How do neighborhoods affect depression outcomes? A realist review and a call for the examination of causal pathways.

PURPOSE

This realist review seeks to elucidate the modifiable causal pathways through which neighborhoods affect depressive symptoms in adult populations.

METHODS

Studies were identified using Medline, PubMed, PsycInfo, Geobase, and Web of Science databases, and chosen using reproducible selection criteria and systematic critical appraisal.

RESULTS

A total of 14 longitudinal studies, published between 2003 and 2011, were included. Eleven of the articles observed a significant relationship between depression and at least one of the following neighborhood-level variables: neighborhood deprivation, disorder, instability, and social ties. Proposed modifiable pathways linking neighborhood characteristics and depression include: (1) the level of neighborhood-based stress that is placed on individuals, (2) the formation and strength of protective and supportive social networks, (3) the level of resiliency to negative affectivity and stress, (4) the perceptions of the esthetic and form of residential space, and (5) the sense of control and agency in place of residence. These pathways represent potential areas for future research and intervention.

CONCLUSIONS

Further research requires a more systematic use of longitudinal design and a diversity of physical and social environmental measures. Interventions aimed at improving affective resiliency need to be tested.