Social determinants of depression among mid-to-older aged Australians:A prospective study of the effects of neighbourhood disadvantage and crime

BACKGROUND: Few studies examining social determinants of depression have incorporated area level objectively measured crime combined with self-report measures of perceived crime. How these factors may interrelate with neighbourhood disadvantage is not well understood, particularly in Australia, where mental health disorders are of major concern. This study examined relationships between area-level objective crime, self-reported perceptions of crime, neighbourhood disadvantage and depression, and potential mechanisms by which these variables indirectly lead to depression. METHODS: This study used data from the HABITAT Project, a representative longitudinal study of persons aged 40–65 years residing in 200 neighbourhoods in Brisbane, Australia, during 2007–2016. A prospective sample of residentially stable persons who reported depression at two years (n =3120) and five years (n=2249) post-follow-up was developed. Area level objective crimes were categorised as either crimes against the person, social incivilities or unlawful entry. Logistic regression was used to establish relationships with depression, followed by a decomposition analysis to establish potential mechanisms. RESULTS: Neighbourhoods in the highest quartile of crimes against the person had an increased risk of individuals reporting depression at all periods of follow-up. Associations were also found between unlawful entry and depression. Decomposition analysis indicated a positive and significant total effect of crime against the person on depression for all periods of follow-up, while an indirect effect of perceived crime was found to partially explain this relationship at 2-years after baseline (prop. Mediated = 46.5%), and at either or both periods of follow-up (prop. Mediated = 53.7%), but not at 5-years follow-up. DISCUSSION: Neighbourhoods with the highest levels of crime against the person may influence depression over time through a pathway of perceived crime. Perceived crime, particularly in areas of high crime against the person should be considered as part of a multi-faceted strategy aimed at improving population mental health

Is Walk Score associated with hospital admissions from chronic diseases? Evidence from a cross-sectional study in a high socioeconomic status Australian city-state

Objectives: To explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for hospital admissions from NCDs. Design: A cross-sectional analysis of public hospital episode data (2007–2013). Setting: Hospitalisations from the ACT, Australia at very small geographic areas. Participants: Secondary data on 75 290 unique hospital episodes representing 39 851 patients who were admitted to ACT hospitals from 2007 to 2013. No restrictions on age, sex or ethnicity. Main exposure measures: Geographic Information System derived or compatible measures of general practitioner access, neighbourhood socioeconomic status, alcohol access, exposure to traffic and Walk Score walkability. Main outcome measures: Hospitalisations of circulatory diseases, specific endocrine, nutritional and metabolic diseases, respiratory diseases and specific cancers. Results: Geographic clusters with significant high and low risks of NCDs were found that displayed an overall geographic pattern of high risk in the outlying suburbs of the territory. Significant relationships between neighbourhood walkability as measured by Walk Score and the likelihood of hospitalisation with a primary diagnosis of myocardial infarction (heart attack) were found. A possible relationship was also found with the likelihood of being hospitalised with 4 major lifestylerelated cancers. Conclusions: Our research augments the growing literature underscoring the relationships between the built environment and health outcomes. In addition, it supports the importance of walkable neighbourhoods, as measured by Walk Score, for improved health.Full Tex

The Built Environment and Social Capital : A Systematic Review

A growing literature has indicated a relationship between social capital and certain aspects of the built environment with contributions from various disciplines, including environmental psychology, urban design, and health geography. In this systematic review and research synthesis, we summarize the literature in this domain using existing sociological and design frameworks to ascertain the effect of specific built environment domains on social capital. Our review shows that there is a significant relationship between social capital and the built environment, specifically between social cohesion and access to destinations/walkability. Positive relationships exist between social capital, design, and diversity, whereas the effect of population density on social capital is negative and unclear. We find significant methodological limitations and gaps in the published literature, including the absence of longitudinal studies and the use of a plethora of social capital and built environment measures. </jats:p

Neighborhood walkability and hospital treatment costs: A first assessment

Health system expenditure is a global concern, with hospital cost a major component. Built environment has been found to affect physical activity and health outcomes. The purpose of the study was a first assessment of the relationship between neighborhood walkability and hospital treatment costs. For 88 neighborhoods in the Australian Capital Territory (ACT), 2011-2013, a total of 30,690 public hospital admissions for the treatment of four diagnostic groups (cancers, endocrine, nutritional and metabolic diseases, circulatory diseases and respiratory diseases) were extracted from the ACT admitted patient care database and analyzed in relation to the Walk Score® index as a measure of walkability. Hospital cost was calculated according to the cost weight of the diagnosis related group assigned to each admission. Linear regressions were used to analyze the associations of walkability with hospital cost per person, admissions per person and cost per admission at the neighborhood level. An inverse association with neighborhood walkability was found for cost per person and admissions per person, but not cost per admission. After adjusting for age, sex and socioeconomic status, a 20-unit increase in walkability was associated with 12.1% (95% CI: 7.1-17.0%) lower cost and 12.5% (8.1-17.0%) fewer admissions. These associations did not vary by neighborhood socioeconomic status. This exploratory analysis suggests the potential for improved population health and reduced hospital cost with greater neighborhood walkability. Further research should replicate the analysis with data from other urban settings, and focus on the behavioral mechanisms underlying the inverse walkability-hospital cost association

Sense of Community and Its Association With the Neighborhood Built Environment

We investigated the influence of neighborhood built form on sense of community in Perth, Western Australia. It was hypothesized that sense of community would be stronger in individuals living in pedestrian-friendly neighborhoods. Multivariate linear regression models explored associations between walking and sense of community, with progressive adjustment for objective and perceived neighborhood characteristics. Sense of community was positively associated with walking for transport and positive perceptions of neighborhood quality, and negatively associated with residential density. The findings highlight the influence of local area perceptions on sense of community that appeared to be more important than objective environment characteristics. However, the latter may influence perceptions, and this requires investigation

Health Pod

General Practitioners manage their local population health as well as their individual patients. Both rely on quality health and clinical data to optimise care. For example BMI, risk of diabetes or heart disease, and lifestyle behaviours are important determinants of health. Evidence suggests such data is not routinely collected in many GP practices. The aims of this study are to test a self-assessment electronic waiting room kiosk, the Patient Empowerment Pod, as a mechanism for improving data collection and generate a ‘report card’ to help empower patients to take action on health issues identified