Sydney School of Public Health, The University of Sydney, Sydney, NSW 2006, Australia.
Public Health Unit, Illawarra Shoalhaven Local Health District, Wollongong, NSW 2502, Australia.
Int J Environ Res Public Health. 2018 Feb 6;15(2):275. doi: 10.3390/ijerph15020275.
Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population cohort at spatial scales comparable to those used for regional planning in Sydney, Australia. Data on psychosocial distress were analysed for 91,142 respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. We fit conditional auto regression models at the postal area level to obtain smoothed "disease maps" for psychosocial distress, and assess its association with area-level walkability after adjusting for individual- and area-level factors. Prevalence of psychosocial distress was 7.8%; similar for low (7.9%), low-medium (7.9%), medium-high (8.0%), and high (7.4%) walkability areas; and decreased with reducing postal area socioeconomic disadvantage: 12.2% (most), 9.3%, 7.5%, 5.9%, and 4.7% (least). Unadjusted disease maps indicated strong geographic clustering of psychosocial distress with 99.0% of excess prevalence due to unobserved and spatially structured factors, which was reduced to 55.3% in fully adjusted maps. Spatial and unstructured variance decreased by 97.3% and 39.8% after adjusting for individual-level factors, and another 2.3% and 4.2% with the inclusions of area-level factors. Excess prevalence of psychosocial distress in postal areas was attenuated in adjusted models but remained spatially structured. Postal area prevalence of high psychosocial distress is geographically clustered in Sydney, but is unrelated to postal area walkability. Area-level socioeconomic disadvantage makes a small contribution to this spatial structure; however, community-level mental health planning will likely deliver greatest benefits by focusing on individual-level contributors to disease burden and inequality associated with psychosocial distress.
步行能力描述了建筑环境促进步行的能力，并被提议作为社区层面心理健康规划的潜在重点。我们通过在与澳大利亚悉尼地区规划使用的空间尺度相当的人群队列中，检验了区域步行能力对心理社会困扰变化的贡献，从而评估了这种可能性。2006 年 1 月至 2009 年 4 月期间，对“45 岁及以上研究”基线调查的 91142 名受访者的心理社会困扰数据进行了分析。我们在邮政区层面拟合条件自回归模型，以获得心理社会困扰的平滑“疾病图”，并在调整个体和区域因素后评估其与区域步行能力的关系。心理社会困扰的患病率为 7.8%；低（7.9%）、低-中（7.9%）、中-高（8.0%）和高（7.4%）步行区的患病率相似；且随着邮政区社会经济劣势的降低而降低：12.2%（最高）、9.3%、7.5%、5.9%和 4.7%（最低）。未调整的疾病图显示，心理社会困扰存在强烈的地理聚集，99.0%的过度流行归因于未观察到的和空间结构因素，在完全调整的地图中，这一比例降低到 55.3%。在调整个体水平因素后，空间和非结构化方差分别降低了 97.3%和 39.8%，而在纳入区域水平因素后，又分别降低了 2.3%和 4.2%。调整模型后，邮政区心理社会困扰的过度流行程度有所减弱，但仍具有空间结构。悉尼的高心理社会困扰邮政区的流行情况呈地理聚集，但与邮政区步行能力无关。区域社会经济劣势对此空间结构的贡献很小；然而，社区层面的心理健康规划可能会通过关注与心理社会困扰相关的疾病负担和不平等的个体水平贡献者，带来最大的收益。
