title: Cross-sectional and longitudinal associations of neighborhood cohesion and stressors with depressive symptoms in the multiethnic study of atherosclerosis.
abstract: OBJECTIVE
  This study examined associations of neighborhood social cohesion, violence, and aesthetic quality with depressive symptoms among 2,619 healthy adults aged 45-84 years enrolled in the Multiethnic Study of Atherosclerosis.
  
  
  METHODS
  Neighborhood characteristics were estimated by surveying a separate sample of area residents. Measures of aesthetic environment, social cohesion, and violence were combined into a summary score with increasing scores indicating more favorable environments. Depressive symptoms were measured using the Center for Epidemiologic Studies-Depression (CES-D) scale. Marginal maximum likelihood estimation was used to assess associations of neighborhood characteristics with CES-D score at baseline and with the odds of developing incident depression (CES-D score >/=16 or use of antidepressants) over a 4-5 year follow-up among persons with CES-D less than 16 at baseline. Models were adjusted for age, income, education, and race/ethnicity.
  
  
  RESULTS
  Lower levels of social cohesion and aesthetic quality and higher levels of violence were associated with higher mean CES-D scores in men and women (P for trend <0.01, adjusted mean difference in CES-D per 1 SD increase in summary score -1.01 [95% confidence interval = -1.85, -0.17] and -1.08 [95% confidence interval = -1.88, -0.28] in men and women, respectively). Associations of neighborhood characteristics with incident depression were in the expected direction for women but confidence intervals were wide (odds ratio of incident depression = 0.89 [0.63, 1.26]). No association was seen for men (odds ratio = 0.96 [0.74, 1.25]).
  
  
  CONCLUSIONS
  Neighborhood social cohesion, aesthetic quality, and violence are associated with the presence of depressive symptoms in residents.
authors.affiliation: Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109-2029, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Mair
authors.forename: Ana V
authors.initials: AV
authors.lastname: Diez Roux
authors.forename: Mingwu
authors.initials: M
authors.lastname: Shen
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.forename: Theresa
authors.initials: T
authors.lastname: Seeman
authors.forename: Sandra
authors.initials: S
authors.lastname: Echeverria
authors.forename: Ellen S
authors.initials: ES
authors.lastname: O'Meara
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000208:ethnology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000208:ethnology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012737:Sex Factors; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000208:ethnology; D014754:Violence / Q000208:ethnology