Department of Human Geography and Spatial Planning, Utrecht University, the Netherlands.
Department of Methodology and Statistics, Utrecht University, the Netherlands.
Soc Sci Med. 2021 Jan;268:113533. doi: 10.1016/j.socscimed.2020.113533. Epub 2020 Nov 18.
Multiple neighbourhood characteristics have been linked to depressive symptoms. However, few studies have simultaneously considered multiple mechanisms that explain this relationship, and how they might interact. Further, most studies regard exposure to the residential environment as constant, and therefore disregard variation in exposure by individual factors. This study investigates whether and to what extent stress and physical activity mediate the association between neighbourhood characteristics and depression, and also to what extent employment status moderates this relationship. A population-representative survey of n = 11,505 people in the Netherlands was conducted. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ-9). Neighbourhood characteristics were perceived green and blue space, pleasantness, environmental disturbance, social cohesion and safety. Employment status was combined with place of work to establish two groups: those who were non-working or who worked from home ('at home'), and those who worked somewhere outside of the home ('working'). Multi-group structural equation modelling was employed to understand the theorised relationships for both groups. Perceived environmental disturbance, social cohesion and safety were significantly indirectly related to depressive symptoms via stress, with larger effect sizes in the 'at home' group. Pleasantness was also significantly indirectly related to depressive symptoms via stress, in the 'at home' group only. There was no evidence for physical activity as a mediator. Our findings suggest that neighbourhood social characteristics may have a greater influence on depressive symptoms than physical characteristics. Stress appears to be a key mediator of this relationship. In addition, the neighbourhood appears to exert a greater influence on those who spend more time in their neighbourhood. Interventions to promote mental health should focus on the social environment, and in particular pay attention to those who are spatially confined in poorer quality neighbourhoods.
多种邻里特征与抑郁症状有关。然而，很少有研究同时考虑解释这种关系的多种机制，以及它们如何相互作用。此外，大多数研究认为居住环境的暴露是恒定的，因此忽略了个体因素对暴露的变化。本研究调查了压力和体力活动是否以及在何种程度上调节了邻里特征与抑郁之间的关系，以及就业状况在多大程度上调节了这种关系。在荷兰进行了一项具有代表性的 n = 11505 人的人群调查。使用病人健康问卷（PHQ-9）测量抑郁症状。邻里特征包括感知的绿色和蓝色空间、宜人程度、环境干扰、社会凝聚力和安全性。就业状况与工作场所相结合，确定了两组人群：不工作或在家工作的人群（“在家”），以及在家庭以外的地方工作的人群（“工作”）。采用多组结构方程模型来理解两组人群的理论关系。感知到的环境干扰、社会凝聚力和安全性通过压力与抑郁症状呈显著间接相关，在家工作的人群的效应量更大。宜人程度也通过压力与抑郁症状呈显著间接相关，仅在家工作的人群如此。没有证据表明体力活动是一种中介。我们的研究结果表明，邻里社会特征对抑郁症状的影响可能大于物理特征。压力似乎是这种关系的关键中介。此外，对于那些在邻里地区花费更多时间的人来说，邻里似乎对他们有更大的影响。促进心理健康的干预措施应侧重于社会环境，特别要注意那些在空间上局限于较差质量邻里地区的人。
