Urbanicity, biological stress system functioning and mental health in adolescents

Stress and the City: Mental Health in Urbanized vs. Rural Areas in Salzburg, Austria

BACKGROUND

Living in the city is associated with a higher risk of suffering from stress, anxiety, and depression. Due to an increase of migration to the city, the association between mental health and city life is highly relevant to society.

METHODS

We analyzed data of 9573 participants (Ø 55.3 years, SD = 7.4) of the Paracelsus 10,000 study (Salzburg, Austria) who were classified into having or not having depressive symptoms. Population density, green space, and noise around the home address of the participants were collected and tested for correlations with mental health defined by depressive symptoms. We additionally tested whether migration status influenced the effect of urbanization on mental health.

RESULTS

There is a positive correlation between degree of urbanization and the probability of suffering from depressive symptoms (p = 0.011), yet this effect is independent of the migration background (p = 0.581). Participants in areas with high residential density were significantly more likely to suffer from poor mental health (p = 0.006 unadjusted). No significant association could be found between mental health and noise (p = 0.126 unadjusted) or green space neither regarding distance to closest green space (p = 0.549 unadjusted), nor size of green space (p = 0.549 unadjusted).

CONCLUSIONS

In the Paracelsus 10,000 cohort, living in the city is associated with lower mental health, especially in participants with a high population density in the direct neighborhood. This might be due to social stress yet does not reflect minority stress in migrants. However, the influence of noise pollution and green space on mental health is limited in this cohort.

Childhood maltreatment and substance use risk: A moderated mediation model of autonomic reactivity and distress tolerance

BACKGROUND/AIMS

The link between child maltreatment (CM) and substance use (SU) in young adulthood is established. The sympathetic nervous system (SNS) division of the autonomic nervous system may mediate this link. However, less is known on the indirect link between CM and SU via SNS functioning. Due to individual variability in the link between SNS functioning and SU risk, we aimed to examine the moderating role of distress tolerance (DT).

METHODS

A longitudinal sample of 118 young adults (YAs) from a low socioeconomic status background were assessed twice (between 9 and 12 months apart). CM, DT, and galvanic skin response (GSR) stress reactivity were measured during the initial study visit, while SU was assessed at both timepoints. Stress reactivity was assessed by measuring the GSR reactivity during a stress task. We tested the indirect associations between CM and changes in SU problems via GSR stress reactivity, and the moderation effects of DT on these indirect associations. A mediation model in the structural equation modeling (SEM) framework was then followed by a moderated mediation model to analyze these data.

RESULTS

YA's stress reactivity mediated the association between CM and alcohol use problems, and this indirect effect was weaker among YAs who had higher levels of DT. This pattern did not emerge with drug use problems.

CONCLUSIONS

Findings suggest that intervention and prevention efforts for SU outcomes should consider incorporating strategies that increase at-risk individuals' levels of DT. Providing strategies to help individuals stem their stress reactivity may reduce their risk for alcohol use.

Burden of depression in adolescents in the Western Pacific Region from 1990 to 2019: An age-period-cohort analysis of the Global Burden of Disease study

BACKGROUND

Depression is a highly prevalent and disabling mental health condition among adolescents. The epidemiology of depression in adolescents has been changing over time, reflecting changes in risk factors as well as disease concepts and diagnosis. However, few studies have characterized the longitudinal epidemiology of depression in adolescents. Understanding trends of disease burden provides key insights to improve resource allocation and design targeted interventions for this vulnerable population. The Western Pacific Region (WPR) is home to over 1.3 billion people with tremendous diversity in culture and socioeconomic development. The epidemiology of adolescent depression in WPR remains largely unknown. In this study, we aimed to estimate trends of disease burden attributable to depressive disorders among adolescents aged 10-24 years in WPR countries between 1990 and 2019, and to investigate period and cohort effects using the Global Burden of Disease (GBD) study database.

METHODS

The study utilized data from the Global Burden of Disease, Injuries, and Risk Factors Study 2019, concentrating on adolescents aged 10 to 24 years with depression. We conducted an in-depth analysis of depression, including its age-standardized prevalence, incidence, and Disability-Adjusted Life Years (DALYs), across diverse demographics such as regions, ages, genders, and socio-demographic indexes, spanning from 1990 to 2019.

RESULTS

The analysis found decreasing trends in the prevalence, incidence, and DALYs of adolescent depression in the WPR between 1990-2019, although some countries like Australia and Malaysia showed increases. Specifically, the prevalence of adolescent depression in the region decreased from 9,347,861.6 cases in 1990 to 5,551,341.1 cases in 2019. The incidence rate declined from 2,508.6 per 100,000 adolescents in 1990 to 1,947.9 per 100,000 in 2019. DALYs decreased from 371.9 per 100,000 in 1990 to ASR 299.7 per 100,000 in 2019.

CONCLUSION

This study found an overall decreasing trend in adolescent depression burden in the Western Pacific Region between 1990 and 2019, with heterogeneity across countries. For 30 years, the 20-24 age group accounted for the majority of depression among adolescents Widening inequality in depression burden requires policy attention. Further analysis of risk factors contributing to epidemiological trends is warranted to inform prevention strategies targeting adolescent mental health in the region.

Urbanicity, posttraumatic stress disorder, and effect modification by socioeconomic position: A nested case-control study of the Korean National Health Insurance Database

BACKGROUND

We aimed to estimate the association between urbanicity and the onset of posttraumatic stress disorder (PTSD) and to investigate heterogeneity therein according to age and socioeconomic position (SEP).

METHODS

We analyzed administrative data from the Korean National Health Insurance Database for patients with PTSD from 2004 to 2018 (N = 109,230) and for a 1:4 sample of age-, sex-, and enrollment year-matched controls. Information on eligibility, SEP (proxied by insurance premium), place of residence, diagnosis, and medical claims was obtained. Urbanicity of administrative districts was assessed using data from the Korean Statistical Information Service, 2005-2018. We estimated hazard ratios (HRs) from baseline and time-dependent models. Subgroup analyses and polynomial splines were used to investigate heterogeneity by age and SEP.

RESULTS

Urbanicity was associated with an increased risk of PTSD (per 10%p increase, HR = 1.056, 95% CI 1.050-1.061). A positive association was estimated among patients aged 0-29 years (HR = 1.115, CI 1.106-1.124), while negative associations were estimated among patients aged 30-64 years (HR = 0.990, CI 0.987-0.994) and 65 years or older (HR = 0.992, CI 0.979-1.014). The estimated associations with urbanicity were more prominent at the extremes of SEP, but only among younger participants.

CONCLUSION

Urban residence was associated with an increased risk of PTSD diagnosis. The estimated association was larger among younger individuals (but not among middle-aged and older individuals). Among younger individuals, the estimated association was larger at both extremes of SEP.

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.

Determinants of Common Mental Disorders (CMD) among adolescent girls aged 15-19 years in Indonesia: Analysis of the 2018 National Basic Health Survey Data

Common Mental Disorders (CMD) are distress conditions which manifest themselves with anxiety, somatic, and depressive symptoms. CMD are highly prevalent in Indonesia especially among adolescents. Adolescent girls have a higher risk to develop CMD than boys. This may be related to anaemia, potentially aggravated by early onset of menstruation. This study aimed to determine the association between haemoglobin concentration and other determinants of CMD among adolescent girls in Indonesia. Data of 1,052 adolescent girls aged 15-19 years old from the Indonesian Basic Health Survey 2018 were analysed. CMD was measured using the Self Reporting Questionnaire (SRQ-20). Principal Component Analysis of main determinants was applied and resulting principal components were investigated as risk factors for CMD. The prevalence of CMD among the study population was 16.5%. Anaemia and Age at Menarche (AAM) were not associated with CMD. Three principal components were significantly associated with higher CMD score: 1) higher parental education, better employment of the father, and living in an urban area (β: 0.16, 95%-CI: 0.02; 0.30); 2) higher consumption of salty foods, high-fat foods, and soft drinks (β: 0.23, 95%-CI: 0.05; 0.40); and 3) having asthma, smoking, and a higher haemoglobin concentration (β: 1.74, 95%-CI: 1.59; 1.89). The strongest clustered associates of CMD among adolescent girls in Indonesia were asthma, smoking status, and higher haemoglobin concentration, whereas anaemia and AAM were not associated. Causality of smoking and diet to CMD could not be disentangled in this cross-sectional study. Our findings imply that adolescent girls who have asthma and smoke, as well as those having parents with higher education and secured occupation, are more likely to have mental disorders.

Urbanicity, behavior problems and HPA axis regulation in preschoolers

Growing up in cities is associated with increased risk for developing mental health problems. Stress exposure and altered stress regulation have been proposed as mechanisms linking urbanicity and psychopathology, with most research conducted in adult populations. Here, we focus on early childhood, and investigate urbanicity, behavior problems and the regulation of the hypothalamus-pituitary-adrenal (HPA) axis, a central circuit of the stress system, in a sample of N = 399 preschoolers aged 45 months. Urbanicity was coded dichotomously distinguishing between residences with more or less than 100,000 inhabitants. Behavior problems were measured using the Child Behavior Checklist (CBCL) 1½ - 5. Cortisol stress reactivity was assessed using an age-appropriated game-like stress task, and cortisol in the first morning urine was measured to assess nocturnal HPA axis activity. Urbanicity was not associated with behavior problems, urinary cortisol or the cortisol stress response. Neither urinary cortisol nor salivary cortisol response after stress exposure were identified as mediators of the relationship between urbanicity and behavior problems. The findings suggest no strong association of urbanicity with behavior problems and HPA axis regulation in preschool age. To our knowledge, this is the youngest sample to date studying the relationship between urbanicity and behavior problems as well as HPA axis regulation. Future research should examine at which age associations can first be identified and which mechanisms contribute to these relationships.

Body dysmorphic disorder and depression among male undergraduate students in a Malaysian University

INTRODUCTION

Body dysmorphic disorder (BDD) and depression have been reported to be both prevalent among young people worldwide, resulting in serious implications in their quality of life and social functioning. This is worrying especially in men where mental disorders are often overlooked and under-researched. This study aims to determine the proportion of male university students with symptoms suggestive of body dysmorphic disorder and depression, as well as their perception on their body image.

METHODS

In this cross-sectional study, 1,308 male students between the aged of 17-26 years in a private university in Malaysia via self-administered online questionnaire comprising the Patient Health Questionnaire (PHQ)-9, the Body Dysmorphic Disorder Questionnaire (BQQD) and the Body Self-Image Questionnaire (BSIQ), in addition to their sociodemographic parameters. Data analyses were performed with Mann Whitney test, chi square test and Fisher's exact test.

RESULTS

3.3 and 54.2% of the students had symptoms suggestive of BDD and depression respectively, with up to 9.02% of the students reporting having moderate to severe depression. There was a significant association between BDD symptoms and students staying alone, whilst depression was significantly associated with studying in the rural campus. Furthermore, a significant association was demonstrated between presence of BDD and depression symptoms. Most of the students were dissatisfied with their whole body, especially their height.

CONCLUSION

The proportion of BDD and depression symptoms among male students in our university is quite high. Universities and the public health sector should develop better support service targeting male university students.

Determinants of Chronic Biological Stress, Measured as Hair Cortisol Concentration, in a General Population of Adolescents: From Individual and Household Characteristics to Neighborhood Urbanicity

Chronic biological stress may adversely affect adolescents' physical and mental health, but insight in the personal and environmental factors that determine chronic stress is limited. We measured 3-month cumulative hair cortisol concentration (HCC) in 419 adolescents, participating in the Flemish Environment and Health Study. Adolescents' health and lifestyle characteristics, household and neighborhood socio-economic status as well as neighborhood urbanicity were assessed as potential determinants of HCC, using multiple linear regression models. We additionally explored heterogeneity of our results by sex. HCC were significantly higher in boys from densely populated neighborhoods, the association was not significant in girls. Accordingly, boys living outside cities had significantly lower HCC than boys, living in cities. HCC was significantly lower in adolescents with an optimal vitality, a measure of a positive mental health status. In adolescent girls, menarcheal status (pre-/postmenarche) was a significant determinant of HCC. Our findings are the first to suggest that residential urbanicity may have an impact on chronic biological stress in a general population of adolescent boys.

Adolescent Brain Cognitive Development (ABCD) study Linked External Data (LED): Protocol and practices for geocoding and assignment of environmental data

Our brain is constantly shaped by our immediate environments, and while some effects are transient, some have long-term consequences. Therefore, it is critical to identify which environmental risks have evident and long-term impact on brain development. To expand our understanding of the environmental context of each child, the Adolescent Brain Cognitive Development (ABCD) Study® incorporates the use of geospatial location data to capture a range of individual, neighborhood, and state level data based on the child's residential location in order to elucidate the physical environmental contexts in which today's youth are growing up. We review the major considerations and types of geocoded information incorporated by the Linked External Data Environmental (LED) workgroup to expand on the built and natural environmental constructs in the existing and future ABCD Study data releases. Understanding the environmental context of each youth furthers the consortium's mission to understand factors that may influence individual differences in brain development, providing the opportunity to inform public policy and health organization guidelines for child and adolescent health.

The Relationship Between Mental Health Problems and Systemic Family Dynamics Among High School and University Students in Shaanxi Province, China

Objectives: The present study aimed to correlate relationships between systemic family dynamics and mental health and to explore family factors that influence adolescent mental health in Shaanxi Province, China.

Methods: A cross-sectional survey was conducted to sample adolescents aged 12–23 using a questionnaire including Self-rating Scale of Systemic Family Dynamics, Symptom Checklist-90 Revised, and general demographic.

Results: More educated parents in white-collar employment and higher family income were associated with better mental health and better family dynamic scores. The total score of family dynamics was positively correlated with mental health scores. The generalized linear mixed model found that poorer mental health was associated with increased age, being in senior high school, having a father in a blue-collar profession, and SSFD square. The structural equation modelling suggested that this is largely a mediated effect via those characteristics impacting family dynamics, which in turn affect mental health.

Conclusion: Family dynamics may be an important contributor to adolescent mental health. Education and interventions aimed at improving family dynamics may be useful for reducing the prevalence of mental health problems amongst adolescents.

Urbanicity mental costs valuation: a review and urban-societal planning consideration

Living in cities has numerous comparative advantages than living in the countryside or in small villages and towns, most notably better access to education, services and jobs. However, it is also associated with a roughly twofold increase in some mental disorders rate incidence compared with living in rural areas. Economic assessments reported a forecasted loss of more than 19 trillion dollars in global GDP between 2011 and 2030 and of around 7 trillion for the year 2030 alone when measured by the human capital method. If we exclude self-selection processes and make the hypothesis to be able to level down the mental illness rate incidence in urban areas to these of the rural by better urban-societal planning, around € 1.2 trillion could be saved yearly worldwide. Even a reduction of only 20% in urban mental illness rate would save around 250 billion dollars yearly.