The effects of changes to the built environment on the mental health and well-being of adults: Systematic review

Mobile phone addiction was the mediator and physical activity was the moderator between bullying victimization and sleep quality

BACKGROUND AND OBJECTIVES

Bullying victimization is strongly associated with sleep quality issues in primary school students, yet the underlying mechanisms among these variables require further exploration. This study investigates the mediating role of mobile phone addiction and the moderating role of physical activity in the relationship between bullying victimization and sleep quality among primary school students, contributing to a deeper understanding of these psychological processes.

METHODS

This study utilized a convenience sampling method to recruit 502 primary school students in 2023. The sample included 232 boys and 270 girls, with ages ranging from 10 to 12 years (mean age = 11.15 ± 0.62). Participants were recruited from specific region or school district to ensure a diverse representation of the target population. Ethical approval was obtained from the relevant institutional review board, and informed consent was obtained from both the students and their parents or guardians prior to data collection.

RESULTS

Bullying victimization was significantly positively correlated with both sleep quality issues and mobile phone addiction. Additionally, mobile phone addiction was significantly positively correlated with sleep quality issues. The analysis confirmed that mobile phone addiction mediates the relationship between bullying victimization and sleep quality. Furthermore, physical activity was found to moderate the relationship between bullying victimization and mobile phone addiction.

CONCLUSIONS

This study elucidates the psychological mechanisms underlying the relationship between bullying victimization and sleep quality among primary school students. Mobile phone addiction serves as a mediating factor, while physical activity acts as a moderating factor in the link between bullying victimization and mobile phone addiction. These findings underscore the importance of addressing mobile phone addiction and promoting physical activity as part of targeted interventions to improve sleep quality among primary school students.

Bullying victimization and associated factors among school-aged adolescents in Africa: a systematic review and meta-analysis

BACKGROUND

Bullying victimization during school age is a global public health concern. School-aged adolescents experiencing bullying victimization are more likely to encounter physical, cognitive, and mental health issues; including greater rates of depression, anxiety, and suicidal behaviors. This systematic review and meta-analysis was conducted to estimate the pooled prevalence of bullying victimization and its determinants among school-aged adolescents in Africa.

METHODS

All studies reporting the prevalence of bullying victimization and its determinants among African school-aged adolescents were included based on the predefined eligibility criteria. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis(PRISMA), a guideline for reporting a systematic review and meta-analysis. A random-effects model was employed to estimate the pooled effect size of bullying victimization and its determinants with their odds ratio (OR) and a 95% confidence interval(CI). Funnel plots analysis and Egger's regression test were conducted to assess publication bias. Subgroup and sensitivity analyses were also performed.

RESULTS

Twenty-five studies involving 41,716 school-aged adolescents were included in this systematic review and meta-analysis. The overall pooled prevalence of bullying victimization among school-aged adolescents in Africa was 46.35%, with a 95% CI (41.45, 51.24). According to the subgroup analysis of the study region, 49.17% of bullying victimization was reported in the Eastern region of Africa whereas, 32.73% was reported in the Southern region. Engaging in physical fights [OR=1.86; 95% CI: 1.66, 2.07], current substance use [OR=1.85; 95% CI: 1.31, 2.62], feeling lonely [OR=1.98; 95% CI: 1.49, 2.65], and being worried [OR=2.56; 95% CI: 2.12, 3.1] were significantly associated with bullying victimization.

CONCLUSION AND RECOMMENDATION

This review revealed that the pooled prevalence of bullying victimization among school-aged adolescents in Africa was high. To ensure adolescents' mental health and cultivate productive manpower, fostering a supportive environment in schools is mandatory.

Redeveloping Low-Income Communities and Residents' Mental Health: Evidence from a Natural Experiment in Watts, Los Angeles

INTRODUCTION

The role of housing and the built and social environments is understudied as a social determinant of mental health. This study leverages a natural experiment created by the ongoing redevelopment of a public housing community to examine the effects of simultaneously improving the housing, built, and social environments on mental health in low-income, minoritized residents.

METHODS

This study analyzed longitudinal data from adult participants in the Watts Neighborhood Health Study. The cohort study includes residents in the public housing community being redeveloped (treatment group) and those in two nearby public housing sites (comparison group) in Watts, Los Angeles. ANCOVA regression models were used to examine whether residents in the treatment group had better mental health scores at follow-up (2021-22) compared to residents in the comparison group, conditional on mental health scores at baseline (2018-19) and other covariates. The analyses leveraged plausibly exogenous variation within the treatment group in exposure to the redevelopment to examine whether mental health at follow-up varied differentially by proximity to the redeveloped areas.

RESULTS

Analyses showed the treatment group experienced slightly fewer depressive symptoms than the comparison group at follow-up. They also revealed a non-linear relationship between proximity to redeveloped areas and residents' mental health within the treatment group.

CONCLUSIONS

Comprehensive redevelopment of low-income minoritized communities is a complex process that entails uneven mental health impacts on residents in the short term. Strategies to help spread these benefits more evenly may be needed.

The central mediating effect of inhibitory control and negative emotion on the relationship between bullying victimization and social network site addiction in adolescents

BACKGROUND AND OBJECTIVES

Bullying victimization is strongly associated with social network site addiction among adolescents. However, the underlying mechanisms between these variables remain unclear. This study aims to explore the psychological mechanisms linking bullying victimization to social network site addiction by examining the mediating roles of depression, anxiety, stress, and inhibitory control.

METHODS

A self-report survey was conducted among a sample of 1,005 adolescents in China. The survey included measures of bullying victimization, social network site addiction, depression, anxiety, stress, and inhibitory control. Descriptive and correlational analyses were performed, followed by the construction of a chain mediation model.

RESULTS

Bullying victimization was significantly positively associated with social network site addiction. However, this relationship became non-significant when negative emotional states (depression, anxiety, stress) and inhibitory control were introduced as mediating variables. Specifically, bullying victimization significantly predicted negative emotional states and was negatively associated with inhibitory control. Negative emotional states were also negatively related to inhibitory control, while inhibitory control was negatively associated with social network site addiction. Among the negative emotional states, stress and anxiety showed a significant negative correlation with social network site addiction.

CONCLUSION

This study sheds further light on the psychological mechanisms linking bullying victimization and social network site addiction among adolescents. Depression, anxiety, stress, and inhibitory control act as mediating factors in this relationship. These findings highlight the importance of targeting these variables in understanding and developing interventions for social network site addiction among adolescents.

The Impact of Place-Based Approaches Addressing Mental Health and Substance Use Among Adolescents: A Systematic Review of the Literature

Objectives

We systematically appraised peer reviewed evidence assessing the impact of "place-based approaches" (PBAs) - those requiring multi-sectoral action within localities to address complex health challenges - on mental health outcomes among adolescents.

Methods

We searched six databases from inception to May 2023. We defined PBAs as at least two sectors (e.g., local government, health) working collaboratively within a locality. Studies reporting mental health and substance-use among young people (aged 10-24) were included. Two authors independently assessed study quality using MMAT. Heterogeneity in PBAs, study design and outcomes prevented meta-analysis; results were narratively synthesised.

Results

Thirty-three publications presented data from 22 PBA evaluations; 6 evaluations assessed mental health or wellbeing, 16 appraised substance use. Higher quality evaluations found no impact on mental health outcomes (n = 4), and some evidence for delayed initiation (n = 4) and reduced point-in-time use (n = 10) of alcohol. Evidence for impact on binge-drinking and drug use was mixed.

Conclusion

Based on very few published studies of mixed quality, PBAs have not improved mental health or wellbeing among adolescents. More evidence exists to suggest PBAs can improve certain alcohol use outcomes in young people.

EnvironMental Health: A Framework for an Emerging Field at the Intersection of the Environment and Mental Health Crises

Understanding how the environment shapes our mental and cognitive health is imperative to support efforts that promote healthy and sustainable living conditions. The etiology of mental health conditions remains often unclear, and social factors have received more scrutiny than natural or built environments. We present a conceptual framework illustrating the emerging intersection between the environment and neuropsychological health, intended to structure and guide research and funding, as well as public health and environmental initiatives. We conducted a scoping review of reviews of existing evidence on the impacts of the environment on mental and cognitive health. We found that an extensive body of work was focused on chemical hazards and the built environment and their associations with neurological and mental health, including attention-deficit/hyperactivity disorder (ADHD), autism, dementia, and mood. We identified emerging areas of research intersecting environmental factors such as air, water, light, and green space with schizophrenia and behavioral health. Our analysis of the intersections between the environment and mental and cognitive health allows for the identification of knowledge clusters and gaps, contextualizing needs and opportunities for future research and funding strategies. These significant connections showcase the importance of understanding the relationships between the environment and mental and cognitive health. With this work, we assert that the protection of the environment and its integration into healthcare can bring cascading benefits and synergies to mental and cognitive health and well-being and address the social and economic burden of the mental health crises.

New York State Climate Impacts Assessment Chapter 07: Human Health and Safety

New Yorkers face a multitude of health and safety risks that are exacerbated by a changing climate. These risks include direct impacts from extreme weather events and other climate hazards, as well as indirect impacts occurring through a chain of interactions. Physical safety, physical health, and mental health are all part of the equation-as are the many nonclimate factors that interact with climate change to influence health outcomes. This chapter provides an updated assessment of all these topics at the intersection of climate change, public health and safety, and equity in the state of New York. Key findings are presented below.

Reimagining global health scholarship to tackle health inequities

•Significant health inequities persist between and within countries, necessitating a paradigm shift in global health scholarship.•Building on the contributions global health experts, this article proposes four key considerations for reframing global health scholarship.•This requires deeper engagement with macrosocial drivers of health and the application of population health science principles.•An evolving field also necessitates innovation in data sources, multidisciplinary engagement, expanded analytical tools, and diverse global perspectives.

"A place where I have lost and made friends": A photovoice study on adolescents' perspectives on health in a new residential development area in Munich, Germany

Worldwide, the number and proportion of people living in cities continue to grow. Building new districts creates opportunities for designing urban environments that promote the health of their residents from the get-go. In this study, we used the photovoice methodology to explore the perspectives of adolescents on health and well-being in a new urban development area in Munich, Germany. Eleven adolescents aged 13-19 years were recruited in the new residential development area of Freiham on the Southwestern outskirts of Munich. Participants were given ten days to take photographs in the study area, focusing on objects or sceneries they considered to be important for their health. We then conducted qualitative interviews related to these photographs. Interviews were transcribed verbatim and analyzed using thematic analysis. We identified eight recurring themes: emotional well-being, meeting peers, being physically active, growing as a person, safety, waste, development of the urban environment, aesthetics of the urban environment. Adolescents highlighted aspects of mental and social health when assessing the urban environment. Interacting with other young people was an important reason for our participants to visit public places. Public health professionals and urban planners should consider the specific needs of this age group when building new urban areas, and especially provide safe and clean public spaces that adolescents can use for recreation and social interactions.

Effect of pre- and post-migration neighborhood environment on migrants' mental health: the case of Shenzhen, China

Existing mental health studies usually disregard people's neighborhood experiences in the past, which may have long-lasting mental health effects. This may particularly be true for migrants. To assess how the perceived pre- and post-migration neighborhood environment shapes migrants' mental health later on in life, a quasi-longitudinal survey (N = 591) among migrants was conducted in Shenzhen, China. The risk of poor mental health was screened with the General Health Questionnaire (GHQ). Perceptions of the pre- and post-migration neighborhood environment were measured retrospectively and assessed with structural equation models. The results show that the direct pathways linking the perceived post-migration neighborhood physical (NPE) and social environment (NSE) to migrants' mental health are significant. No direct association is found between the pre-migration neighborhood environments and mental health. The indirect path between the pre-migration NPE/NSE and mental health is significantly mediated by the post-migration NPE and NSE. Migrants' SES development and their neighborhood attainment interplay overtime which have long-term impacts on their mental health. Our findings suggest that the pre-migration neighborhood plays a crucial role in migrants' mental health. This confirms a path dependency of migrants' neighborhood environment throughout their migrations. Future mental health studies are advised to incorporate neighborhood characteristics along migrants' residential histories.

The role of emotion in urban development decision-making: A qualitative exploration of the perspectives of decision-makers

People's feelings about their neighbourhoods are important for health, but they may be undervalued in urban development decision-making. This study explores how decision-makers understand and respond to residents' emotions. Reflexive thematic analysis was conducted on a secondary dataset consisting of 123 interviews with influential professionals in urban development decision-making. We developed three themes and one subtheme: '(mis)understanding residents' emotions', 'neglecting the health impact of positive emotions', 'avoidance of emotion in community engagement' and 'sanitized emotions'. We recommend decision-makers engage directly with residents' emotions during urban development processes to ensure healthier place-making.

Connecting to Community: A Social Identity Approach to Neighborhood Mental Health

ACADEMIC ABSTRACT

Integrative theorizing is needed to advance our understanding of the relationship between where a person lives and their mental health. To this end, we introduce a social identity model that provides an integrated explanation of the ways in which social-psychological processes mediate and moderate the links between neighborhood and mental health. In developing this model, we first review existing models that are derived primarily from a resource-availability perspective informed by research in social epidemiology, health geography, and urban sociology. Building on these, the social identity model implicates neighborhood identification in four key pathways between residents' local environment and their mental health. We review a wealth of recent research that supports this model and which speaks to its capacity to integrate and extend insights from established models. We also explore the implications of the social identity approach for policy and intervention.

PUBLIC ABSTRACT

We need to understand the connection between where people live and their mental health better than we do. This article helps us do this by presenting an integrated model of the way that social and psychological factors affect the relationship between someone's neighborhood and their mental health. This model builds on insights from social epidemiology, health geography, and urban sociology. Its distinct and novel contribution is to point to the importance of four pathways through which neighborhood identification shapes residents' mental health. A large body of recent research supports this model and highlights its potential to integrate and expand upon existing theories. We also discuss how our model can inform policies and interventions that seek to improve mental health outcomes in communities.

Structural changes in a Danish social housing area: The impact of forced permanent rehousing on contact frequency with general practitioner and use of antidepressants

There is a lack of knowledge about the health consequences of politically initiated forced permanent rehousing (FPR) of residents in social housing areas. This study investigates if FPR is associated with the contact frequency with general practitioner (GP) and the proportion of residents who use antidepressants. The study included 432 rehoused residents matched 1:2 with remaining residents and residents from a comparable neighbouring area without exposure to rehousing. For GP contact frequency, we conducted a difference-in-difference analysis while the proportion of residents who used antidepressants was investigated through descriptive statistics. We found high GP contact frequency in the three groups, but no significant differences. Further, we found a low proportion of residents who used antidepressants in all groups, but a small increase from baseline to follow-up. Our results thus suggest that FPR neither affected the rehoused residents' GP contact frequency nor the proportion who used antidepressants.

Developing Problematic Performance Value Scores: Binding Routine Activity Performance, Environmental Barriers, and Health Conditions

BACKGROUND

Community design features, such as sidewalks and street crossings, present significant challenges for individuals with disabilities, hindering their physical performance and social integration. However, limited research has been conducted on the application of Universal Design (UD) to address these challenges, particularly concerning specific demographic groups and population cohorts. Understanding the influence of environmental features on physical performance is crucial for developing inclusive solutions like UD, which can enhance usability and social integration across diverse populations.

OBJECTIVE

This study aims to bridge this gap by investigating the complex relationships between environmental barriers, health conditions, and routine activity performance. An index was developed to evaluate users' UD performance based on functional capacity, providing scientifically rigorous and objectively measured evidence of UD effectiveness in creating inclusive built environments.

METHOD

Using data from the Problematic Activities Survey (PAS) conducted in the U.S., Canada, and Australia and targeting individuals with and without functional limitations, multinomial logit models were employed to estimate the probabilities of encountering performance problems. This analysis led to the development of the Problematic Performance Value (PPV) score.

RESULTS

The results demonstrated significant disparities in PPVs across various health conditions, particularly concerning curb ramps. Individuals facing mobility issues in their legs/feet, arms/hands, or back/neck encounter more pronounced challenges, especially when curb ramps lack proper design elements. Similarly, individuals with vision impairments face heightened difficulties with traffic signals, particularly due to issues with audible signal systems. These findings underscore the importance of addressing micro-level environmental challenges to accommodate individuals with varying functional capacities effectively.

CONCLUSIONS

By providing insights into the most problematic daily activities encountered by diverse populations, the PPV score serves as a valuable indicator for guiding environmental design improvements and promoting equitable space usage. This can be used to guide improved UD solutions and decide areas of concentration by providing generalized information on specific environmental features that contribute to user performance.

Interventions targeting social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We conducted a systematic review of reviews to examine the evidence base for interventions that map onto the UN SDGs and seek to improve mental health through targeting known social determinants of mental disorders. We included 101 reviews in the final review, covering demographic, economic, environmental events, neighborhood, and sociocultural domains. This review presents interventions with the strongest evidence base for the prevention of mental disorders and highlights synergies where addressing the UN SDGs can be beneficial for mental health.

Short-term health effects of an urban regeneration programme in deprived neighbourhoods of Barcelona

Urban regeneration programmes are interventions meant to enhance the wellbeing of residents in deprived areas, although empirical evidence reports mixed results. We evaluated the health impact of a participatory and neighbourhood-wide urban regeneration programme, Pla de Barris 2016-2020, in Barcelona. A pre-post with a comparison group study design. Using data from a cross-sectional survey performed in 2016 and 2021. The health outcomes analysed were mental health, alcohol and psychotropic drug use, perceived health status, physical activity and obesity. Depending on the investment, two intervention groups were defined: moderate- and high-intensity intervention groups. The analysis combined difference-in-difference estimation with an inverse weighting derived from a propensity score to reduce potential biases. The impact of the intervention in percentages and its confidence interval were estimated with a linear probability model with clustered adjusted errors. The intervention had a positive impact on health outcomes in women in the high-intensity intervention group: a reduction of 15.5% in the relative frequency of those experiencing poor mental health, and of 21.7% in the relative frequency of those with poor self-perceived health; and an increase of 13.7% in the relative frequency of those doing physical activity. No positive impact was observed for men, but an increase of 10.3% in the relative frequency of those using psychotropic drugs in the high-intensity intervention group. This study shows positive short-term effects of the urban regeneration programme Pla de Barris 2016-2020 on health outcomes in women in the high-intensity intervention group. These results can guide future interventions in other areas.

The Influence of Exposure to Nature on Inpatient Hospital Stays: A Scoping Review

AIM

To summarize the existing literature surrounding the influence of natural elements on course in hospital and to introduce clinicians to the concept of biophilic design and the potential for incorporation of nature into the hospital environment as a component of a therapeutic hospitalization.

BACKGROUND

For decades, architects and designers have espoused the benefits of incorporating natural elements into the healthcare environment for therapeutic purposes. The benefits of this "biophilic" design philosophy has been investigated predominantly in long-term care or rehabilitation settings; however, some of the most appealing opportunities lie in the acute care setting.

METHODS

This scoping review surveyed the literature surrounding the influence of exposure to nature on course in acute hospitalizations. After screening 12,979 citations, 41 articles were included. Exposures were divided into seven categories, the most common of which were the presence of a window/natural light, a natural scene through a window, and nature soundscapes. These articles were reviewed in a narrative fashion and thematic analysis was conducted.

RESULTS

Studies were extremely heterogeneous in their design, research questions, and reported outcomes. Types of exposure to nature studied were exposure to a real natural scene through a window, presence of a window/nature light, nature in the healthcare environment, art depicting nature, direct contact with nature, nature soundscapes, and nature experienced through virtual reality (VR).

CONCLUSIONS

Exposure to nature during an acute hospital admission appears to have a real but small therapeutic effect, predominantly on psychological metrics like anxiety/depression, pain, and patient satisfaction. Greater beneficial effects are seen with greater durations of exposure to nature and greater degrees of immersion into nature (e.g., creating multisensory experiences using emerging technology like VR).

Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project) - study protocol

INTRODUCTION

The European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health.

METHODS AND ANALYSIS

DAS-EP is a Spanish multiregional cross-sectional project that combines population health surveys (PHS) and geographical information systems (GIS) allowing to collect rich individual-level data from 17 000 adult citizens participating in the PHS conducted in the autonomous regions of the Basque Country, Andalusia, and the Valencian Community, and the city of Barcelona in the years 2021-2023. This study focuses on the population living in cities or metropolitan areas with more than 100 000 inhabitants. UrbEEs are described by objective estimates at participants' home addresses by GIS, and subjective indicators present in PHS. The health outcomes included in the PHS and selected for this study are self-perceived health (general and mental), prevalence of chronic mental disorders, health-related quality of life, consumption of medication for common mental disorders and sleep quality. We aim to further understand the direct and indirect effects between UrbEEs and health, as well as to estimate the impact at the population level, taking respondents' sociodemographic and socioeconomic characteristics, and lifestyle into consideration.

ETHICS AND DISSEMINATION

The study was approved by the regional Research Ethics Committee of the Basque Country (Ethics Committee for Research Involving Medicinal Products in the Basque Country; PI2022138), Andalusia (Biomedical Research Ethics Committee of the Province of Granada; 2078-N-22), Barcelona (CEIC-PSMar; 2022/10667) and the Valencian Community (Ethics Committee for Clinical Research of the Directorate General of Public Health and Center for Advanced Research in Public Health; 20221125/04). The results will be communicated to the general population, health professionals, and institutions through conferences, reports and scientific articles.

The association between neighborhood social and built environment on loneliness among young adults with cancer

PURPOSE

Young adults with cancer (YAs, aged 18-39) are at increased risk of experiencing loneliness due to their unique challenges of coping with a cancer diagnosis and treatment during young adulthood. Understanding factors that impact loneliness is critical to improving survivorship outcomes for this vulnerable YA population. Neighborhoods are key determinants of health. However, little is known about how such neighborhood characteristics are associated with loneliness among YA survivors.

METHODS

YA survivors (N = 181) drawn from the National Institutes of Health All of Us Research Program completed measures of neighborhood social environment (e.g., shared values), aspects of their neighborhood built environment (e.g., access to transit, recreational activities), and loneliness. Two total scores were calculated with higher scores reflecting higher neighborhood social cohesion and higher neighborhood walkability/bikeability (i.e., built environment). Hierarchical linear regression examined associations between the social and built environment on loneliness.

RESULTS

Higher levels of neighborhood social cohesion (β =  - 0.28, 95% confidence interval (CI) =  - 0.44, - 0.11) and neighborhood walkability/bikeability (β =  - 0.15, 95% CI =  - 0.31, - 0.006) were significantly associated with lower levels of loneliness.

CONCLUSIONS

Findings suggest that living within a cohesive social environment with neighborhood walkability/bikeability to built environment amenities such as green space, grocery stores, and public transportation is protective against loneliness among YA survivors. More longitudinal research is necessary to understand the dynamic changes in loneliness among YA survivors living in diverse social and built environments.

IMPLICATIONS FOR CANCER SURVIVORS

YA survivors may benefit from cultivating neighbor relationships and living within neighborhoods with walkability/bikeability.

Neighborhoods And Health: Interventions At The Neighborhood Level Could Help Advance Health Equity

Housing is tied to neighborhoods. Therefore, to understand how housing affects health and health equity, the role of neighborhood environments must be considered. This article is a critical review of the relationship between neighborhoods and health. We discuss inequality among US neighborhoods and the roots of that inequality. We then explore the ways in which neighborhood environments may shape health, review the evidence about these effects, and discuss policy responses. Many studies document an association between neighborhoods and physical and mental health, and a few studies suggest that some of these relationships are causal. Thus, the evidence suggests that interventions at the neighborhood scale can potentially help advance health equity. Further research on the long-term impacts of neighborhoods on health and more rigorous studies of the impact of particular neighborhood interventions are needed. To advance health equity, policy makers also need to better understand the institutional arrangements and social policies that have created neighborhood inequality and pursue innovative approaches to changing them.

The social determinants of mental health and disorder: evidence, prevention and recommendations

People exposed to more unfavourable social circumstances are more vulnerable to poor mental health over their life course, in ways that are often determined by structural factors which generate and perpetuate intergenerational cycles of disadvantage and poor health. Addressing these challenges is an imperative matter of social justice. In this paper we provide a roadmap to address the social determinants that cause mental ill health. Relying as far as possible on high-quality evidence, we first map out the literature that supports a causal link between social determinants and later mental health outcomes. Given the breadth of this topic, we focus on the most pervasive social determinants across the life course, and those that are common across major mental disorders. We draw primarily on the available evidence from the Global North, acknowledging that other global contexts will face both similar and unique sets of social determinants that will require equitable attention. Much of our evidence focuses on mental health in groups who are marginalized, and thus often exposed to a multitude of intersecting social risk factors. These groups include refugees, asylum seekers and displaced persons, as well as ethnoracial minoritized groups; lesbian, gay, bisexual, transgender and queer (LGBTQ+) groups; and those living in poverty. We then introduce a preventive framework for conceptualizing the link between social determinants and mental health and disorder, which can guide much needed primary prevention strategies capable of reducing inequalities and improving population mental health. Following this, we provide a review of the evidence concerning candidate preventive strategies to intervene on social determinants of mental health. These interventions fall broadly within the scope of universal, selected and indicated primary prevention strategies, but we also briefly review important secondary and tertiary strategies to promote recovery in those with existing mental disorders. Finally, we provide seven key recommendations, framed around social justice, which constitute a roadmap for action in research, policy and public health. Adoption of these recommendations would provide an opportunity to advance efforts to intervene on modifiable social determinants that affect population mental health.

Area-level Measures of the Social Environment: Operationalization, Pitfalls, and Ways Forward

People's mental health is intertwined with the social environment in which they reside. This chapter explores approaches for quantifying the area-level social environment, focusing specifically on socioeconomic deprivation and social fragmentation. We discuss census data and administrative units, egocentric and ecometric approaches, neighborhood audits, social media data, and street view-based assessments. We close the chapter by discussing possible paths forward from associations between social environments and health to establishing causality, including longitudinal research designs and time-series social environmental indices.

Wellbeing-responsive community: a growth target for intentional mental health promotion

With mental illness remaining a significant burden of disease, there is an ongoing need for community-based health promotion, prevention, and responses (or "mental health promotion activities"). The health promotion, community development, and positive psychology literature identifies significant heterogeneity in the design and delivery of these activities. This variability spans: (1) individual vs. group outcomes, (2) psychological vs. sociological determinants of change, (3) promoting wellbeing vs. reducing mental health symptoms, and (4) the degree activities are contextualized vs. standardized in design and delivery. Mental health promotion activities do not easily accomplish this level of complexity within design and implementation. This has led to the emergence of the complexity-informed health promotion literature and the need for innovative tools, methods, and theories to drive this endeavor. This article directly responds to this call. It introduces "wellbeing-responsive community": a vision and outcome hierarchy (or growth target) for intentionally delivered mental health promotion. The construct enables the design and implementation of interventions that intentionally respond to complexity and contextualization through the drivers of co-creation, intentionality, and local empowerment. It represents a community (support team, programme, agency, network, school, or region) that has the shared language, knowledge, methods, and skills to work together in shared intent. In other words, to integrate best-practice science with their local knowledge systems and existing strengths, and intentionally co-create and deliver contextualized wellbeing solutions at both the individual and community levels that span the "system" (e.g., whole-of-community) to the "moment" (e.g., intentional support and care). Co-creation, as applied through a transdisciplinary lens, is emerging as an evidence-based method to respond to complexity. This article describes the rationale and evidence underpinning the conceptualization of a wellbeing-responsive community through the integration of three key disciplines: (1) positive psychology, (2) ecological or systems approaches, and (3) intentional practice (implementation science). A definitional, contextual, and applied overview of the wellbeing-responsive community is provided, including a hierarchy of outcomes and associated definitions. Its purported application across education, mental health, community service, and organizational settings is discussed, including its potential role in making complexity-informed health promotion practical for all knowledge users.

Characteristics of Home and Neighborhood Built Environments During COVID-19 for Older Adults in the United States and Italy

The home and neighborhood environments impact the social and mental health of older adults, yet little research has addressed the various contexts that can affect these relationships, such as community culture, built and natural elements, and demographics. This survey-based study examined community-dwelling older adults' access and use of transitional outdoor/indoor space (i.e., porches, gardens, windows, etc.), and how that use was related to health variables and changed with the pandemic in two available samples of older adults in the United States and Italy. Use of both outdoor and indoor space was found to be more individualistic in Boston, in the United States, than in Chieti, Italy, where use of these areas with others was more common. Results suggest that window viewing from within the home may be an activity that individuals in Italy engage in when feeling lonely. Changes in the use of home and community space after COVID-19 were minimal; only in the United States did individuals report greater time indoors since the onset of the pandemic. Use of the built environment in and around the home by older adults was found to have multidimensional characteristics between the United States and Italy, with the potential to foster connections and improve well-being.

Physical environment features that predict outdoor active play can be measured using Google Street View images

BACKGROUND

Childrens' outdoor active play is an important part of their development. Play behaviour can be predicted by a variety of physical and social environmental features. Some of these features are difficult to measure with traditional data sources.

METHODS

This study investigated the viability of a machine learning method using Google Street View images for measurement of these environmental features. Models to measure natural features, pedestrian traffic, vehicle traffic, bicycle traffic, traffic signals, and sidewalks were developed in one city and tested in another.

RESULTS

The models performed well for features that are time invariant, but poorly for features that change over time, especially when tested outside of the context where they were initially trained.

CONCLUSION

This method provides a potential automated data source for the development of prediction models for a variety of physical and social environment features using publicly accessible street view images.

Short-term impact of a neighbourhood-based intervention on mental health and self-rated health in Hamilton, Ontario, Canada

The Hamilton Neighbourhoods Study aimed to measure the short-term impact of a neighbourhood-based intervention known as the City of Hamilton's Neighbourhood Action Strategy on health and neighbourhood outcomes. A quasi-experimental study with 881 intervention participants across six targeted neighbourhoods and 173 control participants was conducted to investigate changes in self-rated health and mental health from baseline to follow-up. There was evidence of small improvements in mental health in two neighbourhoods, but there was no change in self-rated health. Place-based interventions aimed at high poverty neighbourhoods may have only modest impacts on health in the short-term.

Understanding How Community Wellbeing is Affected by Climate Change: Evidence From a Systematic Literature Review

Social science studies view community wellbeing to be a cumulative construct of multiple dimensions which include social, economic, environmental, physical, political, health, education indicators and more. The study of community wellbeing is compounded by climate change as it increases the frequency of disasters affecting all dimensions of community wellbeing. It becomes crucial for communities to build community resilience and address the impact on community wellbeing in the context of Disaster Risk Reduction and sustainable development. This systematic literature aimed to understand how community wellbeing is affected by climate change. It analysed 23 papers from Scopus, Web of Science, ProQuest, and Google Scholar, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, to address three research questions: (i) how do climate change scholars understand community wellbeing, (ii) how community wellbeing is affected by specific climate change factors/conditions and the nature of impact, and (iii) how the impact on community wellbeing as a result of climate change is being addressed. The study found that climate change scholars hold mixed and multiple views or understanding of community wellbeing and climate change led to mental stress decreasing community wellbeing. The solutions to improve community wellbeing in the context of climate change suggests that adaptation should be the main policy instrument supplemented by mitigation strategies and recommends building a vibrant research culture in wellbeing and climate studies, among others. This review provides insights into the complex relationship between community wellbeing and climate change and identifies areas for future research and policy development.

Human-centred health-care environments: a new framework for biophilic design

Increasing research corroborates that the qualities of the setting in which a patient receives healthcare positively influence health outcomes. Therefore, it has become progressively important to review the concept of therapeutic environments, as places where patients are treated with the most advanced medicine and technology, but also support their users in psychological, emotional and social terms. This quest for the optimal healing environment brings to the forefront the need to include other parameters in our design briefs, where the application of biophilic design proves to be paramount, as exposure to nature is associated with multiple health benefits. However, current biophilic design frameworks fail to provide efficient guidance, as their design recommendations don't differentiate the level of value of each design parameter for each building programme and context. Our position is that a biophilic design framework can only be efficient if it is adapted to specific building functions and is geographically and culturally contextualized. This study assessed the application of biophilic design in therapeutic environments for cancer patients in the UK, and provided a revised conceptual framework that can more efficiently guide designers and policies in future interventions. This framework was informed by synthesised analyses from healthcare environments on the user's experiences, and primary data obtained from semi-structured interviews with architects and managers, which was then benchmarked against scientific data about the impact of biophilic design on humans. This comprehensive approach helped to identify and rank those biophilic design parameters that appear the most critical for promoting and supporting health and wellbeing in cancer healthcare settings and provided an up-to-date compilation of crucial design actions to enact the necessary change in future research and design practice.

Neighborhood walkability, neighborhood social health, and self-selection among U.S. adults

OBJECTIVES

Neighborhood walkability is favorably related to multiple physical health outcomes, but associations with social health are less clear. Present analyses examined how neighborhood walkability was related to neighborhood social health and explored the potential confounding role of neighborhood self-selection.

METHODS

Cross-sectional data were analyzed for 1745 adults, ages 20-66, recruited from two US regions. We created a walkability index around each participant's home (1 km street network buffer) based on residential density, street intersection density, mixed land use, and retail floor area ratio. Neighborhood social health outcomes included reported social interactions with neighbors and sense of community. Two mixed model regressions were conducted for each outcome, with and without adjusting for walkability-related reasons for moving to the neighborhood (self-selection). Covariates included sex, age, socioeconomic status, white/nonwhite race/ethnicity, marital status, and time living in the neighborhood.

RESULTS

Neighborhood walkability was positively related to social interactions with neighbors, both without (b = 0.13, p < .001) and with adjustment for self-selection (b = 0.09, p = .008). Neighborhood walkability was positively associated with sense of community, but only before adjusting for self-selection (b = 0.02, p = .009).

CONCLUSION

Neighborhood walkability may promote specific aspects of neighborhood social health, which together are beneficial for physical and mental health. These findings provide additional impetus for enhancing walkability of US communities.

Exploring the Association Between the Healthcare Design Elements and Physician Well-Being: A Scoping Review

PURPOSE

To evaluate the association between elements of the built environment and physician well-being using a scoping review.

BACKGROUND

Physicians currently report low work satisfaction, high burnout and depression. The built environment has been shown to affect well-being in the general population, but its relationship to physician well-being is not well understood. Gaining a better understanding of this relationship will allow for better evidence-based design for physician well-being.

METHODS

A scoping review of the literature was conducted of Scopus and PubMed databases using key words for (1) environmental variables such as "environmental design"; (2) physician terms, such as "doctor"; and (3) outcome measures of well-being, such as "burnout." Studies were included if they had at least one measure of the built environment and one measure of physician well-being. Of 1,723 abstracts screened, 146 full-text articles were reviewed, leaving 16 articles to be included for data extraction.

RESULTS

Included studies were from all around the world, except for, notably, the United States. Robust interpretation of the data was challenging because of the lack of standardization in the assessment of environmental factors and physician well-being. Excessive noise was the variable most linked to well-being. Suitable surroundings, including lighting, furniture, and art, were also linked with satisfaction, but it was unclear whether there was an association with well-being.

CONCLUSION

Understanding how environmental factors affect physician well-being is paramount but considerably understudied. Standardization of research approach should be developed in order to produce more robust research to create evidence-based designs for physician well-being.

The mental health of rural older adults: the role of the built environment in Jintang County

The mental health of older adults has become one of the major health challenges facing society today, which has attracted wide concerns from scholars in urban areas, but research in rural areas has been neglected. Therefore, this paper took rural older adult residents of 11 sample villages in Jintang County, Chengdu City, Sichuan Province, as the research object. After controlling the demographic characteristics of older adults in rural areas, this paper attempted to explore the effects of the rural built Environment on the mental health of older adults. Through field investigation in the sample villages, 515 valid questionnaires were obtained. The results from the Binary Logistic Regression Model show that good marital status, physical health, education level, well-constructed roads, and safe neighborhoods had significant positive effects on the mental health of rural older adults. Rural older adults who prefer to walk, cycle, and use public transport have better mental health, and accessibility to the periodic market, health station, bus station, village committee, supermarket, and the main road is positively correlated with the mental health of rural older adults, while the distance from home to the town center and coach terminal has a significant negative impact on the mental health of rural older adults. The research results provide a theoretical reference for further construction of rural aging environments.

Effects of major urban redesign on sedentary behavior, physical activity, active transport and health-related quality of life in adults

BACKGROUND

The built environment is increasingly recognized as a determinant for health and health behaviors. Existing evidence regarding the relationship between environment and health (behaviors) is varying in significance and magnitude, and more high-quality longitudinal studies are needed. The aim of this study was to evaluate the effects of a major urban redesign project on physical activity (PA), sedentary behavior (SB), active transport (AT), health-related quality of life (HRQOL), social activities (SA) and meaningfulness, at 29-39 months after opening of the reconstructed area.

METHODS

PA and AT were measured using accelerometers and GPS loggers. HRQOL and sociodemographic characteristics were assessed using questionnaires. In total, 241 participants provided valid data at baseline and follow-up. We distinguished three groups, based on proximity to the intervention area: maximal exposure group, minimal exposure group and no exposure group.

RESULTS

Both the maximal and minimal exposure groups showed significantly different trends regarding transport-based PA levels compared to the no exposure group. In the exposure groups SB decreased, while it increased in the no exposure group. Also, transport-based light intensity PA remained stable in the exposure groups, while it significantly decreased in the no exposure group. No intervention effects were found for total daily PA levels. Scores on SA and meaningfulness increased in the maximal exposure group and decreased in the minimal and no exposure group, but changes were not statistically significant.

CONCLUSION

The results of this study emphasize the potential of the built environment in changing SB and highlights the relevance of longer-term follow-up measurements to explore the full potential of urban redesign projects.

TRIAL REGISTRATION

This research was retrospectively registered at the Netherlands Trial Register (NL8108).

Well-being implications of immobility during COVID-19: evidence from a student sample in Bangladesh using the satisfaction with life scale

Immobility is known to impact health and well-being by reducing social contact, activity participation, and changing time use patterns. These unfortunate effects mostly affect specific demographic segments, including older adults, low income families, people who face disabilities, and those living in conflict zones. Emergency measures taken during the COVID-19 pandemic mandated or strongly recommended limitations to mobility, thereby causing this condition for segments of the public not usually characterized by high levels of immobility. In the context of the pandemic, reduced mobility was the non-pharmaceutical intervention of choice, and the evidence suggests that it helped to keep incidences of the disease from exploding. On the other hand, there is also a need to understand how mobility restrictions may have had incidental impacts, including to well-being, in population groups that have not been studied from this perspective before. In this spirit, the present paper uses the items of the Satisfaction with Life Scale to investigate how aspects of well-being changed during the pandemic, using a sample of 400 college and university students in Dhaka, Bangladesh. Analysis is based on multivariate ordered models and the results suggest that being less mobile, less active, and changes in activity time use due COVID-19 had an impact on the satisfaction with life of students. The detrimental effect was more marked for males and students from low-income households. Additionally, perceptions of residential characteristics and sense of belonging also correlate with satisfaction with life in the period under study.

Is urban regeneration associated with antidepressants or sedative medication users: a registry-based natural experiment

BACKGROUND

Area deprivation is associated with adverse mental health outcomes. In Denmark, urban regeneration is being used to dissolve concentrated socio-economic area deprivation and ethnic segregation. However, evidence on how urban regeneration affects mental health of residents is ambiguous partly due to methodological challenges. This study investigates if urban regeneration affects users of antidepressant and sedative medication among residents in an exposed and control social housing area in Denmark.

METHODS

Using a longitudinal quasi-experimental design we measured users of antidepressant and sedative medication in one area undergoing urban regeneration compared with a control area. We measured prevalent and incident users from 2015 to 2020 among non-Western and Western women and men and used logistic regression to measure annual change in users over time. Analyses are adjusted for a covariate propensity score estimated using baseline socio-demographic characteristics and general practitioner contacts.

RESULTS

Urban regeneration did not affect the proportion of prevalent nor incident users of antidepressant and sedative medication. However, levels were high in both areas compared with the national average. Descriptive levels of prevalent and incident users were generally lower among residents in the exposed area compared with the control area for most years and stratified groups confirmed by the logistic regression analyses.

CONCLUSION

Urban regeneration was not associated with users of antidepressant or sedative medication. We found lower levels of antidepressant and sedative medication users in the exposed area compared with the control area. More studies are needed to investigate the underlying reasons for these findings, and whether they could be related to underuse.

Public mental health: a psychiatry and public health perspective

Mental health issues are fast becoming one of society's greatest health challenges with evidence of higher levels of illness and strain on psychiatric services. The reasons for this trend of increasing mental health problems across the population are complex and there is an urgent need to research and deliver effective public mental health strategies. In this perspective piece we argue that psychiatrists and public health physicians have unique knowledge and perspectives on population mental health. The development of interdisciplinary initiatives and training posts would result in clinicians with expertise to drive forward public mental health strategies. Focused and sustained advocacy and collaboration are necessary for prioritisation of public mental health on policymakers' agendas.

Urban precarity and youth mental health: An interpretive scoping review of emerging approaches

Circumstances of living are key to shaping emotional and affective experiences, long term health, wellbeing and opportunities. In an era characterised by rapid urbanisation across the majority of the world, there is increasing interest in the interaction between mental health and urban environments, but insufficient attention is paid to how mental health is situated in space and time. Socio-economic inequalities are prevalent in many urban environments globally, making conditions of living highly precarious for some social groups including young people. There remains a large volume of unmet mental health service needs, and young people are impacted by uncertain economic futures. The purpose of this scoping review is to develop an interdisciplinary and globally-informed understanding of the urban conditions which affect youth mental health across a range of scales, and to identify protective factors which can promote better youth mental health. We seek to broaden the scope of urban mental health research beyond the physical features of urban environments to develop an interpretive framework based on perspectives shared by young people. We illustrate how concepts from social theory can be used as an integrative framework to emphasise both young people's lived experiences and the wider cultural and political dynamics of urban mental health.

Placemaking and infrastructure through the lens of levelling up for health equity: A scoping review

The planning and delivery of infrastructure influences how places create health equity. The scholarship on place and health has recently been developed into 'levelling up' principles for equity focussed policy and planning. We conducted a scoping review of the literature on infrastructure through urban regeneration and placemaking interventions. We interrogated the 15 final selected articles for their use of one or more of the five 'levelling' up principles. No article encompassed all five principles. It was most common to find two or three principles in action. Reviewing the articles against the principles allows a deeper explanation of how infrastructure planning practice can positively impact on health equity. We conclude that applying all the principles in standard infrastructure planning practice has great potential for creating places that are positive for health equity.

Social relations and health in an ethnically diverse social housing area selected for large structural changes compared to municipal levels: a Danish survey study

BACKGROUND

This study aims to describe demographics, social relations and health in an ethnically diverse social housing area selected to undergo large structural changes and compare it to the surrounding municipality. Furthermore, to explore the association between social relations and self-rated health (SRH) and the interaction with country of origin in both populations.

METHODS

Data sources include a multilingual interviewer-driven survey study in a social housing area (N = 209) and a municipal health survey (N = 1,638) among residents aged 45 + years. Information on social relations include contact frequency with and support from family, friends, and neighbors. Descriptive and multivariate logistic regression analyses adjusted for age, sex, and country of origin are presented, as well as joint effect analyses of social relations and country of origin on SRH.

RESULTS

In the social housing area, 38.8% of the respondents reported poor SRH compared to 19.5% in the municipality. In both study populations low contact frequency was associated with poor SRH, however insignificantly in the social housing area compared to the municipality sample, OR = 1.50 (0.65-3.46) vs. OR = 2.42 (1.70-3.45). Joint exposure to having non-Western background and low contact frequency was strongly associated with poor SRH in the social housing area, OR = 6.28 (1.80-21.89) but less so in the municipality, OR = 3.67 (1.55-8.69). The same tendency was seen regarding low support from social relations.

CONCLUSIONS

This study provides insight to a population that is generally underrepresented in survey studies. In the social housing area, approximately twice as many reported poor SRH compared to the municipality data. In both populations, low contact frequency and low support were associated with poor SRH. Residents with weak social relations and non-Western origin simultaneously were more likely to report poor SRH in the social housing area specifically but less so in the municipality, indicating a higher vulnerability among the residents in the social housing area.

Perceived neighborhood environment walkability and health-related quality of life among predominantly Black and Latino adults in New York City

BACKGROUND

Measures of the built environment such as neighborhood walkability have been associated with health behaviors such as physical activity, the lack of which in turn may contribute to the development of diseases such as obesity, diabetes, cardiovascular disease, and cancer. However, limited research has examined these measures in association with health-related quality of life (HR-QoL), particularly in minoritized populations. We examined the relationship between perceived neighborhood environment and HR-QoL in a sample of mostly Black and Latino residents in New York City (NYC).

METHODS

This study utilized the baseline survey data from the Physical Activity and Redesigned Community Spaces (PARCS) Study among 1252 residents [34.6% Black, 54.1% Latino, 80.1% female, mean(±SD) age = 38.8 ± 12.5) in 54 park neighborhoods in NYC. Perceived built environment was measured using Neighborhood Environment and Walkability Survey, and mental and physical HR-QoL was estimated using Short Form (SF)-12. Using factor analysis, we identified two subscales of neighborhood walkability: enablers (e.g., trails, sidewalks, esthetics) vs. barriers (e.g., high crime and traffic). In addition, we included a third subscale on neighborhood satisfaction. Generalized Estimating Equation models adjusted for demographics and BMI and accounted for the clustering effect within neighborhood. Multiple imputation was used to account for missing data.

RESULTS

Mental HR-QoL was associated with barriers of walkability (β ± SE = - 1.63 ± 0.55, p < 0.01) and neighborhood satisfaction (β ± SE = 1.55 ± 0.66, p = 0.02), after adjusting for covariates. Physical HR-QoL was associated with only barriers of walkability (β ± SE = - 1.13 ± 0.57, p < 0.05).

CONCLUSIONS

Among NYC residents living in minoritized neighborhoods, mitigating negative aspects of the neighborhood environment may be more crucial than adding positive features in terms of HR-QoL. Our study points to the need to investigate further the role of the built environment in urban, minoritized communities.

Neighborhood Socioeconomic Status and Women's Mental Health: A Longitudinal Study of Hurricane Katrina Survivors, 2005-2015

There is limited knowledge on the relationship between neighborhood factors and mental health among displaced disaster survivors, particularly among women. Hurricane Katrina (Katrina) was the largest internal displacement in the United States (U.S.), which presented itself as a natural experiment. We examined the association between neighborhood socioeconomic status (SES) and mental health among women up to 10 years following Katrina (N = 394). We also investigated whether this association was modified by move status, comparing women who were permanently displaced to those who had returned to their pre-Katrina residence. We used hierarchical linear models to measure this association, using data from the American Community Survey and the Gulf Coast Child and Family Health study. Neighborhood SES was created as an index which represented social and economic characteristics of participants' neighborhoods. Mental health was measured using mental component summary (MCS) scores. Increased neighborhood SES was positively associated with mental health after controlling for age, race/ethnicity, economic positioning, time, and move status (19.6, 95% Confidence Interval: 5.8, 33.7). Neighborhood SES and mental health was also modified by move status. These findings underscore the need to better understand the impacts of socioeconomic conditions and health outcomes among women affected by natural disasters.

Aging in Rural Communities

Purpose of Review

Population aging is occurring worldwide, particularly in developed countries such as the United States (US). However, in the US, the population is aging more rapidly in rural areas than in urban areas. Healthy aging in rural areas presents unique challenges. Understanding and addressing those challenges is essential to ensure healthy aging and promote health equity across the lifespan and all geographies. This review aims to present findings and evaluate recent literature (2019-2022) on rural aging and highlight future directions and opportunities to improve population health in rural communities.

Recent Findings

The review first addresses several methodological considerations in measuring rurality, including the choice of measure used, the composition of each measure, and the limitations and drawbacks of each measure. Next, the review considers important concepts and context when describing what it means to be rural, including social, cultural, economic, and environmental conditions. The review assesses several key epidemiologic studies addressing rural-urban differences in population health among older adults. Health and social services in rural areas are then discussed in the context of healthy aging in rural areas. Racial and ethnic minorities, indigenous peoples, and informal caregivers are considered as special populations in the discussion of rural older adults and healthy aging. Lastly, the review provides evidence to support critical longitudinal, place-based research to promote healthy aging across the rural-urban divide is highlighted.

Summary

Policies, programs, and interventions to reduce rural-urban differences in population health and to promote health equity and healthy aging necessitate a context-specific approach. Considering the cultural context and root causes of rural-urban differences in population health and healthy aging is essential to support the real-world effectiveness of such programs, policies, and interventions.

A Systematic Review and Conceptual Framework of Biophilic Design Parameters in Clinical Environments

OBJECTIVES

To provide a live-experience knowledge base about biophilic design parameters and environmental features to inform policy and design in clinical therapeutic environments.

BACKGROUND

It is increasingly important to review hospital design to make the best use of the affordances of natural elements in supporting both patients' and staff's physical and psychological well-being. The biophilic design theory provides an appropriate design approach. However, current biophilic design frameworks fail to provide efficiently standardized guidance. This systematic review aims to examine the experience of hospital users (patients and staff) with a view to informing a standardized biophilic design framework to improve future design in this context.

METHODS

This study performed a review and synthesis of nine studies identified using systematic procedures focusing on biophilic design features in healthcare environments.

RESULTS

The study identified a selection of biophilic parameters specifically relevant to this building typology, according to three different user groups: outpatients (fresh air, light-daylight, thermal comfort, welcoming and relaxing), inpatients (feeling relaxed and comfortable, prospect refuge, security and protection, light-daylight, view), and staff (privacy-refuge, quietness).

CONCLUSIONS

The systematically identified studies helped to identify and rank the biophilic design parameters that appear the most critical for promoting and supporting human health and well-being in clinical therapeutic environments from the user's perspective. It also provides an up-to-date compilation of crucial design interventions related to biophilic parameters and as such provides benchmark information for future research and design guidance in these environments.

Built environment color modulates autonomic and EEG indices of emotional response

Understanding built environment exposure as a component of environmental enrichment has significant implications for mental health, but little is known about the effects design characteristics have on our emotions and associated neurophysiology. Using a Cave Automatic Virtual Environment while monitoring indoor environmental quality (IEQ), 18 participants were exposed to a resting state (black), and two room scenes, control (white) and condition (blue), to understand if the color of the virtual walls affected self-report, autonomic nervous system, and central nervous system correlates of emotion. Our findings showed that exposure to the chromatic color condition (blue) compared to the achromatic control (white) and resting-state (black, no built environment) significantly increased the range in respiration and skin conductance response. We also detected a significant increase in alpha frontal midline power and frontal hemispheric lateralization relative to blue condition, and increased power spectral density across all electrodes in the blue condition for theta, alpha, and beta bandwidths. The ability for built environment design to modulate emotional response has the potential to deliver significant public health, economic, and social benefits to the entire community. The findings show that blue coloring of the built environment increases autonomic range and is associated with modulations of brain activity linked to emotional processing.

Conceptualising public mental health: development of a conceptual framework for public mental health

Background

Numerous determinants have been linked to public mental health; however, they have not been brought together in a comprehensive conceptual framework. The goal of this work was to bring together academic research, practitioner expertise, and public perspectives to create a public mental health conceptual framework.

Methods

The development process proceeded in four stages. First, we identified a comprehensive list of potential determinants through a state-of-the-art academic literature review, grey literature review, and created mind maps created by peer researchers. Next, we conducted in-person workshops, consultations, and an online survey with academics, practitioners, policy makers, and members of the public to review the potential determinants, nominate additional determinants, and prioritise determinants by importance for understanding public mental health. This iterative process resulted in the final list of determinants contained in the framework. We then conducted rapid reviews to define each determinant and to identify key research, interventions, and resources. Finally, we worked with a design team to visualise the conceptual framework as an online tool and printable infographic.

Results

We found substantial overlap between sources reflecting a shared understanding of the key drivers of public mental health. The unique determinants that emerged from each data source highlighted the importance of using multiple sources to create a comprehensive model. 72 potential determinants were prioritised through stakeholder consultations, resulting in a final list of 55 determinants and organised into four levels: individual, family, community, and structural.

Conclusions

This is the most complete conceptual framework for public mental health to date, bringing together academic research, policy and practitioner views, and lived experience perspectives. The co-production processes and tools we used provides a template for researchers looking to include multiple perspectives in their research.

The conceptual framework draws together current knowledge on each determinant, but also highlights areas where further research is needed to better understand the relationship between each factor and mental health, which can inform the research agenda. This online tool and infographic can be used by practitioners to identify interventions for promoting mental health, and by the general public as a resource to increase awareness of the broad factors which shape public mental health.

Neighbourhood income inequalities in mental health in Barcelona 2001-2016: a Bayesian smoothed estimate

OBJECTIVE

Obtaining reliable health estimates at the small area level (such as neighbourhoods) using survey data usually poses the problem of small sample sizes. To overcome this limitation, we explored smoothing techniques in order to estimate poor mental health prevalence at the neighbourhood level and analyse its profile by income in Barcelona city (Spain).

METHOD

A Bayesian smoothing model with a logit-normal transformation was applied to four repeated cross-sectional waves of the Barcelona health survey for 2001, 2006, 2011 and 2016. Mental health status was identified from the 12-item General Health Questionnaire. Income inequalities were analysed with neighbourhood income in quantiles for each year and trends in the pooled analysis.

RESULTS

The prevalence of poor mental health ranged from 14.6% in 2001 to 18.9% in 2016. The yearly difference between neighbourhoods was 12.4% in 2001, 16.7% in 2006, 14.2% in 2011, and 20.0% in 2016. The odds ratio and 95% credible interval (95%CI) of experiencing poor mental health was 1.40 times higher (95%CI: 1.02-1.91) in less advantaged neighbourhoods than in more advantaged neighbourhoods in 2001, 1.61 times higher (95%CI: 1.01-2.59) in 2006 and 2.31 times higher (95%CI: 1.57-3.40) in 2016.

CONCLUSIONS

This study shows that the Bayesian smoothed techniques allows detection of inequalities in health in neighbourhoods and monitoring of interventions against them. In Barcelona, mental health problems are more prevalent in low-income neighbourhoods and raised in 2016.

A Meta-Analysis on the Influence of Age-Friendly Environments on Older Adults' Physical and Mental Well-Being

The importance of age-friendly environments (AFEs) for older adults has been empirically and theoretically highlighted by the extant literature. However, the strength of the association between environments and older adults’ well-being has not been comprehensively quantified. Given the different attributes of the physical and mental dimensions, this meta-analysis aims to synthesise and quantify the association between AFEs and the physical and mental well-being of older adults. Fourteen eligible studies were included in this analysis: among which eight explored the link between AFEs and physical well-being, and eleven investigated AFEs in association with mental well-being. A random-effects model showed a small but significant correlation between AFEs and the mental well-being of older adults (r = 0.160, 95% CI [0.084, 0.224], p < 0.001), and the correlation between AFEs and physical well-being was also significant (r = 0.072, 95% CI [0.026, 0.118], p < 0.01). The number of environmental factors involved in AFEs moderated the association with physical well-being, from which the association was only significant among studies focusing on fewer environmental factors (n < 6). Results of this meta-analysis indicated that AFEs may be more effective in promoting the emotions of older adults, compared to ameliorating their physical functioning. The limitations of current empirical studies and directions for future research in the field of environmental gerontology were also discussed.

Association Between Urban Regeneration and Healthcare-Seeking Behavior of Affected Residents: A Natural Experiment in two Multi-Ethnic Deprived Housing Areas in Denmark

Area regeneration of deprived neighborhoods is being used to reduce health inequality, socioeconomic deprivation and ethnic segregation. This quasi-experimental study examines if long-term graded exposure to urban regeneration is associated with primary healthcare-seeking behavior among residents. We compared general practitioner (GP) contacts from 2015-2020 in two adjacent, deprived social housing areas, one exposed to area regeneration. Populations were into Western and non-Western males and females aged 15 years and older (N = 3,960). Mean annual GP contact frequency for each group were estimated and a difference-in-difference (DiD) analysis was conducted with adjustments for propensity scores based on baseline characteristics. GP contact frequency increased for all groups across time with a systematically higher level and faster increase in the control groups. In particular, the mean difference between the exposed and control area for non-Western women more than doubled from -0.61 to -1.47 annual contacts across the period. The mean differences in contact frequency increased for all groups but results of the DiD analyses were insignificant. In conclusion, an emerging gap in GP contact frequency, with the highest levels in the control area, was observed for all comparisons across time. More long-term research is needed to understand how the emerging gaps evolve.

Functional brain connectivity during exposure to the scale and color of interior built environments

Understanding brain activity linked to built environment exposure is important, as it may affect underlying cognitive, perceptual, and emotional processes, which have a critical influence in our daily life. As our time spent inside buildings is rising, and mental health problems have become more prevalent, it is important we investigate how design characteristics of the built environment impact brain function. In this study, we utilized electroencephalography to understand whether the design elements of scale and color of interior built environments modulate functional brain connectivity (i.e., brain network communication). Using a Cave Automatic Virtual Environment, while controlling indoor environmental quality responsible for physiological comfort, healthy adult participants aged 18-55 years (66 for scale, subset of 18 for color), were exposed to context-neutral indoor room scenes presented for two-minutes each. Our results show that both enlarging and reducing scale enhanced theta connectivity across the left temporoparietal region and right frontal region. We also found when reducing the built environment scale, there was a network exhibiting greater high-gamma connectivity, over the right frontoparietal region. For color, the condition (blue) contrasted to our achromatic control (white) increased theta connectivity in the frontal hemispheres. These findings identify a link between theta and gamma oscillations during exposure to the scale and color of the built environment, showing that design characteristics of the built environment could affect our cognitive processes and mental health. This suggests that, through the design of buildings, we may be able to mediate performance and health outcomes, which could lead to major health and economic benefits for society.

Finding the right words: Articulating the value of mental health promotion. A focus group study

The Lapinlahti Hospital initiative in Helsinki has transformed a disused psychiatric hospital into an open site for mental health promotion. The current study uses qualitative methods to explore how the initiative may promote population mental health. The phenomenological study comprised of data from 7 focus group including 28 participants. Resulting data were thematically analysed to articulate how the initiative supports mental wellbeing in different ways. Mental health benefits were categorized into three themes; mental health value, civil values and common values which were comprised of nine subthemes; paradigm shift, social inclusion, personal meaning, regeneration, ambience, stigma, sustainability, democracy and environment. Mental health promotion emphasises the impact of daily environments in which people live their lives. Results from this study support the use of broad based actions which promote different components of mental wellbeing simultaneously. Psychiatric hospitals may offer historically meaningful sites for such actions.

Age-friendly environment, social support, sense of community, and loneliness among middle-aged and older adults in Korea

OBJECTIVES

The purpose of this research is to explore the relationship between age-friendly environment, social support, sense of community, and loneliness of Korean adults aged 45 and above.

METHODS

A total of 590 participants from a cross-sectional and secondary data from an age integration survey conducted in 2018 was used for analysis. Structural equation modelling and bootstrapping method were applied to examine the mediating role of social support and sense of community on the relationship between age-friendly environment and loneliness.

RESULTS

Age-friendly environment was positively associated with social support (β=.310, p<.001) and sense of community (β=.479, p<.001). Social support was negatively associated with loneliness (β=-.190, p<.001). Full mediation effect of social support was observed in the pathway from age-friendly environment to loneliness (95% CI: -0.135 to -0.036).

CONCLUSION

Social support was fundamental in lowering loneliness in an age-friendly environment. There was no significant association linking age-friendly environment, sense of community, and loneliness. The results support the adoption of AFE to protect people at risk of loneliness with social support mediating this relationship.