Makram Omar M, Pan Alan, Parekh Tarang, Maddock Jay E, Kash Bita
Center for Health & Nature, Houston Methodist Research Institute, Houston, TX, 77030, USA.
Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston, TX, 77030, USA.
Heliyon. 2025 Feb 14;11(4):e42710. doi: 10.1016/j.heliyon.2025.e42710. eCollection 2025 Feb 28.
While importance of walkable neighborhoods for health is increasingly recognized, the relationship between walkability and mental health remains, especially in urban settings, unclear. This study investigated the link between walkability and mental health in urban Texas. We hypothesized that higher neighborhood walkability would correlate with lower mental health encounters.
A cross-sectional study using Texas adult outpatient encounters from 2014 to 2019 supplemented by ZIP Code-level US-census socioeconomics data. Neighborhood walkability was assessed using the 2019-WalkScore (0-100) and was categorized into four groups: from completely car-dependent to very walkable/walker's paradise. Outpatient mental health encounters included depression, bipolar disorder, anxiety, and stress disorders. Generalized linear models were used to assess the association between walkability and mental health, while adjusting for demographics and socioeconomics.
We included 55 million encounters from 751 Texas ZIP Codes (median WalkScore 28, 73 % < 65 years, 64 % women, 15 % Blacks, 16 % Hispanics, 15 % live in poverty, and 17 % without health insurance). Anxiety/stress disorders contributed to 68 % of the mental health encounters. The rate of mental health encounters was at least 3 times higher (5543 vs 1827 encounters per 100,000 population) (RR 3.03, 95%CI 1.53-6.03) in urban areas with the highest WalkScores, compared to lowest walkability neighborhoods. A similar pattern was found among depression (RR 4.8, 95%CI 2.45-9.46) and bipolar (RR 10.8, 95%CI 4.17-28.07) encounters. After adjusting for demographic and socioeconomic factors, the positive association remained significant for both depression (aRR 1.94, 95%CI 1.19-3.17) and bipolar (aRR 2.76, 95%CI 1.65-4.65) encounters, but not for total mental health encounters (aRR 1.22, 95%CI 0.76-1.96, P = 0.416).
The study findings challenge our initial hypothesis, revealing a positive association between neighborhood walkability and various mental health encounters, emphasizing the complex intersection between urban environment and mental health. This suggests that walkability does not solely determine mental health outcomes. A deeper understanding of how demographics, socioeconomic factors, and neighborhood characteristics interact is essential to inform policies that create more equitable mentally-healthy cities.
虽然适宜步行的社区对健康的重要性日益得到认可，但步行便利性与心理健康之间的关系，尤其是在城市环境中，仍不明确。本研究调查了德克萨斯州城市中步行便利性与心理健康之间的联系。我们假设社区步行便利性越高，心理健康问题发生率越低。
一项横断面研究，使用2014年至2019年德克萨斯州成人门诊就诊数据，并辅以邮政编码级别的美国人口普查社会经济数据。使用2019年步行分数（0 - 100）评估社区步行便利性，并分为四组：从完全依赖汽车到非常适宜步行/步行者的天堂。门诊心理健康问题包括抑郁症、双相情感障碍、焦虑症和应激障碍。使用广义线性模型评估步行便利性与心理健康之间的关联，同时对人口统计学和社会经济因素进行调整。
我们纳入了来自德克萨斯州751个邮政编码地区的5500万次就诊数据（步行分数中位数为28，73%年龄<65岁，64%为女性，15%为黑人，16%为西班牙裔，15%生活在贫困中，17%没有医疗保险）。焦虑/应激障碍占心理健康问题就诊的68%。步行分数最高的城市地区心理健康问题发生率至少高出3倍（每10万人中有5543次就诊vs 1827次就诊）（相对风险3.03，95%置信区间1.53 - 6.03），而步行便利性最低的社区则较低。在抑郁症（相对风险4.8，95%置信区间2.45 - 9.46）和双相情感障碍（相对风险10.8，95%置信区间4.17 - 28.07）就诊中也发现了类似模式。在调整人口统计学和社会经济因素后，抑郁症（校正后相对风险1.94，95%置信区间1.19 - 3.17）和双相情感障碍（校正后相对风险2.76，95%置信区间1.65 - 4.65）就诊的正相关仍然显著，但心理健康问题总就诊次数（校正后相对风险1.22，95%置信区间0.76 - 1.96，P = 0.416）不显著。
研究结果挑战了我们最初的假设，揭示了社区步行便利性与各种心理健康问题就诊之间的正相关，强调了城市环境与心理健康之间的复杂交叉点。这表明步行便利性并非唯一决定心理健康结果。深入了解人口统计学、社会经济因素和社区特征如何相互作用，对于制定创建更公平的心理健康城市的政策至关重要。
