Examining neighborhood effects on mental health utilizing a novel two-stage modeling approach

Abstract

Neighourhood conditions may affect health, but health may also determine a preference where to live. This study estimates the effect of neighbourhood characteristics on mental health while aiming to adjust for this residential self-selection. A two-step method was implemented using register data from Statistics Netherlands from all residents of the city of Rotterdam relocating within the city in 2013 (N=12.456). First, using a conditional logit model, we estimated for each individual the probability of relocating to a neighbourhood over all other neighbourhoods in Rotterdam, based on personal and neighbourhood characteristics in 2013. Second, we corrected for this selection process in a model investigating the effects of neighbourhood characteristics in 2014 on reimbursed anti-depressant/anti-psychotic medication in 2016. Personal and neighbourhood characteristics predicted neighbourhood choice, indicating strong patterns of selection into neighbourhoods. Unadjusted for selection log neighbourhood income was associated with reimbursed medication (β=─0.040,95%CI:─0.060,─0.020), but the association strongly attenuated after controlling for self-selection into neighbourhoods (β=─0.010,95%CI:─0.030,0.011). The opposite was observed for contact with neighbors; unadjusted for self-selection there was no association (β=─0.020, 95%CI:─0.073,0.033), but after adjustment increased neighborhood contact was associated with an 8.5% relative reduction in reimbursed medication (β=-0.075,95%CI:=─0.126,─0.025). The method illustrated in this study offers new opportunities to disentangle selection from causation in neighbourhood health research.