Socioeconomic Inequalities in Psychological Distress among Urban Adults: The Moderating Role of Neighborhood Social Cohesion.

Özcan Erdem,Frank J Van Lenthe,Toon A J J Voorham,Alex Burdorf,Rick G Prins,Jonathan K Burns

doi:10.1371/journal.pone.0157119

Abstract

BackgroundVarious studies have reported socioeconomic inequalities in mental health among urban residents. This study aimed at investigating whether neighborhood social cohesion influences the associations between socio-economic factors and psychological distress.MethodsCross-sectional questionnaire study on a random sample of 18,173 residents aged 16 years and older from 211 neighborhoods in the four largest cities in the Netherlands. Psychological distress was the dependent variable (scale range 10–50). Neighborhood social cohesion was measured by five statements and aggregated to the neighborhood level using ecometrics methodology. Multilevel linear regression analyses were used to investigate cross-level interactions, adjusted for neighborhood deprivation, between individual characteristics and social cohesion with psychological distress.ResultsThe mean level of psychological distress among urban residents was 17.2. Recipients of disability, social assistance or unemployment benefits reported higher psychological distress (β = 5.6, 95%CI 5.2 to 5.9) than those in paid employment. Persons with some or great financial difficulties reported higher psychological distress (β = 3.4, 95%CI 3.2 to 3.6) than those with little or no financial problems. Socio-demographic factors were also associated with psychological distress, albeit with much lower influence. Living in a neighborhood with high social cohesion instead of low social cohesion was associated with a lower psychological distress of 22% among recipients of disability, social assistance or unemployment benefits and of 13% among citizens with financial difficulties.ConclusionsResiding in socially cohesive neighborhoods may reduce the influence of lack of paid employment and financial difficulties on psychological distress among urban adults. Urban policies aimed at improving neighborhood social cohesion may contribute to decreasing socio-economic inequalities in mental health.

Highlights

Depression is a common health problem among adults in European countries, including the Netherlands [1, 2]
Residing in socially cohesive neighborhoods may reduce the influence of lack of paid employment and financial difficulties on psychological distress among urban adults
Urban policies aimed at improving neighborhood social cohesion may contribute to decreasing socio-economic inequalities in mental health

Summary

Introduction

Depression is a common health problem among adults in European countries, including the Netherlands [1, 2]. The largest cities in the Netherlands host relatively many residents from lower socioeconomic groups [12], which may be one of the reasons of a higher prevalence of depression in those cities (12–15%) as compared to the overall prevalence in the Netherlands (10%) [13] Explanations for these inequalities include poor material circumstances, lack of social support, and unhealthy behaviors [14]. These individual factors cannot entirely explain the observed between-neighborhood variation in depression in the Netherlands. This study aimed at investigating whether neighborhood social cohesion influences the associations between socio-economic factors and psychological distress

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