Neighborhoods, psychological distress, and the quest for causality
Introduction
Metropolitan city centers, sparsely populated suburbs, remote rural towns, and other residential locations differ from each other in many aspects. Some neighborhoods have plenty of recreational opportunities, other have high crime rates; some invest in new bike lanes and urban amenities, others cannot attract money to cover pot holes; some attract young singles who soon move away, others are inhabited by families and retirees who tend to stay longer. It is reasonable to hypothesize that such differences in residential characteristics influence people’s mental health and wellbeing [1, 2, 3].
Dozens of studies have linked neighborhood characteristics with residents’ mental health problems, including depression, schizophrenia, and antisocial behaviors [4]. These associations are commonly labelled as neighborhood effects, but often the label promises too much; the majority of neighborhood studies have been cross-sectional, which makes it impossible to exclude the alternative explanation of selective residential mobility [5]. People with poorer mental health may, on average, end up living in different neighborhoods than those without mental health problems [2,6]. This could be caused directly by mental health problems (e.g. lower motivation to move, difficulties in deciding where to move) or indirectly by factors that influence both residential mobility and mental health (e.g. lower socioeconomic status constraining mobility options).
Yet it seems plausible that neighborhoods do influence mental health. The current review focuses on studies that have leveraged experimental or quasi-experimental study designs to identify potentially causal neighborhood effects on psychological distress, that is, symptoms of depression, anxiety, and unspecified somatic complaints that tend to co-occur in the general population. To cover the research literature as broadly as possible, I performed a literature search using Scopus database (scopus.com) searching titles, abstracts, and keywords for: (‘neighborhood’) AND (causal OR longitudinal OR experiment* OR quasi-experiment* OR twin) AND (depress* OR distress OR anxiety). After reviewing the titles and abstracts of 526 documents, I found 15 relevant studies and one review (not counting all the published articles from some of the individual studies) that formed the core of this review.
Section snippets
Community interventions
In the Moving to Opportunity (MTO) experiment, low-income families in five large U.S. cities were randomized to get housing vouchers that allowed them to move away from high-poverty neighborhoods [7]. This led to lower psychological distress among adult participants in the treatment versus control group [8], and some mental health benefits were observed even in the long-term follow-up 10–15 years after the experiment [9]. A further analysis showed that mental health improved only for those who
Longitudinal studies with fixed-effect regression
Longitudinal studies that measure mental health at multiple time points are an improvement to cross-sectional studies. But if they measure neighborhood characteristics only at baseline, they are still subject to similar confounding biases as cross-sectional studies. A better longitudinal study design uses repeated measurements of both neighborhoods and mental health, so that the participants can act as their own controls at different time points, adjusting for all individual characteristics
Twin studies
Twin studies can adjust for confounding that arises due to genetic and environmental influences that have made siblings more similar to each other. Three studies from the Washington State Twin Registry have examined neighborhood associations with mental health. The first [27•] reported that neighborhood deprivation was not associated with depression after the shared genetic and environmental factors of twin pairs were taken into account (0.10SD versus 0.035SD difference per 1SD difference in
Conclusions
In an ideal situation, evidence from different study designs, samples, and methods would converge to a common conclusion when weighting all the available evidence for causality [31]. In the case of neighborhood effects, the causal evidence has not yet converged to robust conclusions [5,32]. The overall evidence from different types of studies of psychological distress is not particularly strong, but some of the results from experimental and quasi-experimental study designs do suggest possible
Conflict of interest statement
Nothing declared.
References and recommended reading
Papers of particular interest, published within the period of review, have been highlighted as:
• of special interest
•• of outstanding interest
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2021, Health and PlaceCitation Excerpt :Previous research on neighbourhood effects on adolescents has mainly concentrated on socioeconomic outcomes, particularly education (for a review, see Nieuwenhuis and Hooimeijer 2016). Adolescent health outcomes, on the other hand, have been analysed less often (for a review, see Visser et al., 2021), although there is a large body of evidence on the association between the place of residence and health in the adult population (see reviews by Oakes et al., 2015; Arcaya et al., 2016; Jokela 2020). Nonetheless, it is important to understand the association, and potential causality, between health outcomes among children and place of residence when policy interventions are designed and targeted to individuals, schools, or neighbourhoods.
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