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利用地理信息系统评估美国退伍军人的邻里资源与心理健康状况。

Evaluation of neighborhood resources and mental health in American military Veterans using geographic information systems.

作者信息

Shin Park Young, Wyman Jean F, McMorris Barbara J, Pruinelli Lisiane, Song Ying, Kaas Merrie J, Sherman Scott E, Fu Steven

机构信息

School of Nursing, University of Minnesota, Minneapolis, MN, USA.

Mo-Im Kim Nursing Research Institute College of Nursing, Yonsei University, Seoul, South Korea.

出版信息

Prev Med Rep. 2021 Sep 3;24:101546. doi: 10.1016/j.pmedr.2021.101546. eCollection 2021 Dec.

Abstract

Neighborhood-level social determinants are increasingly recognized as factors shaping mental health in adults. Data-driven informatics methods and geographic information systems (GIS) offer innovative approaches for quantifying neighborhood attributes and studying their influence on mental health. Guided by a modification of Andersen's Behavioral Model of Health Service Use framework, this cross-sectional study examined associations of neighborhood resource groups with psychological distress and depressive symptoms in 1,528 U.S. Veterans. Data came from the Veteran Affairs (VA) Health Services Research and Development Proactive Mental Health trial and publicly available sources. Hierarchical clustering based on the proportions of neighborhood resources within walkable distance was used to identify neighborhood resource groups and generalized estimating equations analyzed the association of identified neighborhood resource groups with mental health outcomes. Few resources were found in walkable areas except alcohol and/or tobacco outlets. In clustering analysis, four meaningful neighborhood groups were identified characterized by alcohol and tobacco outlets. Living in an alcohol-permissive and tobacco-restrictive neighborhood was associated with increased psychological distress but not depressive symptoms. Living in urban or rural areas and access to VA care facilities were not associated with either outcome. These findings can be used in developing community-based mental health-promoting interventions and public health policies such as zoning policies to regulate alcohol outlets in neighborhoods. Augmenting community-based services with Veteran-specialized services in neighborhoods where Veterans live provides opportunities for improving their mental health.

摘要

社区层面的社会决定因素日益被视为影响成年人心理健康的因素。数据驱动的信息学方法和地理信息系统(GIS)为量化社区属性及其对心理健康的影响提供了创新方法。本横断面研究以对安德森健康服务利用行为模型框架的修改为指导,调查了1528名美国退伍军人中社区资源组与心理困扰和抑郁症状之间的关联。数据来自退伍军人事务部(VA)卫生服务研究与发展主动心理健康试验以及公开可用的来源。基于可步行距离内社区资源比例的层次聚类用于识别社区资源组,广义估计方程分析了所识别的社区资源组与心理健康结果之间的关联。除了酒精和/或烟草销售点外,在可步行区域发现的资源很少。在聚类分析中,识别出了四个有意义的社区组,其特征为酒精和烟草销售点。生活在允许售酒但限制售烟的社区与心理困扰增加有关,但与抑郁症状无关。生活在城市或农村地区以及是否能使用退伍军人事务部的护理设施与这两种结果均无关。这些发现可用于制定基于社区的促进心理健康的干预措施和公共卫生政策,如分区政策以规范社区内的酒精销售点。在退伍军人居住的社区,用退伍军人专用服务增强基于社区的服务,为改善他们的心理健康提供了机会。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/32b5/8683884/2af9f173206b/gr1.jpg

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