Neighbourhood characteristics are linked to mental health in older age, but the magnitude of effects might differ across countries. Using data from 16 different countries, our paper in the American Journal of Epidemiology indicated that country-level social, political, economic and environmental characteristics may explain differences in how neighbourhood affects mental health.
Depression, local area and macro-level context
Depression is a common mental disorder with substantial disability and economic burden worldwide. More than 10% of adults aged 50 years and older present depressive symptoms with an even greater proportion of the population suffering in older age groups. Older adults spend more time in their neighbourhood, so that social and physical features of the residential area become increasingly important for them.
Signs of neighbourhood disorder, such as crime, vandalism and exposure to rubbish, are thought to indicate problems in the residential environment, by elevating the level of stress and fear among residents. On the other hand, positive aspects of neighbourhoods such as social cohesion – which is often characterised as a sense of community, help and support among neighbours – have the potential to buffer the effects of stress and contribute to healthy ageing. Both neighbourhood disorder and social cohesion has been linked to mental health problems.
Neighbourhoods are situated within macro-level environments capturing larger geographic areas such as local authorities, counties or even countries (Figure 1). Policies, as well as social, economic and environmental characteristics of macro environments can affect citizens’ life and health, and also shape the physical and social characteristics of local communities, where people live and age. It is important, as both local and macro-level environments are modifiable, presenting opportunities for improving population mental health and contributing to healthy ageing.
Neighbourhoods influence mental health among older adults
We investigated the associations between neighbourhood disorder, lack of social cohesion and depression among adults aged 50 and over. Longitudinal information on perceived neighbourhood characteristics and depressive symptoms across 16 high-income countries were utilised, including 32000 older adults. Results showed that living in an area with significant neighbourhood disorder increased the chance of developing depression (Figure 2), and so did lack of social cohesion (Figure 3). If people were already in retirement, effects became stronger.
Neighbourhood effects differ across countries
As the magnitude of the associations varied across the 16 included countries, we further explored country-level differences.
Amongst other, we found that in countries with higher population density, lack of social cohesion was more detrimental for mental health. Particularly in the oldest age groups, where limited mobility is more likely present, neighbours can be an important source of social and emotional support. In countries where people live closer to each other, not having proper social ties to neighbours can lead to social isolation and higher risk of developing mental health problems.
Also, in countries with higher pension spending, the adverse effect of neighbourhood disorder on depression was buffered for individuals already in retirement. It is plausible that by providing material resources, more generous welfare states equip older people to deal with stressors arising from less safe and deteriorated residential neighbourhoods.
Macro-level context and policy recommendations
Understanding how larger context can influence mental health inequalities across neighbourhoods has the potential to inform policy, and provide more tailored recommendations. For example, tackling crime and vandalism in countries with lower pension spending would be particularly beneficial for mental health, as older people has less material resources to protect themselves from the negative effects of neighbourhood disorder. Supporting social ties and improving social capital in densely populated areas may stronger contribute to healthy ageing and lead to better mental health among older adult.
By Gergő Baranyi, School of Geosciences, University of Edinburgh