Geomatics Lab, Geography Department, Humboldt-Universität zu Berlin, Berlin, Germany.
BMC Public Health. 2012 Mar 9;12:177. doi: 10.1186/1471-2458-12-177.
Urban health is of global concern because the majority of the world's population lives in urban areas. Although mental health problems (e.g. depression) in developing countries are highly prevalent, such issues are not yet adequately addressed in the rapidly urbanising megacities of these countries, where a growing number of residents live in slums. Little is known about the spectrum of mental well-being in urban slums and only poor knowledge exists on health promotive socio-physical environments in these areas. Using a geo-epidemiological approach, the present study identified factors that contribute to the mental well-being in the slums of Dhaka, which currently accommodates an estimated population of more than 14 million, including 3.4 million slum dwellers.
The baseline data of a cohort study conducted in early 2009 in nine slums of Dhaka were used. Data were collected from 1,938 adults (≥ 15 years). All respondents were geographically marked based on their households using global positioning systems (GPS). Very high-resolution land cover information was processed in a Geographic Information System (GIS) to obtain additional exposure information. We used a factor analysis to reduce the socio-physical explanatory variables to a fewer set of uncorrelated linear combinations of variables. We then regressed these factors on the WHO-5 Well-being Index that was used as a proxy for self-rated mental well-being.
Mental well-being was significantly associated with various factors such as selected features of the natural environment, flood risk, sanitation, housing quality, sufficiency and durability. We further identified associations with population density, job satisfaction, and income generation while controlling for individual factors such as age, gender, and diseases.
Factors determining mental well-being were related to the socio-physical environment and individual level characteristics. Given that mental well-being is associated with physiological well-being, our study may provide crucial information for developing better health care and disease prevention programmes in slums of Dhaka and other comparable settings.
全球关注城市健康问题，因为世界上大多数人口居住在城市地区。尽管发展中国家的心理健康问题（如抑郁症）非常普遍，但这些国家快速城市化的特大城市尚未充分解决这些问题，越来越多的居民居住在贫民窟。人们对城市贫民窟的心理健康状况知之甚少，而这些地区促进健康的社会物理环境的知识也很匮乏。本研究采用地理流行病学方法，确定了导致达卡贫民窟居民心理健康的因素，目前达卡容纳了超过 1400 万人口，其中包括 340 万贫民窟居民。
本研究使用了 2009 年初在达卡九个贫民窟进行的一项队列研究的基线数据。数据来自 1938 名成年人（≥15 岁）。所有受访者都根据他们的家庭使用全球定位系统（GPS）在地理上进行标记。非常高分辨率的土地覆盖信息在地理信息系统（GIS）中进行处理，以获得额外的暴露信息。我们使用因子分析将社会物理解释变量减少到一组不相关的变量线性组合。然后，我们将这些因素与作为自我评估心理健康的替代指标的世界卫生组织-5 幸福感指数进行回归。
心理健康与各种因素显著相关，如自然环境的某些特征、洪水风险、卫生设施、住房质量、充足性和耐久性。我们还发现与人口密度、工作满意度和收入来源有关，同时控制了年龄、性别和疾病等个体因素。
决定心理健康的因素与社会物理环境和个体水平特征有关。鉴于心理健康与生理健康有关，我们的研究可能为在达卡和其他类似环境中的贫民窟制定更好的医疗保健和疾病预防计划提供重要信息。
