self-harm or suicidality) in urban versus rural environments? (b) What aspects of the urban environment pose risk for suicidality and self-harm? Thirty-five studies met our criteria. Our findings reflect a mixed picture, but with a tendency for urban living to be associated with an increased risk of suicidality and self-harm over rural living, particularly for those living in deprived areas. Further research should focus on the clustering and additive effects of risk and protective factors for suicidality and self-harm in urban environments.

Master-planned communities in the United States as novel contexts for individual and population-level research

It has long been known that social and physical environments can shape individual and population health, for better or worse. Master-planned communities (MPCs) in the US are custom-designed residential neighborhoods with defined boundaries planned and developed under a single, private owner or entity from their inception. Across the US, these vary greatly in scale ranging from 100 to over 50,000 homes, but broadly all provide residents with housing, infrastructure, landscaping, and purpose-built facilities to support socialization. Current research in the urban planning literature suggests that MPCs can influence the health of their residents. However, few studies have examined the use of MPCs as settings to conduct individual or population health research. In this paper, we examine the potential of MPCs as context for observational or intervention studies aimed at understanding individual and population-level health and well-being. We first summarize links between built and social environment and individual and population health research. Next, we describe the history of planned communities in the US. Then, we review specific features of MPCs related to governance, development, design, and social structure. We end by exploring how those specific features may lead to potential opportunities and challenges when using MPCs in health research. Through this discussion, we highlight MPCs as overlooked settings that may offer potential for collaborative, innovative, and socially engaged health research.

Do social isolation and neighborhood walkability influence relationships between COVID-19 experiences and wellbeing in predominantly Black urban areas?

Black Americans have been disproportionately affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic. Since the pandemic's start, we have observed compounded health, social, and economic impacts for communities of color, fueled in part by profound residential segregation in the United States that, for centuries prior to the pandemic, created differences in access to opportunity and resources. Based on a longitudinal cohort of Black residents living in two racially isolated Pittsburgh neighborhoods, we sought to: 1) describe the experiences of behavioral responses to COVID-19 conditions (e.g., closures of businesses, schools, government offices) and illness experiences reported by residents within these disinvested, urban areas and 2) determine if these experiences were associated with perceptions of risk, negative mental health outcomes, and food insecurity; and 3) examine whether any of the associations were explained by social isolation or modified by neighborhood walkability. We found direct associations between residents' experience with COVID-19-related closures and with the illness, with perceived risk, and change in psychological distress, sleep quality, and food insecurity from pre-COVID-19 levels. Social isolation was a statistically significant mediator of all of these associations, most strongly mediating the pathway to psychological distress. We found neighborhood walkability to be a significant moderator of the association between closure experiences and sleep quality. The results suggest that experiences of COVID-19 closures and illness were associated with serious threats to public health in Black, disinvested, urban neighborhoods, beyond those caused directly by the virus. Outcomes of the pandemic appear very much dependent on the extent to which social and physical resources are available to meet the demands of stress.

COVID-19 lockdown impact on mental health in a large representative sample of Italian adults

BACKGROUND

The potential benefits of the COVID-19 lockdown need to be carefully weighed versus the possible impact on people's daily life and negative mental health effects.We aimed to assess the prevalence of depression, anxiety, insomnia and quality of life before and during the COVID-19 lockdown,identifying subgroups at higher risk of mental distress as a consequence of COVID-19 associated restrictions.

METHODS

Within the Lost in Italy project, a web-based cross-sectional study was conducted on a representative sample of 6003 Italian adults aged 18-74 recruited from April 27 to May 3, 2020, within the nation-wide stay-at-home order.

RESULTS

The prevalence of depressive symptoms (PHQ-2 ≥ 3) increased from 14.3% before lockdown to 33.2% during lockdown, anxiety symptoms (GAD-2 ≥ 3) from 18.1% to 41.5%, insufficient sleep (≤6 h/day) from 33.7% to 41.1%, unsatisfactory sleep from 17.0% to 38.8% and unsatisfactory quality of life from 13.1% to 42.1%.Overall, 47.7% reported worsened depressive symptoms, 43.6% worsened anxiety symptoms, sleep quantity (31.5%) and quality (35.0%),and 64.1% worsened quality of life.A statistically significant relationship with all mental health outcomes considered was found for women vs. men (multivariate odds ratio,OR between 1.13 and 1.63), for current vs. never smokers (OR between 1.15 and 1.25), and with increasing physical activity (p for trend<0.001 for all the indicators).The use of at least one psychotropic drug increased by 20% compared to pre-lockdown (from 9.5% to 11.4%).

CONCLUSIONS

This is the first cross-sectional study conducted in Italy on a representative sample of adults to testify the huge implications of the lockdown on mental health.

A multi-scalar perspective on health and urban housing: an umbrella review

With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.

COVID-19 Lockdown: Housing Built Environment's Effects on Mental Health

Since the World Health Organization (WHO) declared the coronavirus infectious disease 2019 (COVID-19) outbreak a pandemic on 11 March, severe lockdown measures have been adopted by the Italian Government. For over two months of stay-at-home orders, houses became the only place where people slept, ate, worked, practiced sports, and socialized. As consolidated evidence exists on housing as a determinant of health, it is of great interest to explore the impact that COVID-19 response-related lockdown measures have had on mental health and well-being. We conducted a large web-based survey on 8177 students from a university institute in Milan, Northern Italy, one of the regions most heavily hit by the pandemic in Europe. As emerged from our analysis, poor housing is associated with increased risk of depressive symptoms during lockdown. In particular, living in apartments <60 m² with poor views and scarce indoor quality is associated with, respectively, 1.31 (95% CI: 1046–1637), 1.368 (95% CI: 1166–1605), and 2.253 (95% CI: 1918–2647) times the risk of moderate–severe and severe depressive symptoms. Subjects reporting worsened working performance from home were over four times more likely to also report depression (OR = 4.28, 95% CI: 3713–4924). Housing design strategies should focus on larger and more livable living spaces facing green areas. We argue that a strengthened multi-interdisciplinary approach, involving urban planning, public mental health, environmental health, epidemiology, and sociology, is needed to investigate the effects of the built environment on mental health, so as to inform welfare and housing policies centered on population well-being.