Abstract
With rapid urbanization, understanding the role of residential environments in the development of depression has gained importance. However, the potential associations of residential space and density with depression have been understudied. To investigate longitudinal associations of residential livable space and density with depression. This longitudinal cohort study used data from 2 waves of the FAMILY Cohort, a population-based cohort in the Hong Kong Special Administrative Region, China, recruited between February 28, 2009, and March 28, 2011, at baseline and followed up between August 3, 2011, and June 19, 2013, at wave 2. Data were analyzed from September 1, 2020, through August 10, 2021. A total of 16 968 participants aged 16 years or older underwent assessment using the Patient Health Questionnaire-9 (PHQ-9) and had complete data across all variables. Residential density was objectively assessed at 3 scales (within apartment, building block, and at neighborhood level) at baseline and follow-up. Depressive symptoms were defined in terms of a PHQ-9 threshold greater than or equal to 5 and probable major depression with a cutoff value greater than or equal to 10. A continuous PHQ-9 score was used as a secondary outcome. Multilevel logistic regression models were used to examine associations of the residential density with probable major depression and depressive symptoms adjusted for time-varying sociodemographic and lifestyle factors, comorbidities, and other environment variables. Of the 16 968 participants with complete data, the mean (SD) age was 45.5 (16.7) years, and 9328 participants (55.0%) were women at baseline. The mean follow-up was 2.2 years (range, 1.3-3.6 years). At the household level, after full adjustments, each IQR increment in residential livable area was associated with lower odds of probable major depression (adjusted odds ratio [aOR], 0.84; 95% CI, 0.71-0.98; P = .03) and depressive symptoms (aOR, 0.93; 95% CI, 0.86-1.00; P = .04). At the building-block level, each IQR increment in block density was associated with higher odds of depressive symptoms (aOR, 1.11; 95% CI, 1.01-1.22; P = .03), but only in single-housing environment models. The results remained consistent in models with continuous PHQ-9 evaluation. This study's findings suggest that residential livable space and block density may play a role in the development of depression. Integrated mental health and housing policies promoting mental capital in cities, such as health-optimized density at the household and building-block levels, might serve as a population approach to reduce the burden of depression.
Highlights
Depression is a leading cause of mental health–related disease burden, affecting 4.4% of the global population (322 million people in 2015) and accounting for 54 million years lived with disability, which accounts for 7.5% of all years lived with disability.[1]
After full adjustments, each IQR increment in residential livable area was associated with lower odds of probable major depression and depressive symptoms
At the building-block level, each IQR increment in block density was associated with higher odds of depressive symptoms, but only in single-housing environment models
Summary
Depression is a leading cause of mental health–related disease burden, affecting 4.4% of the global population (322 million people in 2015) and accounting for 54 million years lived with disability, which accounts for 7.5% of all years lived with disability.[1]. The role of housing environments—in particular, living density—in depression has been understudied. An ecological study in Chicago reported the number of units per block to be the second most important housing feature (following the number of persons per room) associated with social aberrations.[11] At the macroscale, residential density, defined by the number of dwelling units within a residential catchment (neighborhood), is a well-established measure, often acting as a proxy for exposure to health and welfare-enhancing urban attributes, such as availability of community services, walkability, choice of destinations, social interactions, and livability.[12,13] A study conducted in the US reported higher Census tract–level residential density to be associated with fewer depressive symptoms.[14]
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