title: The impact of the physical and urban environment on mental well-being.
abstract: OBJECTIVE
  To examine the strength of association between physical and social factors in the built environment and mental well-being, and to determine which factors are the most important.
  
  
  METHODS
  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 subscales for mental health (MH) and vitality (V). Additional household and area level data were appended for each respondent from a range of sources.
  
  
  RESULTS
  1012 questionnaires were returned (38% response rate). At the univariate level significant confounders that were associated with poorer mental well-being were being female, 85+ years, unemployed or retired, on housing benefit, council tenant, two or more children, and having requested re-housing Better mental well-being was associated with being aged 65 years to 84 years (better MH and V). Within domain analysis, adjusting for each of the confounding factors, resulted in the following factors being significantly associated with being in the lowest quartile for MH score: (i) control over the internal environment (damp), (ii) design and maintenance (not liking the look of the estate/road, (iii) noise (neighbour noise), (iv) density and escape (feeling over-crowded in the home, being dissatisfied with green spaces, dissatisfied with social and entertainment facilities) being dissatisfied with community facilities (such as libraries and community centres) was only significant for vitality, (v) fear of crime and harassment (feeling unsafe to go out in the day, feeling unsafe to go out at night, agreeing that needles and syringes left lying around are a problem) (vi) social participation (not enough events to get people together, not enough places to stop and chat). When these 12 factors were entered into a single model with the significant confounders five remained significantly associated with being in the lowest quartile for MH or V: neighbour noise MH OR 2.71 [95% CI 1.48, 4.98]; feeling over-crowded in the home MH OR 2.22 [1.42, 3.48]; being dissatisfied with access to green open spaces MH OR 1.69 [1.05, 2.74]; access to community facilities V OR 1.92, [1.24, 3.00]; feeling unsafe to go out in the day MH OR 1.64 [1.02, 2.64]; V OR 1.58 [1.00, 2.49].
  
  
  CONCLUSIONS
  This 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. This study highlights the need to intervene on both design and social features of residential areas to promote mental well-being.
authors.affiliation: Greenwich Teaching Primary Care Trust, 31-37 Greenwich Park St., London, SE109LR UK. Hilary.guite@nhs.net
authors.forename: H F
authors.initials: HF
authors.lastname: Guite
authors.forename: C
authors.initials: C
authors.lastname: Clark
authors.forename: G
authors.initials: G
authors.lastname: Ackrill
mesh_terms: D000328:Adult; D000368:Aged; D002391:Catchment Area, Health; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004779:Environment Design; D004782:Environmental Health / Q000706:statistics & numerical data*; D006801:Humans; D008131:London; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D011593:Psychology, Social; D011634:Public Health / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014504:Urban Health / Q000706:statistics & numerical data*