Neighbourhood effects, local crime and mental health: longitudinal analyses over the life course

Mental health conditions are major contributors to global disability and suffering, with a substantial social and economic burden. Besides well-established individuallevel biopsychosocial determinants, emerging literature emphasises that social and physical features of the residential environment are associated with mental health. However, there is a limited understanding of how, where and for whom neighbourhood matters for mental health, partly because of the methodological shortcomings of existing literature. This thesis takes a longitudinal approach to examine the links between place-based factors, in particular neighbourhood crime, and anxiety, depression and psychosis. A systematic review and meta-analysis on the association between local crime and mental disorders sets the context for the thesis. Based on 50 studies meeting the inclusion criteria, random-effects meta-analyses indicated higher risk of depression and psychological distress in high crime areas; for anxiety and psychosis there was only limited evidence. Associations varied by study design (longitudinal versus cross-sectional), type of crime measurement (perceived versus objective) and between different age groups. Importantly, the review identified research gaps, which were the focus of the following chapters. The thesis was structured around four longitudinal investigations, two utilizing perceived and two objective neighbourhood measurements. First, available evidence in the field is limited to a few countries and there is no information on country-level heterogeneity. Data on perceived neighbourhood conditions and depression from 16 countries were utilised across three ageing cohorts (English Longitudinal Study of Ageing; Health and Retirement Study; Survey of Health, Ageing and Retirement in Europe [SHARE]) capturing adults aged 50 and over (n=32,531). Findings indicated elevated risk of depression amongst participants living in an area with perceived neighbourhood disorder (including crime) or with lack of social cohesion. Further analyses uncovered cross-level interactions by income inequality, population density and air pollution for social cohesion and by forest coverage for neighbourhood disorder. Second, neighbourhood effects might be determined by vulnerability build up over the life course; however, no information is available on the long-term impact of childhood stressors, a sensitive period in human development. Prospective and retrospective data on adults aged 50 and over (n=10,328), were analysed from the SHARE survey. In addition to a higher risk of depression when living in areas with perceived neighbourhood nuisances (including crime), and lower in areas with good access to neighbourhood services, childhood socioeconomic conditions modified neighbourhood effects. Older adults who grew up in better childhood circumstances benefited more from neighbourhood resources, but they were at higher risk of depression when exposed to neighbourhood problems. Third, there is a lack of understanding of different neighbourhood crime and mental health associations across psychiatric conditions. A large data-linkage study (Scottish Longitudinal Study [SLS]), on small area-level crime rates and prescribed psychotropic medications was carried out (n=129,945). Findings indicated higher risk of antidepressants and antipsychotics, but not anxiolytics medications in high crime areas. Moreover, there was higher risk of antidepressants prescriptions among adults aged 24-53 in 2009, antipsychotics among men aged 44-53 in 2009, and among those in the middle of the social ladder, when living in high crime areas. Fourth, although changing levels of neighbourhood exposure may help in understanding the causal relationship between context and health, very few studies have utilised repeated measurements of small area-level crime. Analysis based on the previous study (SLS) with additional linkage for three consecutive area crime measurements were carried out, to explore the association of changing crime rates with self-reported mental illness and prescribed medications among residential stayers and movers (n=112,251). Recent increase in crime exposure was associated with mental health problems among stayers aged 16-30 (self-reported mental illness, antidepressants), and among movers aged 31-45 (self-reported mental illness, antipsychotic medication). After excluding individuals with pre-existing mental health conditions, findings suggested causation for the former, and health selective migration for the latter group. Neighbourhood crime and other contextual factors in the residential area are significant determinants of mental health, but associations differ by childhood and adult socioeconomic conditions, across sex and age groups, and between anxiety, depressive and psychotic disorders. Place-based interventions aimed at reducing crime, supporting social cohesion and allocating targeted mental health preventions and services in the vicinity of high crime areas, may have long-term benefits for residents’ mental health, especially for those more vulnerable. Future research should investigate the relationship between area stressors and mental health by exploring direct and indirect pathways, studying crime effects at different geographical levels, and applying the life course framework

Systematic Review of the Health and Equity Impacts of Remediation and Redevelopment of Contaminated Sites

(1) Background: Globally there is a vast legacy of contaminated sites from past industrial, commercial and military activity, waste disposal, and mineral extraction. This review examined the extent to which the remediation of contaminated sites reduces health risks to new and existing populations. (2) Methods: Standard academic databases were searched for papers that reported on health-related outcomes in humans following remediation and redevelopment of contaminated sites. Title/abstract screening, followed by full-text screening identified sixteen papers that met the eligibility criteria. (3) Results: Most studies were set in the United States of America and reported changes in blood lead concentrations in children, following soil remediation and, in some cases, public health campaigns to reduce exposure. Two further studies examined the impacts of remediation on soil contaminated with chromium and sediments contaminated with polychlorinated biphenyls (PCBs). (4) Conclusions: Overall, the evidence suggests that remediation via removal, capping, and replacing soil, and planting vegetation is effective at reducing concentrations of lead and chromium in blood and urine in children. There is also evidence that sediment dredging can reduce PCB concentrations in umbilical cords in infants. Study designs are relatively weak and some recommendations are provided for those wishing to examine the health impacts of remediation

Changing levels of local crime and mental health: a natural experiment using self-reported and service use data in Scotland

Background: This study contributes robust evidence on the association between mental health and local crime rates by showing how changing exposure to small area-level crime relates to self-reported and administrative data on mental health. Methods: The study sample comprised 112 251 adults aged 16–60 years, drawn from the Scottish Longitudinal Study, a 5.3% representative sample of Scottish population followed across censuses. Outcomes were individual mental health indicators: self-reported mental illness from the 2011 Census and linked administrative data on antidepressants and antipsychotics prescribed through primary care providers in the National Health Service in 2010/2012. Crime rates at data zone level (500–1000 persons) were matched to the participants’ main place of residence, as defined by general practitioner patient registration duration during 2004/2006, 2007/2009 and 2010/12. Average neighbourhood crime exposure and change in area crime were computed. Covariate-adjusted logistic regressions were conducted, stratified by moving status. Results: In addition to average crime exposure during follow-up, recent increases in crime (2007/2009–2010/2012) were associated with a higher risk of self-reported mental illness, among ‘stayers’ aged 16–30 years (OR=1.11; 95% CI 1.00 to 1.22), and among ‘movers’ aged 31–45 years (OR=1.07; 95% CI 1.01 to 1.13). Prescribed medications reinforced these findings; worsening crime rates were linked with antidepressant prescriptions among young stayers (OR=1.09; 95% CI 1.04 to 1.14) and with antipsychotic prescriptions among younger middle-aged movers (OR=1.11; 95% CI 1.01 to 1.23). Conclusion: Changing neighbourhood crime exposure is related to individual mental health, but associations differ by psychiatric conditions, age and moving status. Crime reduction and prevention, especially in communities with rising crime rates, may benefit public mental health

The impact of neighbourhood crime on mental health: a systematic review and meta-analysis

Background: Growing evidence indicates that the residential neighbourhood contributes to the complex aetiology of mental disorders. Although local crime and violence, key neighbourhood stressors, may be linked to mental health through direct and indirect pathways, studies are inconclusive. This systematic review and meta-analysis aimed to synthetize the evidence on the association between neighbourhood crime and individual-level mental health problems. Method: We searched 11 electronic databases, grey literature and reference lists to identify relevant studies published before September 14, 2020. Studies were included if they reported confounder-adjusted associations between objective or perceived area-level crime and anxiety, depression, psychosis or psychological distress/internalising symptoms in non-clinical samples. Effect measures were first converted into Fisher's z-s, pooled with three-level random-effects meta-analyses, and then transformed into Pearson's correlation coefficients. Univariate and multivariate mixed-effects models were used to explore between-study heterogeneity. Results: We identified 63 studies reporting associations between neighbourhood crime and residents’ mental health. Pooled associations were significant for depression (r = 0.04, 95% CI 0.03–0.06), psychological distress (r = 0.04, 95% CI 0.02–0.06), anxiety (r = 0.05, 95% CI 0.01–0.10), and psychosis (r = 0.04, 95% CI 0.01–0.07). Moderator analysis for depression and psychological distress identified stronger associations with perceived crime measurement and weaker in studies adjusted for area-level deprivation. Importantly, even after accounting for study characteristics, neighbourhood crime remained significantly linked to depression and psychological distress. Findings on anxiety and psychosis were limited due to low number of included studies. Conclusions: Neighbourhood crime is an important contextual predictor of mental health with implications for prevention and policy. Area-based crime interventions targeting the determinants of crime, prevention and service allocation to high crime neighbourhoods may have public mental health benefits. Future research should investigate the causal pathways between crime exposure and mental health, identify vulnerably groups and explore policy opportunities for buffering against the detrimental effect of neighbourhood stressors.Fil: Baranyi, Gergö. University of Edinburgh; Reino UnidoFil: Di Marco, Martín Hernán. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Instituto de Investigaciones "Gino Germani"; ArgentinaFil: Russ, Tom C.. University of Edinburgh; Reino UnidoFil: Dibben, Chris. University of Edinburgh; Reino UnidoFil: Pearce, Jamie. University of Edinburgh; Reino Unid

Universal, selective and indicated interventions for supporting mental health at the workplace: an umbrella review of meta-analyses

The current umbrella review aimed to assess and summarise evidence on universal, selective and indicated interventions for mental health at the workplace. This umbrella review forms one of the evidence reviews which were commissioned by the WHO to develop global guidelines on mental health at work. We conducted systematic searches in five bibliographic databases (PubMed, Embase, PsycINFO, Cochrane and Global Medicus Index) and included meta-analyses of randomised trials examining psychosocial, physical activity and lifestyle interventions delivered to all general workers (universal interventions), at-risk workers (selective interventions) and workers already experiencing symptoms of mental disorders (indicated interventions). We included outcomes from seven domains: symptoms of mental health conditions, positive mental health, quality of life, work-related outcomes, substance use, suicide-related outcomes and potential adverse effects. We identified 16 meta-analyses producing 66 pooled effect sizes of the examined interventions, mostly on symptoms of mental health conditions (n=43 pooled effect sizes) (eg, burnout, insomnia, stress) and positive mental health (n=15) (eg, well-being). Most of the evidence on universal, selective and indicated interventions was focused on psychosocial interventions, showing small to moderate effects across the various outcomes. Certainty levels according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) were low to very low in almost all of the examined outcomes. The results of existing meta-analyses are promising for the use of preventative and early treatment interventions in the workplace. However, the quality and certainty of the evidence were very modest, and further research on the effectiveness of these interventions is warranted

Mental health at work: WHO guidelines

[no abstract available

Higher air pollution exposure in early life is associated with worse health among older adults: a 72-year follow-up study from Scotland

Air pollution increases the risk of mortality and morbidity. However, limited evidence exists on the very long-term associations between early life air pollution exposure and health, as well as on potential pathways. This study explored the relationship between fine particle (PM2.5) exposure at age 3 and limiting long-term illness (LLTI) at ages 55, 65 and 75 using data from the Scottish Longitudinal Study Birth Cohort 1936, a representative administrative cohort study. We found that early life PM2.5 exposure was associated with higher odds of LLTI in mid-to-late adulthood (OR = 1.10, 95% CI: 1.06, 1.14 per 10 μg m−3 increment) among the 2085 participants, with stronger associations among those growing up in disadvantaged families. Path analyses suggested that 15–21% of the association between early life PM2.5 concentrations and LLTI at age 65 (n = 1406) was mediated through childhood cognitive ability, educational qualifications, and adult social position. Future research should capitalise on linked administrative and health data, and explore causal mechanisms between environment and specific health conditions across the life course

A longitudinal study of neighbourhood conditions and depression in ageing European adults: Do the associations vary by exposure to childhood stressors?

Emerging literature emphasises the association between neighbourhood conditions and late life depression. Childhood experiences, crucial for life course development of mental health, may modify how neighbourhood affects subsequent depression. This study assessed the longitudinal associations of access to services and neighbourhood nuisance with depression among older adults, and tested whether these associations varied by exposure to childhood stressors. Data were drawn from the cross-national Survey of Health, Ageing and Retirement in Europe, a prospective cohort study between 2004/2005 and 2015, representative for European adults over the age of 50. Individual perceptions of neighbourhood were measured at baseline; childhood stressors, defined as socioeconomic conditions, adverse experiences and health problems, were collected retrospectively. Multilevel logistic regression estimated the risk of depression (n=10,328). Access to services were negatively (OR=0.78, 95% CI 0.68–0.90) and neighbourhood nuisance positively (OR=1.36, 95% CI 1.18–1.56) associated with the probability of depression during follow-up. We found interactions between neighbourhood and childhood socioeconomic conditions, but not with adverse experiences and health problems. While older adults who grew up in better childhood socioeconomic conditions benefited more from living in a residential area with good access to services, they were at higher risk of developing depression when residing in areas with more neighbourhood nuisances. Older adults' mental health can benefit from better access to public transportation and neighbourhood amenities, while physical and social problems in the local area increase the risk of depression. Importantly, socioeconomic circumstances in early life may influence vulnerability to neighbourhood effects in older age

Balancing making a difference with making a living in the conservation sector

Goals play important roles in people's lives by focusing attention, mobilizing effort, and sustaining motivation. Understanding conservationists’ satisfaction with goal progress may provide insights into real-world environmental trends and flag risks to their well-being and motivation. We asked 2694 conservationists working globally how satisfied they were with progress towards goals important to them. We then explored how this satisfaction varied between groups. Finally, we looked at respondents' experiences associated with goal progress satisfaction. Many (94.0%) said “making a meaningful contribution to conservation” was an important goal for them, with over half being satisfied or very satisfied in this area (52.5%). However, respondents were generally dissatisfied with progress to collective conservation goals, such as stopping species loss, echoing formal assessments. Some groups were more likely to report dissatisfaction than others. For instance, those in conservation for longer tended to be less satisfied with collective goal progress (log-odds -0.21, 95% credibility interval (CI) -0.32 to -0.10), but practitioners reported greater satisfaction (log-odds 0.38, 95% CI 0.15-0.60). Likewise, those who are more optimistic in life (log-odds 0.24, 95% CI 0.17-0.32), male (log-odds 0.25, 95% CI 0.10-0.41), and working in conservation practice (log-odds 0.25, 95% CI 0.08-0.43) reported greater satisfaction with individual goal progress. Free-text responses suggested widespread dissatisfaction around livelihood goals, particularly related to job security and adequate compensation. While contributing to conservation appeared to be a source of satisfaction, slow goal progress in other areas – particularly around making a living – looked to be a source of distress and demotivation. Employers, funders, professional societies, and others should consider ways to help those in the sector make a difference whilst making a living, including by prioritizing conservationists' well-being when allocating funding. This support could include avoiding exploitative practices, fostering supportive work environments, and celebrating positive outcomes