Abstract
BackgroundPoor micro-scale environmental features, such as graffiti and broken windows, have been associated with crime and signs of social disorder with a potential impact on mental health. The aim of this study is to investigate the association between micro-scale environment and mental health problems in later life, including cognitive (cognitive impairment and dementia) and common mental disorders (depressive and anxiety symptoms). MethodsThe method of visual image audits was used to collect micro-scale environmental data for 3590 participants in the Cognitive Function and Ageing Study II, a population-based multicentre cohort of people aged 65 or above in England. Multilevel logistic regression was used to examine the associations between the quality of micro-scale environment and mental health problems taking into account urban/rural difference. ResultsPoor quality of micro-scale environment was associated with nearly 20% increased odds of depressive (OR: 1.19; 95% CI: 0.99, 1.44) and anxiety symptoms (OR: 1.17; 95% CI: 0.99, 1.38) while the direction of association for cognitive disorders differed across urban and rural settings. Although higher odds of cognitive disorders were found in rural settings, living in a poor quality environment was associated with nearly twice higher odds of cognitive impairment (OR: 1.88; 95% CI: 1.18, 2.97) in urban conurbations but 20% lower odds in rural areas (OR: 0.80; 95% CI: 0.57, 1.11). LimitationsThe causal direction could not be fully determined due to the cross-sectional nature of the data. The visual nature of the environmental assessment tool means it likely does not fully capture features related to the availability of local support services, or opportunities for social participation and interaction. ConclusionsThe quality of micro-scale environment appears to be important to mental health in older people. Interventions may incorporate the environmental aspect to reduce cognitive and common mental disorders.
Highlights
There has been a growing interest in identifying environmental factors related to mental disorders (Mair et al, 2008)
In order to assess micro-scale level features in a large population, in an earlier study (Wu et al, 2014) we have previously developed and validated the method of visual image audits based on the Residential Environmental Assessment Tool (REAT) (Dunstan et al, 2005), a UK-based instrument designed for assessing specific micro-scale features within a postcode unit
This study investigated the associations between the quality of micro-scale environment and mental health using a multicentre study of older people in England
Summary
There has been a growing interest in identifying environmental factors related to mental disorders (Mair et al, 2008). Physical characteristics at the micro-scale level, such as poor pavement condition, graffiti, vandalism and litter, have been reported to be related to social disorder and lack of informal control in local areas (Kelling and Wilson, 1982; Blair et al, 2014) and might have a potential impact on stress and insecurity as well as increasing the risk of mental illnesses (Blair et al, 2014; Julien et al, 2012) These detailed features are advocated as providing additional information on the living environment, they cannot be captured from the existing collection of small area statistics. Interventions may incorporate the environmental aspect to reduce cognitive and common mental disorders
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