Abstract
BackgroundLittle is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. Furthermore, the role of physical activity (PA) as a mediator of this association has not been investigated. The two-fold objectives of this study, therefore, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA.MethodsWe used baseline data from the Jackson Heart Study (JHS), a single-site, prospective, community-based study of African-American adults (n = 2209) recruited from Jackson, Mississippi. PNSE variables included scores for neighborhood violence (i.e., higher score = more violence), problems (higher score = more problems), and social cohesion (higher score = more cohesion). Depressive symptoms were measured by the 20-item Center for Epidemiological Studies Depression (CES-D) score. First, multilevel modeling, controlling for census tract clustering effects, was used to estimate associations between each PNSE variable and CES-D score, adjusting for covariates, including demographic, health-related, and population density. Second, validated, self-reported total PA, based on active living, sport, and home indices, was tested as the mediator. Multivariable linear regressions with bootstrap-generated 95% bias-corrected confidence intervals (BC CIs) were estimated to test for significant unstandardized indirect effects, controlling for all covariates.ResultsOur participants were 64.2% female with a mean age of 52.6 (SD = 12.2) and a mean CES-D score of 10.8 (SD = 8.1). In the fully-adjusted model, neighborhood violence and problems were positively related to depressive symptoms (B = 3.59, 95%CI = 0.93, 6.26, and B = 3.06, 95%CI = 1.19, 4.93, respectively). Neighborhood violence and problems were also indirectly related to depressive symptoms via total PA (B = 0.26, 95%BC CI = 0.05, 0.55; and B = 0.15, 95%BC CI = 0.02, 0.34, respectively). Social cohesion was neither directly nor indirectly related to depressive symptoms.ConclusionsWe found that higher levels of perceived neighborhood problems and violence were directly and positively associated with depressive symptoms. These associations may be explained in part by lower total PA levels. Future interventions to reduce depressive symptoms attributed to neighborhood features should consider emphasizing built environment features that facilitate PA increases in conjunction with community efforts to reduce neighborhood violence and problems.
Highlights
Depressive symptoms represent a major public health problem in the U.S, with rates of clinically significant depression exceeding 8% in a representative U.S adult population from the 2013–2016 National Health and Nutrition Examination Survey (NHANES) [1]
We found that higher levels of perceived neighborhood problems and violence were directly and positively associated with depressive symptoms
Future interventions to reduce depressive symptoms attributed to neighborhood features should consider emphasizing built environment features that facilitate physical activity (PA) increases in conjunction with community efforts to reduce neighborhood violence and problems
Summary
Depressive symptoms (e.g., loss of interest in typical activities, difficulty concentrating, psychomotor changes) represent a major public health problem in the U.S, with rates of clinically significant depression exceeding 8% (approximately 1 in 12) in a representative U.S adult population from the 2013–2016 National Health and Nutrition Examination Survey (NHANES) [1]. More specific features of neighborhood-level characteristics, such as the perceived neighborhood social environment (PNSE), may influence depressive symptoms [10]. This has increasingly led researchers to analyze depression within a social ecological framework [11, 12], and to identify associations of various domains of neighborhood social environment (such as violence, problems, and social cohesion) with depression [13,14,15]. Another study using MESA data demonstrated that lower levels of neighborhood social cohesion were associated with more depressive symptoms [15]. A previous study among British older adults demonstrated that greater personal sense of control and quality friendships mediated the negative association between neighborhood social cohesion and depressive symptoms [17]. Little is known about the associations between perceived neighborhood social environment (PNSE) and depressive symptoms among African Americans. The two-fold objectives of this study, were (1) to examine the associations between PNSE and depressive symptoms among African Americans, and (2) to test the degree to which these associations were mediated by total PA
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