Cross-Sectional and Longitudinal Associations of Neighborhood Cohesion and Stressors with Depressive Symptoms in the Multiethnic Study of Atherosclerosis

doi:10.1016/j.annepidem.2008.10.002

Annals of Epidemiology

Volume 19, Issue 1, January 2009, Pages 49-57

https://doi.org/10.1016/j.annepidem.2008.10.002 Get rights and content

Purpose

This study examined associations of neighborhood social cohesion, violence, and aesthetic quality with depressive symptoms among 2,619 healthy adults aged 45–84 years enrolled in the Multiethnic Study of Atherosclerosis.

Methods

Neighborhood characteristics were estimated by surveying a separate sample of area residents. Measures of aesthetic environment, social cohesion, and violence were combined into a summary score with increasing scores indicating more favorable environments. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. Marginal maximum likelihood estimation was used to assess associations of neighborhood characteristics with CES-D score at baseline and with the odds of developing incident depression (CES-D score ≥16 or use of antidepressants) over a 4–5 year follow-up among persons with CES-D less than 16 at baseline. Models were adjusted for age, income, education, and race/ethnicity.

Results

Lower levels of social cohesion and aesthetic quality and higher levels of violence were associated with higher mean CES-D scores in men and women (P for trend <0.01, adjusted mean difference in CES-D per 1 SD increase in summary score −1.01 [95% confidence interval = −1.85, −0.17] and −1.08 [95% confidence interval = −1.88, −0.28] in men and women, respectively). Associations of neighborhood characteristics with incident depression were in the expected direction for women but confidence intervals were wide (odds ratio of incident depression = 0.89 [0.63, 1.26]). No association was seen for men (odds ratio = 0.96 [0.74, 1.25]).

Conclusion

Neighborhood social cohesion, aesthetic quality, and violence are associated with the presence of depressive symptoms in residents.

Introduction

There has been growing interest in understanding the effects of neighborhood conditions on psychological well-being (1). It has been hypothesized that contextual characteristics of neighborhoods may be related to mental health outcomes, above and beyond the effects of individual characteristics. The majority of studies of neighborhood characteristics and depressive symptoms have focused on the effects of area socioeconomic position, after controlling for individual-level characteristics. Most 2, 3, 4, 5, 6, 7, 8, 9, although not all 10, 11, 12, 13, of these studies have documented a small contextual effect of low neighborhood or area socioeconomic conditions on depressive symptoms. Although useful as an initial approximation, this approach has methodologic limitations related to difficulties in isolating true contextual effects 14, 15 and the inability to identify the specific contextual characteristics that are relevant (15).

A relatively small number of studies have investigated associations between specific features of the local environment (such as residential instability, racial/ethnic composition, perceived ambient hazards, or a poor quality physical environment) and depressive symptoms: some have documented a small but statistically significant association 1, 5, 6, 7, 8, 16, 17, 18, 19, 20, 21 whereas others have not (12). Many studies use the same study population to measure depressive symptoms and neighborhood conditions 5, 6, 18, 19, 20, 21, 22. This can create spurious associations (sometimes referred to as same-source bias) because a depressed person might see his or her neighborhood in a more negative light than someone exhibiting no depressive symptoms. In addition, the majority of work has been cross-sectional with only a small number of studies investigating longitudinal associations (23). An important limitation of cross-sectional analyses is that they are limited in their ability to determine the direction of causality (i.e., neighborhood characteristics causing depression vs. depression causing individuals to live in certain kinds of neighborhoods). Hence, longitudinal analyses are needed.

Using data from the Multi-Ethnic Study of Atherosclerosis (MESA), a large, population-based cohort study, we examined cross-sectional and prospective associations of three measures of specific neighborhood characteristics with depressive symptoms, among healthy adults 45–84 years of age. We hypothesized that low levels of neighborhood social cohesion and high levels of neighborhood stressors would be associated with higher levels of depressive symptoms as well as with increases in depressive symptoms over time, after adjustment for individual socioeconomic characteristics. In measuring neighborhood social cohesion and stressors we used validated scales and data from a survey of non-MESA participants who resided in the same neighborhoods as members of the cohort. The use of these measures avoids same-source bias and increases the validity of measures by aggregating responses across several respondents thus reducing variability due to individual subjectivity and measurement error (24).

Section snippets

Study Setting and Population

Information on depressive symptoms and relevant covariates was obtained from participants in MESA, a 10-year longitudinal study of men and women 45–84 years of age. Participants were enrolled at six study field centers between August 1, 2000 and July 30, 2002 using population-based approaches. Participants were free of clinical cardiovascular disease at enrollment (25). The participation rate among those screened and deemed eligible was 58%. Analyses reported in this study are restricted to

Results

Table 1 shows the distribution of selected individual- and neighborhood-level characteristics by gender. Approximately 13% of participants were in the oldest age category (75–84) with the rest being approximately distributed evenly across categories. The annual income and mean level of education of women were lower than those of men (Table 1). Intraclass correlation coefficients for CES-D scores within each neighborhood were 7.8% in women and 9.8% in men (not shown in table).

Table 2 shows the

Discussion

Depression was associated with neighborhood characteristics in this population-based sample. In cross-sectional analyses, lower levels of neighborhood social cohesion and aesthetic quality and higher levels of neighborhood violence were associated with higher mean CES-D scores in both men and women. Mean CES-D score decreased with increasing levels of the index summary score in both men and women after adjustment for individual-level characteristics. Living in neighborhoods with better

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Cross-Sectional and Longitudinal Associations of Neighborhood Cohesion and Stressors with Depressive Symptoms in the Multiethnic Study of Atherosclerosis

Purpose

Methods

Results

Conclusion

Introduction

Section snippets

Study Setting and Population

Results

Discussion

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