(Un)Healthy in the City: Respiratory, Cardiometabolic and Mental Health Associated with Urbanity

Lifetime prevalence of psychotic-like experiences and associated factors in Chile

INTRODUCTION

Psychotic-like experiences (PLEs), which include hallucinations and delusional experiences, are usually present in healthy populations, and their persistence, quality, and severity are associated with the development of psychiatric diseases, including schizophrenia and other poor psychosocial outcomes. Urbanicity, depression, and other psychosocial stressors have been associated with PLEs. However, evidence of PLEs in Latin American (LATAM) countries is still scarce, and there are no studies about PLEs in Chile. The main aim of this study is to describe the prevalence of PLEs in a nationally representative sample according to other social determinants of health.

METHODS

The last results of the Chilean National Health Survey (ENS 2016-2017) were analyzed. PLEs were obtained from the Composite International Diagnostic Interview (CIDI) 3.0 and included in this survey. Other psychosocial variables (age, sex, educational level, financial stress, depressive symptoms, and urbanicity) were also included for further analysis. Exclusion criteria were (1) >  = 65 and < 18 years old, and (2) previous diagnosis or treatment for schizophrenia or bipolar disorder. Descriptive statistics were used to describe data, and Poisson regression models were performed to weight variables and find psychosocial correlations with PLEs.

RESULTS

2095 subjects were considered for this study (women 62.9% and mean age = 42.5, SD = 13.5). The lifetime prevalence of the PLEs (> = 1 PLE) in Chile was 12.9%. Visual hallucinations were the most common PLE (9.6%), and ideas of reference were the least common (0.4%). The Poisson regression model showed a higher prevalence of PLEs in the Gran Concepción conurbation (OR = 2.56) and Gran Valparaíso conurbation (OR = 1.69) compared with non-big cities. On the other hand, the 18-24 year group had higher PLEs prevalence compared to other age groups. No correlations were found with educational status, financial stress, or depressive symptoms.

CONCLUSIONS

A relatively high prevalence of PLEs was found in the Chilean general population, particularly in youth living in large urban areas (Gran Valparaíso and Gran Concepción), which is compatible with previous research. Considering that there were no correlations between low educational level and financial or depressive symptoms, it is necessary to have more studies that correlate other urban relevant variables, such as natural disasters, drug consumption, and domestic or neighborhood violence.

Urban densification in the Netherlands and its impact on mental health: An expert-based causal loop diagram

Urban densification is a key strategy to accommodate rapid urban population growth, but emerging evidence suggests serious risks of urban densification for individuals' mental health. To better understand the complex pathways from urban densification to mental health, we integrated interdisciplinary expert knowledge in a causal loop diagram via group model building techniques. Six subsystems were identified: five subsystems describing mechanisms on how changes in the urban system caused by urban densification may impact mental health, and one showing how changes in mental health may alter urban densification. The new insights can help to develop resilient, healthier cities for all.

Gender Differences in the Prevalence and Clinical Correlates of Metabolic Syndrome in First-Episode and Drug-Naïve Patients With Major Depressive Disorder

OBJECTIVE

Major depressive disorder (MDD) is a severe psychiatric symptom worldwide, and the coexistence of MDD with metabolic syndrome (MetS) is common in clinical practice. However, gender differences in comorbid MetS in first-episode and drug-naïve (FEDN) MDD patients have not been reported. Here, we explored potential gender differences in the prevalence and clinical correlates of comorbid MetS in FEDN MDD patients.

METHODS

A cross-sectional study of 1718 FEDN MDD patients was conducted. Demographic and clinical data were collected. The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale, and Positive and Negative Syndrome Scale positive subscale were used to evaluate depression, anxiety, and psychotic symptoms, respectively.

RESULTS

The prevalence of MetS was 1.645-fold higher in female MDD patients (38.50%) than in male patients (26.53%). Patients with MetS had higher HAMD score, Hamilton Anxiety Scale score, and Positive and Negative Syndrome Scale positive subscale score than patients without MetS (p values < .001). Furthermore, suicide attempts (male: odds ratio [OR] = 1.706, p = .034; female: OR = 1.639, p = .004) and HAMD score (male: OR = 1.251, p < .001; female: OR = 1.148, p < .001) were independently associated with MetS in male and female patients, whereas age of onset was independently associated with MetS only in female patients (OR = 1.744, p = .047).

CONCLUSIONS

Our findings suggest significant gender differences in the prevalence and clinical correlates of comorbid MetS in FEDN MDD patients. Clinical variables (suicide attempts and HAMD scores) may be independently associated with MetS in MDD patients.

Cities and mental health: The role of the built environment, and environmental and lifestyle factors in Barcelona

Built environment characteristics and related environmental exposures and behaviors have been, separately, implicated in the development of poor mental health. However, it is unclear how these factors act together in relation to mental health. We studied these factors simultaneously to evaluate the impact of the built environment, and the mediating role of environmental exposures and physical activity, on mental health, while also studying moderation by sex, age, and length of residence. We used a cross-sectional population-based sample of 3145 individuals aged 15-97 years from Barcelona, Spain. Time spent walking and mental health status were assessed with validated questionnaires, administered through a face-to-face interview. We characterized the built environment (e.g., building, population and intersection density and green space), road traffic noise, and ambient air pollution at the residential level using land cover maps, remote sensing, noise maps and land use regression models. Adjusted regression models accounting for spatial clustering were analyzed to study associations between built environment attributes and mental health, and mediation and moderation effects. Density attributes were directly or indirectly, through air pollution and less consistently through walking, associated with poor mental health. Green space indicators were associated with lower prevalence of poor mental health, partly through lower air pollution exposure and more walking. In some cases, these associations differed by sex, age or length of residence. Non-linear associations of density indicators with environmental exposures, and of particulate matter with poor mental health indicated threshold effects. We conclude that living in dense areas with high air pollution concentrations was associated with poor mental health. On the other hand, green areas with lower air pollution concentrations were protective against poor mental health. Greater urban density might benefit health, but might only do so when air pollution concentrations are low.

Associations between neighbourhood characteristics, physical activity and depressive symptoms: the Northern Finland Birth Cohort 1966 Study

BACKGROUND

Due to rapid urbanization, there is a need to better understand the relative roles of residential environment and physical activity in depression. We aimed to investigate whether neighbourhood characteristics are related to the presence of depressive symptoms and whether the association is modified by physical activity.

METHODS

This cross-sectional study used the 46-year-old follow-up data (n = 5489) from the Northern Finland Birth Cohort 1966. Data on depressive symptoms, measured by Beck Depression Inventory-II, and self-reported and accelerometer-measured physical activity were included. Neighbourhood characteristics, population density, distance to the closest grocery store, bus stops and cycle/pedestrian paths, distance to the nearest parks and forests, residential greenness and level of urbanicity were calculated using Geographic Information System methods based on participants' home coordinates.

RESULTS

According to ordinal logistic regression analyses adjusted for physical activity at different intensities and individual covariates, living in a neighbourhood with higher population density and urbanicity level were associated with a higher risk of experiencing more severe depressive symptoms. Higher residential greenness was associated with a lower risk of experiencing more severe depressive symptoms after adjustment for self-reported light and moderate-to-vigorous physical activity, accelerometer-measured moderate-to-vigorous physical activity and individual covariates. Both higher self-reported and accelerometer-measured physical activity were independently associated with a lower risk of more severe depressive symptoms.

CONCLUSIONS

Both residential environment and physical activity behaviour play an important role in depressive symptoms; however, further research among populations of different ages is required. Our findings can be utilized when designing interventions for the prevention of depression.

Do Municipal Contexts Matter for Adolescent Mental Health? A Within-Municipality Analysis of Nationwide Norwegian Survey Data Across Six Years

Despite growing concerns about substantial socio-economic differences between districts in many developed nations, limited attention has been paid to how adolescent mental health may be shaped by district characteristics. A few studies have shown that adolescent mental health is related to contextual factors such as district socio-economic status, neighborhood disorder, and quality of infrastructure. However, prior estimates may be an artifact of unmeasured differences between districts. To address these concerns, we used data from the nationwide Norwegian Ungdata surveys (N = 278,764), conducted across the years 2014 to 2019. We applied three-level hierarchical linear models to examine within-municipality associations between municipal factors and adolescent mental health in the domains of internalizing problems (i.e., depressive symptoms), externalizing problems (i.e., behavioral problems), and well-being (i.e., self-esteem), thereby accounting for all time-invariant municipality-level confounders. Our results showed that municipal-level safety, infrastructure, and youth culture are associated with adolescent mental health problems. Further, cross-level interaction models indicated gender-specific associations, with stronger associations of municipality infrastructure and community belongingness with increased self-esteem and reduced delinquent behaviors among girls than boys. Our findings highlight that municipality-level interventions may be a feasible strategy for adolescent mental health, even in a society characterized by low inequality and high redistribution.

Urban vs. rural differences in psychiatric diagnoses, symptom severity, and functioning in a psychiatric sample

OBJECTIVE

Identifying whether certain groups of people experience elevated rates or severities of psychiatric symptoms provides information to guide healthcare allocation. People living in urban areas have higher rates of some psychiatric disorders relative to people living in rural settings, however, it is unclear if psychiatric severity is more elevated in urban vs. rural settings. This study investigates the urban vs. rural differences in rates of psychiatric disorders and severity of psychiatric symptoms.

METHOD

A cohort of patients (63% women, 85% White) presenting to an outpatient psychiatric treatment center in the U.S. completed patient-reported outcomes at all clinic visits as part of standard care. Rurality was determined by municipality population density. Sociodemographic characteristics, psychiatric diagnoses, trauma exposure, psychiatric symptom severity, functioning, and suicidality were compared by rural vs. urban municipality.

RESULTS

There were virtually no differences between patients living in rural vs. urban municipalities on rates of psychiatric disorders, severity of psychiatric symptoms, functional impairment, and suicidality (ps≥.09). The only difference was that patients living in rural municipalities had higher exposure to serious accidents than patients living in urban municipalities (p < .01); exposure to nine other traumatic events did not differ between groups (p≥.07).

CONCLUSIONS

People living in urban and rural municipalities have a similar need for mental health treatment. Access to care may be one explanatory factor for the occasional rural-urban differences in rates of psychiatric disorders. In other words, if people living in rural areas can access care, their symptom presentations appear unlikely to differ from those of people living in urban areas.

Social and physical neighbourhood characteristics and 10-year incidence of depression and anxiety in older adults: Results from the Longitudinal Aging Study Amsterdam

OBJECTIVE

A growing literature suggests that neighbourhood characteristics are associated with mental health outcomes, but the evidence in older adults is inconsistent. We investigated the association of neighbourhood characteristics, pertaining to demographic, socio-economic, social and physical environment domains, with the subsequent 10-year incidence of depression and anxiety, in Dutch older adults.

METHODS

In the Longitudinal Aging Study Amsterdam depressive and anxiety symptoms were assessed four times between 2005/2006 and 2015/2016, using the Center for Epidemiological Studies Depression Scale (n = 1365) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (n = 1420). Neighbourhood-level data on urban density, percent population over 65 years of age, percent immigrants, average house price, average income, percent low-income earners, social security beneficiaries, social cohesion, safety, proximity to retail facilities, housing quality, percent green space, percent water coverage, air pollution (particulate matter (PM2.5)), and traffic noise, were obtained for study baseline years 2005/2006. Cox proportional hazard regression models, clustered within neighbourhood, were used to estimate the association between each neighbourhood-level characteristic and the incidence of depression and anxiety.

RESULTS

The incidence of depression and anxiety was 19.9 and 13.2 per 1000 person-years, respectively. Neighbourhood characteristics were not associated with the incidence of depression. However, various neighbourhood characteristics were associated with an increased incidence of anxiety, including: higher urban density level, higher percent immigrants, greater proximity to retail facilities, lower housing quality score, lower safety score, higher PM2.5 levels and less green space.

CONCLUSION

Our results indicate that several neighbourhood characteristics are associated with anxiety but not with depression incidence in older age. Several of these characteristics have the potential to be modifiable and thus could serve as a target for interventions at the neighbourhood-level in improving anxiety, provided that future studies replicate our findings and provide further evidence for a causal effect.

Association Between Commuting Time and Subjective Well-Being in Relation to Regional Differences in Korea

BACKGROUND

Long commuting times have a negative impact on mental health. However, few studies have explored the relationship between commuting time and well-being based on urbanization by region. Our study examines this relationship as well as the effect of regional differences on Korean workers.

METHODS

We used data from the sixth Korean Working Conditions Survey. Commuting time and occupational factors were assessed using a questionnaire, and subjective well-being was assessed using the World Health Organization-5 Well-Being Index. Regions were divided into the cities and the provinces based on Korea's administrative divisions. Logistic regression analysis was performed to investigate the association between commuting time and well-being. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for well-being were estimated, using participants commuting time of < 20 minutes as a reference group.

RESULTS

The total number of workers was 29,458 (13,855 men, 15,603 women). We found higher aORs for low well-being among workers with long commuting times (aOR, 1.23; 95% CI, 1.11-1.36 and aOR, 1.28; 95% CI, 1.16-1.42 for 60-79 and ≥ 80 minutes, respectively). When stratified by sex and region, higher aORs for low well-being were found only in the workers who lived in cities.

CONCLUSION

Long commuting time was negatively associated with well-being in Korean wage workers living in the cities. Policies for reducing commuting time should be discussed to address the mental health of workers, especially those living in metropolitan cities.

Ecological Study of Urbanicity and Self-reported Poor Mental Health Days Across US Counties

Geography may influence mental health by inducing changes to social and physical environmental and health-related factors. This understanding is largely based on older studies from Western Europe. We sought to quantify contemporary relationships between urbanicity and self-reported poor mental health days in US counties. We performed regression on US counties (n = 3142) using data from the County Health Rankings and Roadmaps. Controlling for state, age, income, education, and race/ethnicity, large central metro counties reported 0.24 fewer average poor mental health days than small metro counties (t = - 5.78, df = 423, p < .001). Noncore counties had 0.07 more average poor mental health days than small metro counties (t = 3.06, df = 1690, p = 0.002). Better mental health in large central metro counties was partly mediated by differences in the built environment, such as better food environments. Poorer mental health in noncore counties was not mediated by considered mediators.

Urbanicity-Perspectives from Neuroscience and Public Health: A Scoping Review

Urban residency is associated with exposure to environmental factors, which can influence health in many ways. Neuroscientific research, as well as Public Health research, aim towards broadening evidence in the field of Urban Health. However, it is unclear whether the association between urban living and mental illnesses is causal rather than explainable by other selective effects. This review seeks to gather information on the current evidence regarding urban living and neurological outcomes to demonstrate how Public Health and Neuroscience could complement each other in the field of Urban Health. A scoping review was conducted in four electronic databases according to the PRISMA-statement guidelines. 25 empirical studies were included. Outcomes such as schizophrenia and psychotic disorders, social and cognitive functioning were scrutinised. Evidence was found for alteration of brain functioning and brain structure. Most studies researching cognitive functioning or cognitive decline displayed possible protective effects of urban living compared to rural living. The different study designs in Public Health and Neuroscience could profit from each other. Although the comparability of studies is limited by the inconsistent assessments of urbanity. Synergies and potentials to combine aspects of Public Health and Neuroscience in the field of Urban Health to improve population health became apparent.

The evaluation of the 3-30-300 green space rule and mental health

BACKGROUND AND AIMS

Urban green space has many health benefits, but it is still unclear how much actually is needed for better health. Recently a new 3-30-300 rule of thumb for urban forestry and urban greening has been proposed, but this rule has not been evaluated for benefits on health. The rule requires that every citizen should be able to see at least three trees from their home, have 30 percent tree canopy cover in their neighbourhood and not live more than 300 m away from the nearest park or green space. The aim of this study was to evaluate the relationship between the 3-30-300 green space rule and its components in relation to mental health.

METHODS

We conducted a cross-sectional study based on a population-based sample of 3145 individuals aged 15-97 years from in Barcelona, Spain who participated in the Barcelona Health Survey (2016-2017). We created 3-30-300 green space indicators using questionnaire data, GIS, remote sensing and land cover maps. Mental health status was assessed with the 12-item General Health Questionnaire (GHQ-12) and also the use of tranquilizer/sedatives or antidepressants and psychiatrist or psychologist visits. Analyses were conducted using mixed effects logistic regression models with districts as the random effect, adjusted for relevant covariates.

RESULTS

We found that people in Barcelona had relatively little exposure to green space, whether through window view, living in an area with sufficient greenness, or access to a major green space, and only 4.7% met a surrogate 3-30-300 green space rule. Residential surrounding greenness, but not tree window view or access to major green space, was significantly associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits. Meeting the full surrogate 3-30-300 green space rule was associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits, but only for the latter combined the association was statistically significant (Odds ratio = 0.31, 95% CI: 0.11, 0.91).

CONCLUSION

Few people achieved the 3-30-300 green space in Barcelona and we used a surrogate measure. We observed health benefits when the full surrogate rule was met.

Perceived Neighborhood Safety and Active Transportation in Adults from Eight Latin American Countries

Neighborhood built environment is associated with domain-specific physical activity. However, few studies with representative samples have examined the association between perceived neighborhood safety indicators and domain-specific active transportation in Latin America. This study aimed to examine the associations of perceived neighborhood safety with domain-specific active transportation in adults from eight Latin American countries. Data were obtained from the Latin American Study of Nutrition and Health (n = 8547, aged 18-65). Active transportation (walking and cycling) was assessed using the long form of the International Physical Activity Questionnaire. Specifically, traffic density and speed as well as street lightening, visibility of residents regarding pedestrians and bicyclists, traffic lights and crosswalks, safety of public spaces during the day and at night, crime rate during the day and at night were used to evaluate perceived neighborhood safety. Slow traffic speeds, unsafe public spaces during the day, and crime during the day were associated with ≥10 min/week vs. <10 min/week of walking. Furthermore, drivers exceeding the speed limit and crime rate during the day were associated with reporting ≥10 min/week vs. <10 min/week of cycling. These results indicate a stronger association of the perceived neighborhood safety with walking compared to cycling.

Nonproductive thoughts, somatic symptoms and well-being in adolescence: testing the moderator role of age and gender in a representative study

Background

Previous findings suggest a female preponderance in nonproductive thoughts -rumination and worry-, but studies on gender differences in the strength of the relationship between nonproductive thoughts, somatic symptoms and subjective well-being are scarce. Our aim was to test whether gender and age would moderate these associations.

Methods

1572 adolescents were involved in this representative cross-sectional study (770 boys; mean age = 15.39; SD = 2.26 years). Nonproductive thoughts were measured by Nonproductive Thoughts Questionnaire for Children (NPTQ-C), somatic symptoms were assessed by Somatic Complaint List (SCL), while Mental Health Continuum-Short Form (MHC-SF) was used to measure subjective well-being. To assess the moderation effects of age and gender on the relationship between nonproductive thoughts, somatic symptoms and well-being, four multiple indicator multiple causes (MIMIC) models were defined.

Results

Our results suggested that higher rates of nonproductive thoughts predicted a higher level of somatic symptoms and a lower level of subjective well-being. The analyses revealed that although nonproductive thoughts were strongly and equally associated with somatic symptoms among boys and girls, age was a significant moderator. Gender also moderated the relationship between nonproductive thoughts and subjective well-being.

Conclusions

Our results support the importance of nonproductive thoughts in somatic symptoms and highlight that the strength of the relationship is similar across both genders but could be dependent upon age. The findings also shed light on the decreased well-being of girls, especially with elevated level of nonproductive thoughts.

The Impacts of Housing Characteristics and Built-Environment Features on Mental Health

In this study, we examined the relationships between housing characteristics, neighborhood built-environment features, and people's mental health in Hong Kong, an Asian city well known for its high-density and high-rise housing. The potential mediating effects of people's perceived living environment were also considered in the analysis. We collected data from 221 participants from two communities in Hong Kong, i.e., Sham Shui Po (SSP) and Tin Shui Wai (TSW), using a stratified random sampling approach. Big datasets were also used to derive relevant built-environment features at the street block level. We used structural equation modeling to explore the complex relationships among housing characteristics, built-environment features, and mental health. The results indicate that the associations between built-environment quality and people's mental health are weak. For communities with relatively poor housing conditions (i.e., SSP in this study), the impact of housing characteristics on mental health may be more direct; for communities with relatively good housing conditions (i.e., TSW in this study), the effect of housing characteristics on mental health may be indirect. Our findings shed light on the importance of considering different contexts in developing policies related to housing and built environment and mental health.

The association between fast-food outlet proximity and density and Body Mass Index: Findings from 147,027 Lifelines Cohort Study participants

Unhealthy food environments may contribute to an elevated Body Mass Index (BMI), which is a chronic disease risk factor. We examined the association between residential fast-food outlet exposure, in terms of proximity and density, and BMI in the Dutch adult general population. Additionally, we investigated to what extent this association was modified by urbanisation level. In this cross-sectional study, we linked residential addresses of baseline adult Lifelines Cohort participants (n = 147,027) to fast-food outlet locations using geo-coding. We computed residential fast-food outlet proximity, and density within 500 m, 1, 3, and 5 km. We used stratified (urban versus rural areas) multilevel linear regression models, adjusting for age, sex, partner status, education, employment, neighbourhood deprivation, and address density. The mean BMI of participants was 26.1 (SD 4.3) kg/m². Participants had a mean (SD) age of 44.9 (13.0), 57.3% was female, and 67.0% lived in a rural area. Having two or more (urban areas) or five or more (rural areas) fast-food outlets within 1 km was associated with a higher BMI (B = 0.32, 95% confidence interval (CI): 0.03, 0.62; B = 0.23, 95% CI: 0.10, 0.36, respectively). Participants in urban and rural areas with a fast-food outlet within <250 m had a higher BMI (B = 0.30, 95% CI: 0.03, 0.57; B = 0.20, 95% CI: 0.09, 0.31, respectively). In rural areas, participants also had a higher BMI when having at least one fast-food outlet within 500 m (B = 0.10, 95% CI: 0.02, 0.18). In conclusion, fast-food outlet exposure within 1 km from the residential address was associated with BMI in urban and rural areas. Also, fast-food outlet exposure within 500 m was associated with BMI in rural areas, but not in urban areas. In the future, natural experiments should investigate changes in the fast-food environment over time.

The Effects of Urban Green Space on Depressive Symptoms of Mid-Aged and Elderly Urban Residents in China: Evidence from the China Health and Retirement Longitudinal Study

The aim of this study is to assess the impacts of urban green space on depressive symptoms among Chinese urban residents aged 45 and older. In total, 7397 urban respondents were included in this study. Each respondent participated in the China Health and Retirement Longitudinal Study Wave 3 (2015). Environmental-level variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were used in the multilevel regression analysis. Almost one-third of the sample population suffered from depressive symptoms (31.20%). The multilevel logistic regression model showed that green coverage ratio of city-built districts is negatively associated with the prevalence of depressive symptoms among urban mid-aged (OR = 0.79, p < 0.05) and elderly (OR = 0.75, p < 0.05) residents, and the public recreational green space helps to reduce elderly people’s depressive symptoms (OR = 0.77, p < 0.05). This study adds insights about the impact of green space and other environmental factors on depressive symptoms among mid-aged and elderly urban dwellers. It is important to provide enough and accessible overall urban green spaces; additionally, attention should also be paid to specific green space forms such as public recreational green space.

Vulnerability and Resilience of Urban Traffic to Precipitation in China

The concept of Healthy Cities, introduced by the World Health Organization, demonstrates the value of health for the whole urban system. As one of the most important components of urban systems, transportation plays an important role in Healthy Cities. Many transportation evaluation systems focus on factors such as road networks, parking spaces, transportation speed, accessibility, convenience, and commuting time, while the vulnerability and resilience of urban transportation are rarely evaluated. This study presents the preliminary progress in the evaluation of traffic vulnerability and resilience during precipitation events in 39 Chinese cities. Traffic congestion index data, derived from the Baidu Map Smart Transportation Platform, and rainfall data, derived from NASA's global precipitation measurement, are utilized. Traffic vulnerability index, traffic resilience index, and the corresponding quantitative methods are proposed, and the analysis results are presented. This study is of value in improving the understanding of urban traffic vulnerability and resilience, and in enabling the quantitative evaluation of them in urban health assessment and the Healthy Cities program.

Impact of Rainfall on Traffic Speed in Major Cities of China

The construction of healthy transportation is an important ingredient for promoting the healthy development of cities. The establishment of an urban traffic evaluation mechanism can provide an important basis for the construction of healthy transportation. This study focused on the impact of precipitation on traffic speed and developed an urban traffic vulnerability index. This index reflects the degree of traffic affected by precipitation, which is calculated based on the traffic congestion index under different rainfall intensities. The traffic vulnerability indices of 41 major cities in China under rainfall conditions were evaluated. Based on the above traffic vulnerability indexes, the impact of socioeconomic factors on urban traffic vulnerability was analyzed. The three key findings of this study are as follows: there was a positive correlation between the vulnerability index and the gross domestic product (GDP); the urban population (POP) had a significant impact on the urban traffic vulnerability; and urban car ownership had little impact on traffic vulnerability. Based on these findings, possible measures to improve urban traffic vulnerability are proposed. The construction of an index system provides a basis for enhancing the urban traffic assessment mechanism, promoting the development of urban physical examinations and building healthy transportation and healthy cities.

Prevalence of Major Depressive Disorder Among Adults in China: A Systematic Review and Meta-Analysis

Background: Prevalence estimates of major depressive disorder (MDD) among adults in China have varied widely between studies. In this systematic review and meta-analysis, the overall prevalence of MDD in the Chinese population was estimated from published epidemiological studies and potential moderators that account for variability in estimates were assessed. Methods: A systematic literature search was conducted in PubMed, EMBASE, Web of Science, PsycINFO, China National Knowledge Internet (CNKI), and WanFang databases to identify relevant studies. Data analyses were conducted using the Comprehensive Meta-Analysis Version 2.0. Results: Forty studies comprising 1,024,087 subjects were included. The pooled point, 12-month, and lifetime prevalence rates of MDD in China were 1.1% (95% CI: 0.9-1.4%), 1.6% (95% CI: 1.0-2.5%), and 1.8% (95% CI: 1.5-2.2%), respectively. Subgroup and meta-regression analyses revealed gender, marital status, survey year, being published in English language, use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic systems and age as significant moderators of MDD prevalence. Conclusion: The overall prevalence of MDD in the Chinese population appears to be lower than that of most countries, but the rates have been increasing over time and are elevated in particular demographic subgroups. Due to the negative consequences of MDD, effective preventive measures, early identification, and timely treatments are still important and should be offered to those in need.

Impact of road traffic noise on obesity measures: Observational study of three European cohorts

BACKGROUND

Environmental stressors such as transport noise may contribute to development of obesity through increased levels of stress hormones, sleep deprivation and endocrine disruption. Epidemiological evidence supporting an association of road traffic noise with obesity markers is still relatively scant and confined to certain geographical regions. We aimed to examine the cross-sectional associations between road traffic noise and obesity markers in three large European cohorts involving nearly 500,000 individuals.

METHODS

Three population-based cohorts (UK Biobank, Lifelines, HUNT3) were established between 2006 and 2013 in the UK, the Netherlands and Norway respectively. For all three cohorts, residential 24-h road traffic noise (Lden) for 2009 was modelled from a standardised European noise assessment framework. Residential exposures to NO2 for 2007 and PM2.5 for 2010 were estimated from Europe-wide land use regression models. Obesity markers including body mass index and waist circumference were measured at recruitment. Obesity and central obesity status were subsequently derived. Regression models were fitted in each cohort, adjusting for a harmonised set of demographic and lifestyle covariates, with further adjustments for air pollution in the main model.

RESULTS

The main analyses included 412,934 participants of UK Biobank, 61,032 of Lifelines and 30,305 of HUNT3, with a mean age of 43-56 years and Lden ranging 42-89 dB(A) across cohorts. In UK Biobank, per 10 dB(A) higher of Lden: BMI was higher by 0.14kg/m2 (95%CI: 0.11-0.18), waist circumference higher by 0.27 cm (95%CI: 0.19-0.35), odds of obesity was 1.06 (95%CI: 1.04-1.08) and of central obesity was 1.05 (95%CI: 1.04-1.07). These associations were robust to most other sensitivity analyses but attenuated by further adjustment of PM2.5 or area-level socioeconomic status. Associations were more pronounced among women, those with low physical activity, higher household income or hearing impairment. In HUNT3, associations were observed for obesity or central obesity status among those exposed to Lden greater than 55 dB(A). In contrast, no or negative associations were observed in the Lifelines cohort.

CONCLUSIONS

This largest study to date providing mixed findings on impacts of long-term exposure to road traffic noise on obesity, which necessitates future analyses using longitudinal data to further investigate this potentially important epidemiological link.

Comparing the Use of Spatially Explicit Indicators and Conventional Indicators in the Evaluation of Healthy Cities: A Case Study in Shenzhen, China

Various indicator systems have been developed to monitor and assess healthy cities. However, few of them contain spatially explicit indicators. In this study, we assessed four health determinants in Shenzhen, China, using both indicators commonly included in healthy city indicator systems and spatially explicit indicators. The spatially explicit indicators were developed using detailed building information or social media data. Our results showed that the evaluation results of districts and sub-districts in Shenzhen based on spatially explicit indicators could be positively, negatively, or not associated with the evaluation results based on conventional indicators. The discrepancy may be caused by the different information contained in the two types of indicators. The spatially explicit indicators measure the quantity of the determinants and the spatial accessibility of these determinants, while the conventional indicators only measure the quantity. Our results also showed that social media data have great potential to represent the high-resolution population distribution required to estimate spatially explicit indicators. Based on our findings, we recommend that spatially explicit indicators should be included in healthy city indicator systems to allow for a more comprehensive assessment of healthy cities.

The contribution of financial well-being, social support, and trait emotional intelligence on psychological distress

OBJECTIVES

While financial deprivation, social isolation, and low emotional intelligence (EI) have been separately identified as important predictors of mental illness, no research has assessed the contribution of these factors together in understanding early markers of severe psychological distress. This information can have key implications for the development of comprehensive interventions and psychological treatment programmes. This study investigated the shared and unique contribution of financial well-being, social support, and trait EI on different types of psychological distress.

DESIGN

A total of 309 patients seeking psychological treatment at an outpatient mental health clinic in the United States provided consent to participate in this study. Patients responded to online questionnaires corresponding to symptomatology, demographic characteristics, and psychometric assessments.

METHODS

Hierarchical linear regressions identified the common and unique role of each set of variables in predicting nine different symptom clusters of psychological distress.

RESULTS

Financial well-being, social support, and trait EI were negatively related to the majority of symptom clusters, together explaining between 20% and 53% of the variance. Whereas financial well-being and social support uniquely captured a significant amount of the variance in all outcomes, trait EI, most notably the well-being and self-control dimensions, captured the most.

CONCLUSIONS

The results highlight the importance of all factors in understanding variations in mental health among help-seeking urban individuals. Furthermore, the results identify well-being and self-control as emotional facets to consider in therapeutic programmes in as much as to mitigate the risk of severe psychological distress within this population.

PRACTITIONER POINTS

Together, financial well-being, social support, and trait emotional intelligence (EI) can help prevent psychological distress in help-seeking urban individuals. Perceived social support and social contact differentially contributed to improved symptoms of psychological distress. Studies should examine the impact of targeting well-being and self-control in psychological treatment. The correlational nature of this study highlights the need to replicate findings via experimental or longitudinal designs.

Airborne Particulate Matter: Human Exposure and Health Effects

OBJECTIVE

Exposure to airborne particulate matter (PM) is estimated to cause millions of premature deaths annually. This work conveys known routes of exposure to PM and resultant health effects.

METHODS

A review of available literature.

RESULTS

Estimates for daily PM exposure are provided. Known mechanisms by which insoluble particles are transported and removed from the body are discussed. Biological effects of PM, including immune response, cytotoxicity, and mutagenicity, are reported. Epidemiological studies that outline the systemic health effects of PM are presented.

CONCLUSION

While the integrated, per capita, exposure of PM for a large fraction of the first-world may be less than 1 mg per day, links between several syndromes, including attention deficit hyperactivity disorder (ADHD), autism, loss of cognitive function, anxiety, asthma, chronic obstructive pulmonary disease (COPD), hypertension, stroke, and PM exposure have been suggested. This article reviews and summarizes such links reported in the literature.

Associations of neighbourhood sociodemographic characteristics with depressive and anxiety symptoms in older age: Results from a 5-wave study over 15 years

We examined the long-term association between objective neighbourhood sociodemographic characteristics (index of socioeconomic position (SEP), average income, percent low-income earners, average house price, percent immigrants and urban density) with depressive and anxiety symptoms, covering five 3-year waves of the Longitudinal Aging Study Amsterdam (n = 3,772). Multi-level regression models assessed each neighbourhood-level characteristic separately, adjusting for individual-level covariates. A higher percentage of immigrants and higher urban density, but not other neighbourhood characteristics, were significantly associated with depressive and anxiety symptoms over time in models adjusted for individual SEP. Results of time interaction models indicated that the associations were stable over the 15-year period.

Neighbourhood characteristics and prevalence and severity of depression: pooled analysis of eight Dutch cohort studies

BACKGROUND

Studies on neighbourhood characteristics and depression show equivocal results.AimsThis large-scale pooled analysis examines whether urbanisation, socioeconomic, physical and social neighbourhood characteristics are associated with the prevalence and severity of depression.

METHOD

Cross-sectional design including data are from eight Dutch cohort studies (n = 32 487). Prevalence of depression, either DSM-IV diagnosis of depressive disorder or scoring for moderately severe depression on symptom scales, and continuous depression severity scores were analysed. Neighbourhood characteristics were linked using postal codes and included (a) urbanisation grade, (b) socioeconomic characteristics: socioeconomic status, home value, social security beneficiaries and non-Dutch ancestry, (c) physical characteristics: air pollution, traffic noise and availability of green space and water, and (d) social characteristics: social cohesion and safety. Multilevel regression analyses were adjusted for the individual's age, gender, educational level and income. Cohort-specific estimates were pooled using random-effects analysis.

RESULTS

The pooled analysis showed that higher urbanisation grade (odds ratio (OR) = 1.05, 95% CI 1.01-1.10), lower socioeconomic status (OR = 0.90, 95% CI 0.87-0.95), higher number of social security beneficiaries (OR = 1.12, 95% CI 1.06-1.19), higher percentage of non-Dutch residents (OR = 1.08, 95% CI 1.02-1.14), higher levels of air pollution (OR = 1.07, 95% CI 1.01-1.12), less green space (OR = 0.94, 95% CI 0.88-0.99) and less social safety (OR = 0.92, 95% CI 0.88-0.97) were associated with higher prevalence of depression. All four socioeconomic neighbourhood characteristics and social safety were also consistently associated with continuous depression severity scores.

CONCLUSIONS

This large-scale pooled analysis across eight Dutch cohort studies shows that urbanisation and various socioeconomic, physical and social neighbourhood characteristics are associated with depression, indicating that a wide range of environmental aspects may relate to poor mental health.Declaration of interestNone.

Not urbanization level but socioeconomic, physical and social neighbourhood characteristics are associated with presence and severity of depressive and anxiety disorders

BACKGROUND

Which neighbourhood factors most consistently impact on depression and anxiety remains unclear. This study examines whether objectively obtained socioeconomic, physical and social aspects of the neighbourhood in which persons live are associated with the presence and severity of depressive and anxiety disorders.

METHODS

Cross-sectional data are from the Netherlands Study of Depression and Anxiety including participants (n = 2980) with and without depressive and anxiety disorders in the past year (based on DSM-based psychiatric interviews). We also determined symptom severity of depression (Inventory of Depression Symptomatology), anxiety (Beck Anxiety Inventory) and fear (Fear Questionnaire). Neighbourhood characteristics comprised socioeconomic factors (socioeconomic status, home value, number of social security beneficiaries and percentage of immigrants), physical factors (air pollution, traffic noise and availability of green space and water) and social factors (social cohesion and safety). Multilevel regression analyses were performed with the municipality as the second level while adjusting for individual sociodemographic variables and household income.

RESULTS

Not urbanization grade, but rather neighbourhood socioecononomic factors (low socioeconomic status, more social security beneficiaries and more immigrants), physical factors (high levels of traffic noise) and social factors (lower social cohesion and less safety) were associated with the presence of depressive and anxiety disorders. Most of these neighbourhood characteristics were also associated with increased depressive and anxiety symptoms severity.

CONCLUSION

These findings suggest that it is not population density in the neighbourhood, but rather the quality of socioeconomic, physical and social neighbourhood characteristics that is associated with the presence and severity of affective disorders.

Active commuting through natural environments is associated with better mental health: Results from the PHENOTYPE project

BACKGROUND

Commuting routes with natural features could promote walking or cycling for commuting. Commuting through natural environments (NE) could have mental health benefits as exposure to NE can reduce stress and improve mental health, but there is little evidence. This study evaluates the association between NE and commuting, whether active or not, and the association between commuting (through NE), whether active or not, and mental health. We also evaluate the moderating effect of NE quality on the association between NE commuting and mental health.

METHODS

This cross-sectional study was based on adult respondents (n = 3599) of the Positive Health Effects of the Natural Outdoor Environment in Typical Populations in Different Regions in Europe (PHENOTYPE) project. Data were collected in four European cities in Spain, the Netherlands, Lithuania and the United Kingdom. Data on commuting behavior (active commuting at least one day/week, daily NE commuting) and mental health were collected with questionnaires. Associations were estimated with multilevel analyses including random intercepts at city- and neighborhood level.

RESULTS

Adjusted multilevel analyses showed that daily NE commuters were more often active commuters (OR 1.42; 95% CI 1.19, 1.70). There was no association between active commuting and mental health, but daily NE commuters had on average a 2.74 (95% CI 1.66, 3.82) point higher mental health score than those not commuting through NE. The association with mental health was stronger among active commuters (4.03, 95% CI 2.13, 5.94) compared to non-active commuters (2.21; 95% CI 0.90, 3.51) when daily commuting through NE, but NE quality did not have a moderating effect.

CONCLUSIONS

Daily NE commuting was associated with better mental health, especially for active commuters. Daily NE commuters were likely to be active commuters. Active commuting itself was not associated with mental health. These findings suggest that cities should invest in commuting routes with nature for cycling and walking.

Factors related to quality of life among middle-aged and older korean adults in 2006 and 2014: A nationally representative study

Factors related to quality of life (QoL) were investigated using data from middle-aged and older Korean respondents to the 2006 and 2014 Korean Longitudinal Study of Ageing. Respondents' QoL score in 2014 (6.03 ± 1.69) was lower than in 2006 (6.20 ± 2.12). All socio-demographic and health-related variables seemed to influence QoL in 2006 (R² = 0.238) and 2014 (R² = 0.234). Four factors significantly associated with QoL in both years were health, household income, depression, and regular exercise. Rural and mid-sized city dwellers were more likely to have a better QoL than residents of metropolitan areas; residential area had a greater influence on QoL in 2014.

Factors associated with the emotional health of children: high family income as a protective factor

Anxiety and depressive symptoms have adverse effects on children's development. The present study investigates the associations of socioeconomic factors as well as maternal emotional health with children's emotional health status. The data were collected between 2011 and 2015 in the LIFE Child study, a population-based cohort study in Leipzig, Germany. The emotional health status of 1093 children (2.5-11.9 years old) was investigated using the subscale 'emotional problems' of the Strengths and Difficulties Questionnaire. Associations of maternal emotional health, family status, and socioeconomic status (SES) with the emotional health status of children were estimated via regression analyses. 21.13% of the participating children were assigned to the 'risk' group for emotional problems. The results furthermore revealed that children of mothers reporting more depressive symptoms, children living in single-parent families, and children of families with lower SES scored higher in the emotional problems scale. When considering the different indicators of SES (parental education, occupational status, and monthly net income) separately, only income showed significant associations with children's emotional health status. The prevalence of emotional problems in children in Leipzig, a city in East Germany, appears to be higher than the previously reported German average. Maternal depressive symptoms, single-parent families, lower SES, and especially lower income can be seen as risk factors for children's emotional health.

Benefits of maternal education for mental health trajectories across childhood and adolescence

RATIONALE

Mental health problems in children and adolescents are widespread and are a primary public health concern worldwide. During childhood and adolescence different challenges must be met. Whether the corresponding developmental tasks can be mastered successfully and in a psychologically healthy manner depends on the availability of resources.

OBJECTIVE

The aim of the current study was to examine the benefits of maternal education on the development of mental health in children and adolescents.

METHOD

Data from 2810 participants (48.7% female, 7- to 19-years old) of the longitudinal BELLA study (mental health module of the representative German KiGGS study) were analyzed from up to four measurement points (2003-2012). Individual growth modeling was employed to estimate the benefits of maternal education (Comparative Analysis of Social Mobility in Industrial Nations, CASMIN) for the trajectories of mental health problems (parent-reported Strengths and Difficulties Questionnaire, SDQ) in children and adolescents.

RESULTS

Children of mothers with low education had significantly more mental health problems compared to children of mothers with high education. This difference due to maternal education applied for girls as well as boys and especially for participants who did not live with both biological parents. Further, the difference in mental health problems due to varying maternal education decreased with increasing age of the participants.

CONCLUSION

Prevention programs should focus on children of mothers with lower education who additionally live in single- or step-parent families as a high-risk group. Knowledge of the underlying mechanism between education and mental health is highly important.

Living environment and its relationship to depressive mood: A systematic review

BACKGROUND AND AIMS

The notion that environment affects mental health has a long history; in this systematic review, we aimed to study whether the living environment is related to depressive mood.

METHODS

We searched databases of PubMed, Scopus and Web of Science for population-based original studies prior to October 2016. We included studies that measured depressive symptoms or depression and had measures of urbanization, population density, aesthetics of living environment, house/built environment, green areas, walkability, noise, air pollution or services.

RESULTS

Out of 1,578 articles found, 44 studies met our inclusion criteria. Manual searches of the references yielded 13 articles, resulting in 57 articles being included in the systematic review. Most of the studies showed statistically significant associations with at least one of the characteristics of living environment and depressive mood. House and built environment with, for example, poor housing quality and non-functioning, lack of green areas, noise and air pollution were more clearly related to depressive mood even after adjustment for different individual characteristics. On the contrary, the results in relation to population density, aesthetics and walkability of living environment, and availability of services and depressive mood were more inconsistent.

CONCLUSION

Adverse house/built environment, including poor housing quality and non-functioning, lack of green spaces, noise and air pollution are related to depressive mood and should be taken into account during planning in order to prevent depressive mood.

Genome-wide association study for genetic variants related with maximal voluntary ventilation reveals two novel genomic signals associated with lung function

Genome-wide association studies (GWAS) for spirometry parameters have been limited to forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and their ratio. This study examined to identify genetic variants associated with maximal voluntary ventilation (MVV), an important spirometry parameter presenting inspiratory muscle strength.A total of 8842 Korean subjects participated in the Korean Association REsource Consortium were used to identify nucleotide variants associated with MVV and other spirometry parameters through a GWAS. Genetic associations were determined by employing a mixed model that can control background polygenic effects.The analysis revealed 3 nucleotide variants associated with MVV (P < 5 × 10). One (rs1496255) was also associated with FVC and FEV1. The other 2 variants were identified only for MVV and located in the genes of LOC102724340 (rs41434646) and FHIT (rs9833533). In particular, FHIT represses transcriptional activity of β-catenin, a critical protein for growth of skeletal muscle, and thus might have influenced the level of MVV.The current study revealed 2 novel nucleotide variants as genetic association signals for MVV. The association signals were suggested specific for neuromuscular diseases with a restrictive ventilatory impairment. Further studies are required to understand underlying mechanisms for their influence to restrictive lung diseases.

The LifeLines Cohort Study: a resource providing new opportunities for environmental epidemiology

BACKGROUND

Lifelines is a prospective population-based cohort study investigating the biological, behavioral and environmental determinants of healthy ageing among 167,729 participants from the North East region of the Netherlands. The collection and geocoding of (history of) home and work addresses allows linkage of individual-level health data to detailed exposure data. We describe the reasons for choosing particular assessments of environmental exposures in LifeLines and consider the implications for future investigations.

METHODS

Exposure to ambient air pollution and road traffic noise was estimated using harmonized models. Data on noise annoyance, perceived exposure to electromagnetic fields, perceived living environment, and neighborhood characteristics were collected with questionnaires. A comprehensive medical assessment and questionnaires were completed in order to assess determinants of health and well-being. Blood and urine samples were collected from all participants and genome wide association data are available for a subsample of 15,638 participants.

RESULTS

Mean age was 45 years (standard deviation (SD) 13 years), and 59 % were female. Median levels of NO2 and PM10 were 15.7 (interquartile range (IQR) 4.9) μg/m(3) and 24.0 (IQR 0.6) μg/m(3) respectively. Median levels of daytime road traffic noise were 54.0 (IQR 4.2) dB(A).

CONCLUSIONS

The combination of harmonized environmental exposures and extensive assessment of health outcomes in LifeLines offers great opportunities for environmental epidemiology. LifeLines aims to be a resource for the international scientific community.