Characteristics of the Residential Environment and Their Association With Depression in Hong Kong

ABSTRACT: Key Points

Question

Are residential environments, specifically livable space and residential density at a building-block and neighborhood level, associated with depression?

Findings

In this cohort study involving 16 968 participants followed up over 2 waves, each IQR increment in livable area was associated with 16% lower odds of probable major depression and 7% lower odds of depressive symptoms. Each IQR increment in building-block density was associated with 11% higher odds of depressive symptoms, only in single-housing environment models.

Meaning

These findings suggest that policies to provide more residential livable space and lower residential density at the building-block scale may be associated with less depression.

Importance

With rapid urbanization, understanding the role of residential environments in the development of depression has gained importance. However, the potential associations of residential space and density with depression have been understudied.

Objective

To investigate longitudinal associations of residential livable space and density with depression.

Design, Setting, and Participants

This longitudinal cohort study used data from 2 waves of the FAMILY Cohort, a population-based cohort in the Hong Kong Special Administrative Region, China, recruited between February 28, 2009, and March 28, 2011, at baseline and followed up between August 3, 2011, and June 19, 2013, at wave 2. Data were analyzed from September 1, 2020, through August 10, 2021. A total of 16 968 participants aged 16 years or older underwent assessment using the Patient Health Questionnaire–9 (PHQ-9) and had complete data across all variables.

Exposures

Residential density was objectively assessed at 3 scales (within apartment, building block, and at neighborhood level) at baseline and follow-up.

Main Outcomes and Measures

Depressive symptoms were defined in terms of a PHQ-9 threshold greater than or equal to 5 and probable major depression with a cutoff value greater than or equal to 10. A continuous PHQ-9 score was used as a secondary outcome. Multilevel logistic regression models were used to examine associations of the residential density with probable major depression and depressive symptoms adjusted for time-varying sociodemographic and lifestyle factors, comorbidities, and other environment variables.

Results

Of the 16 968 participants with complete data, the mean (SD) age was 45.5 (16.7) years, and 9328 participants (55.0%) were women at baseline. The mean follow-up was 2.2 years (range, 1.3-3.6 years). At the household level, after full adjustments, each IQR increment in residential livable area was associated with lower odds of probable major depression (adjusted odds ratio [aOR], 0.84; 95% CI, 0.71-0.98; P = .03) and depressive symptoms (aOR, 0.93; 95% CI, 0.86-1.00; P = .04). At the building-block level, each IQR increment in block density was associated with higher odds of depressive symptoms (aOR, 1.11; 95% CI, 1.01-1.22; P = .03), but only in single-housing environment models. The results remained consistent in models with continuous PHQ-9 evaluation.

Conclusions and Relevance

This study’s findings suggest that residential livable space and block density may play a role in the development of depression. Integrated mental health and housing policies promoting mental capital in cities, such as health-optimized density at the household and building-block levels, might serve as a population approach to reduce the burden of depression. This cohort study examines the rate of depression associated with residential livable space in Hong Kong.

SUBMITTER: Sarkar C 

PROVIDER: S-EPMC8556618 | biostudies-literature |

REPOSITORIES: biostudies-literature