Neighbourhood environment and positive mental health in older people: The Hertfordshire Cohort Study

Abstract

Little is known about the potential effects of neighbourhood environment on positive mental health in older people. We examined cross-sectional associations between the index of multiple deprivation score of the census area of residence, perceptions of neighbourhood cohesion and neighbourhood problems and mental wellbeing, as measured by the Warwick–Edinburgh Mental Wellbeing Scale, in 1157 men and women aged 69–78 years from Hertfordshire, UK. We found no association between area-level deprivation and mental wellbeing. People who felt a stronger sense of cohesion within their neighbourhood and reported fewer neighbourhood problems had higher levels of mental wellbeing, independently of social class, income, presence of limiting illness or disability, mobility problems, and perceived social support. Adjustment for emotional stability attenuated the associations between mental wellbeing and both of these measures of perceived neighbourhood environment, particularly in the case of neighbourhood problems. How older people feel about their neighbourhood may be important for positive mental health in later life.

Introduction

There is some evidence that neighbourhood environment may be important for mental health. Living in an area that has more socioeconomic deprivation has been linked with a higher prevalence of anxiety and depression (Fone et al., 2007), an increased risk of incident depression (Galea et al., 2007), and a greater likelihood of admission to psychiatric hospital, independently of individual-level socioeconomic factors (Sundquist and Ahlen, 2006). But this is not a consistent finding. Studies from Sweden (Lofors et al., 2006), the UK (Propper et al., 2005), and the Netherlands (Reijneveld and Schene, 1998) found that neighbourhood deprivation appeared to have little or no influence on the prevalence of anxiety or depression once individual socioeconomic status had been accounted for.

Fewer studies have examined the potential effect of neighbourhood environment on mental health in older people (Yen et al., 2009). It seems plausible that characteristics of the immediate residential neighbourhood may be more important for mental wellbeing at older ages because such individuals are less likely to go out to work and have an increased risk of mobility limitations. Yet findings on the relation between neighbourhood socioeconomic deprivation and depressive symptoms in older people have been as inconsistent as those in the general population, with two studies finding a significant association between neighbourhood poverty and increased depression after adjustment for individual characteristics (Kubzansky et al., 2005, Ostir et al., 2003), but others showing no effect (Aneshensel et al., 2007, Walters et al., 2004). There is only limited evidence on the relationship between perceived aspects of neighbourhood and mental health in older people, but findings linking self-reports of problems with the neighbourhood (Schieman and Meersman, 2004), neighbourhood social environment (Brown et al., 2009) and sense of belonging to a neighbourhood (Young et al., 2004) with psychological distress in older people suggest that how individuals feel about the physical and social environment where they live may be more strongly associated with their mental health than objective, area-level measures of neighbourhood deprivation.

Most studies into the relation between neighbourhood and mental health have assessed symptoms of depression or anxiety. Such measures have drawbacks as an indicator of the continuum of mental wellbeing in population samples because of their ceiling effects; in other words a large proportion of respondents will report no such symptoms. The Warwick–Edinburgh Mental Wellbeing Scale was developed specifically to measure mental wellbeing in population samples, focusing entirely on positive aspects of mental health (Tennant et al., 2007). We used this measure in a survey of men and women aged 69–78 years, and investigated the cross-sectional relations between neighbourhood area-level deprivation, perceptions of neighbourhood problems and neighbourhood cohesion, and positive mental health. We were able to examine the role of several other factors that could potentially confound or mediate any association between our measures of neighbourhood environment and positive mental health, including individual socioeconomic circumstances, presence of limiting long-term illness or disability, mobility problems, the personality trait emotional stability (or neuroticism), and perceived level of social support. Our hypothesis was that how older people felt about neighbourhood problems and how strongly they felt a sense of cohesion with their neighbourhood would be more strongly linked to their positive mental health than an objective measure of deprivation in their area.