A3. Place quality and mental health

Neighbourhood amenity and depression

Aims and method:

Assesses the association between urban neighbourhood amenity and depression in older adults and how this is modified by mobility. This cross-sectional study used data from a random digit dial sample of community-dwelling older adults in Philadelphia, PA (age range: 65-98, n=658). Amenity diversity was assessed using the LEED-ND index for participants’ neighbourhoods. Mobility was assessed using the Life-Space Assessment (LSA). Depressive symptoms were measured using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D).

Key findings:

· Mobility significantly modified association between amenity, diversity and depression.

· After adjustment for factors such as: age, sex, education, marital status, race / ethnicity, smoking, and income, high mobility older adults living in low amenity and moderate amenity neighbourhoods were more likely to have symptoms of depression compared to people living in high neighbourhood amenity areas (OR 95%, CI: 5.75, 1.14 – 28.91, 3.93, 0.80-19.19, respectively).

· Neighbourhood amenity diversity was not associated with depression among low mobility older adults.

Reference:

Shahirah, G., LeVasseur, M. & Michael, Y. (2017) "Neighbourhood Amenities and Depressive Symptoms in Urban-Dwelling Older Adults." Journal of Urban Design and Mental Health; 2:4

http://www.urbandesignmentalhealth.com/journal2-olderadults.html

Urban quality, mood and physiological arousal

Aims and method:

Studies how environment influences psychology during a dynamically unfolding urban tourism experience. Participants carried smartphones programmed to ask them location-specific questions about their current mood and levels of physiological arousal, and to invite them to contribute words and sentences describing their impressions. Participants wore bracelets that measured their skin conductivity, a standard measure of physiological arousal.

Key findings:

· Peoples’ mood was higher in locations with high visual permeability than at those with low permeability, demonstrating the unpopularity of closed facades.

· Generally, people showed the highest levels of positive mood in green spaces

· Relatively quietness was not a consistent predictor of either mood or arousal

Reference:

Ellard, C. & Montgomery, C. (n.d.) “Testing, testing: A psychological study on city spaces and how they affect our bodies and minds” BMW Guggenheim Lab

http://www.bmwguggenheimlab.org/testing-testing-mumbai

Environmental quality, incivilities and mental health

Aims and method:

Studies possible psychosocial consequences of peoples’ subjective perceptions of their everyday street-level environment, such as the incidence of litter and graffiti. A random sample of 1637 adults living across a range of neighbourhoods throughout Scotland were interviewed.

Key findings:

· Respondents with the highest levels of perceived street-level incivilities were almost twice as likely as those who perceived the lowest levels of street-level incivilities to report frequent feelings of anxiety and depression.

· Perceived absence of environmental quality and amenities was associated with increased anxiety (2.5 times more likely) and depression (90% more likely), and a 50% increased likelihood of being a smoker.

Reference:

Ellaway, A., Morris, G., Curtice, J., Robertson, C., Allardice, G., & Robertson, R. (2009). Associations between health and different types of environmental incivility: a Scotland-wide study. Public health, 123(11), 708-713.

https://www.ncbi.nlm.nih.gov/pubmed/19883927

The urban environment and severe psychosis

Aims and method:

Explores the complex relationship between severe psychosis and the environment. This review article takes a phenomenological approach to understand how we read meaning in the urban environment and how that can stimulate psychosis.

Key findings:

· There is a cogent and growing body of evidence demonstrating that severe psychoses (including schizophrenia) are caused by the repetitive onslaught of emotionally negative, yet demanding phenomenological experience. This is not only in the social environment, but particularly by the physical environment where every element carries designed meaning.

· The Ecological Hypothesis for Schizophrenia asserts that overt psychotic symptoms can be directly triggered by constant demands of the environment, especially where these demands are emotionally negative in nature as would be evident in a poor quality built environment.

Reference:

Golembiewski, J. (2017) "Architecture, the urban environment and severe psychosis: Aetiology." Journal of Urban Design and Mental Health 2017; 2:1

http://www.urbandesignmentalhealth.com/journal2-psychosis.html

Urban versus rural impacts on mental health

Aims and method:

Investigates whether there is an association between type of living environment (urban versus rural) and anxiety, depression and psychosis. Data was obtained from the Scottish Neighbourhood Statistics database and Scottish Index of Multiple Deprivation for urban / rural classifications of 6505 data zones across Scotland.

Key findings:

· Urban / rural classification significantly predicted poorer mental health both before (β=−0.29) and after (β=−0.20) controlling for a large number of socio-economic variables

· Urban areas notably had higher rates of prescriptions for psychotropic medication for anxiety, depression and psychosis.

Reference:

McKenzie, K., Murray, A., & Booth, T. (2013). Do urban environments increase the risk of anxiety, depression and psychosis? An epidemiological study. Journal of affective disorders, 150(3), 1019-1024.

http://www.sciencedirect.com.libproxy.ucl.ac.uk/science/article/pii/S0165032713003911

Urban / rural differences in psychiatric disorders

Aims and method:

Investigates the link between urbanisation and psychopathology. A meta-analysis of urban/rural differences in prevalence was conducted on data taken from 20 population survey studies published since 1985. Pooled urban–rural odds ratios (OR) were calculated for the total prevalence of psychiatric disorders, and specifically for mood, anxiety and substance use disorders.

Key findings:

· Significant pooled urban / rural odds ratios (OR) were found for the total prevalence of psychiatric disorders, and for mood disorders and anxiety disorders.

· It was shown for psychiatric disorders (38% higher), mood disorders (39%) and anxiety disorders (21%) that the pooled urban prevalence rate was higher in urban areas compared with rural areas.

· Even when controlling for a relatively large number of confounders, the urban environment seems to be associated with the prevalence of psychopathology, an association that can’t be explained solely by population characteristics such as age, gender, marital status, social class or ethnicity.

· No significant association with urbanisation was found for substance use disorders.

Reference:

Peen, J., Schoevers, R. A., Beekman, A. T., & Dekker, J. (2010). The current status of urban‐rural differences in psychiatric disorders. Acta Psychiatrica Scandinavica, 121(2), 84-93.

https://www.ncbi.nlm.nih.gov/pubmed/19624573

Blue space preference and restorative potential

Aims and method:

Investigates the restorative effect of aquatic environments or ‘blue space’. A set of 120 photographs of natural and built scenes were collated, half of which contained ‘aquatic’ elements. Proportions of aquatic, green and built environments in each scene were standardised. Preferences (attractiveness, willingness to visit and willingness to pay for a hotel room with the view), affect and perceived restorativeness ratings were assessed.

Key findings:

· Both natural and built scenes containing water were associated with higher preferences, greater positive affect and higher perceived restorativeness (relief from stress) than those without water. Effect sizes were consistently large.

· Intriguingly, images of built environments containing water were rated just as positively as natural green space.

Reference:

White, M., Smith, A., Humphryes, K., Pahl, S., Snelling, D., & Depledge, M. (2010). Blue space: The importance of water for preference, affect, and restorativeness ratings of natural and built scenes. Journal of Environmental Psychology, 30(4), 482-493.

http://www.sciencedirect.com.libproxy.ucl.ac.uk/science/article/pii/S0272494410000496

Perceptions of place and mental health

Aims and method:

Investigates sense of place among three neighbourhood groups in Hamilton, Ontario representing areas of low, mixed and high socio-economic status (SES). It analyses data from a 16-point sense of place scale derived from the Hamilton Household Quality of Life Survey carried out in 2010–2011 among 1,002 respondents.

Key findings:

· The research found a strong association existed between sense of place and self-perceived mental health

· Sense of place is perceived to be significantly stronger amongst retired people who own spacious houses and those who have lived in a neighbourhood for a longer time

Reference:

Williams, A., & Kitchen, P. (2012). Sense of place and health in Hamilton, Ontario: A case study. Social indicators research, 1-20.

https://link.springer.com/article/10.1007%2Fs11205-012-0065-1?LI=true

The physical environment and mental well-being

Aims and method:

Examined the strength of association between physical and social factors in the built environment and mental well-being to determine which factors are the most important. A postal survey based on a theoretical model of domains that might link the physical and urban environment with mental well-being was sent to 2696 adults aged 18 years or over, in four areas of Greenwich, London. Mental health was measured using the SF36 sub-scales for mental health and vitality. Additional household and area level data was appended for each respondent from a range of sources in relation to the 1012 questionnaires returned. A range of confounders were controlled for.

Key findings:

· The study confirms an association between the physical environment and mental well-being across a range of domains.

· The most important factors that operate independently are neighbour noise, sense of over-crowding in the home and escape facilities such as green spaces and community facilities, and fear of crime.

· The study highlighted the need to intervene on both design and social features of residential areas in order to promote mental well-being.

Reference:

Guite, H., Clark, C., & Ackrill, G. (2012). The impact of the physical and urban environment on mental well-being. Public Health, 120, 1117-1126.

http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.473.926&rep=rep1&type=pdf

The physical environment and mental well-being

Happiness and the built environment

Aims and method:

Examines the impact of built environment on subjective well-being (a positive evaluation of one’s own life, or what is sometimes referred to at happiness). Based on a quantitative analysis of a survey of 562 households in Sydney, Australia, the relative influence of objective and perceived built environment variables were analysed against multiple elements of subjective well-being

Key findings:

· Only the perceived evaluations of built environment characteristics were associated with happiness

· Those who perceive their neighbourhood to be more walkable, aesthetically pleasing and hosting a well-connected community were more likely to say they felt happy

· Those who are satisfied with life live in objectively measured walkable neighbourhoods

Reference:

Kent, J., Ma, L. & Malley, C. (2017) The objective and perceived built environment: What matters for happiness?, Cities & Health 1(1): 59-71

https://dpi.org/10.1080/23748834.2017.1371456