Effect of neighbourhood deprivation and social cohesion on mental health inequality: a multilevel population-based longitudinal study.
BACKGROUND
The common mental disorders (CMDs) of anxiety and depression are the most common form of poor mental health in the general population. Evidence from the small number of previous cohort studies on the role of neighbourhood factors in mental health is inconclusive. We tested the hypothesis that high levels of neighbourhood social cohesion modify an adverse association between change in individual mental health and neighbourhood deprivation.


METHODS
We carried out a longitudinal multilevel analysis using data from the Caerphilly Health and Social Needs Cohort Study with a 7-year follow-up (n = 4426; age range 18-74 years at baseline). Neighbourhood deprivation and neighbourhood social cohesion were assessed at baseline and change in mental health between follow-up and baseline was assessed using the five-item Mental Health Inventory (MHI-5).


RESULTS
Residence in the most deprived neighbourhoods was negatively associated with change in mental health, after adjusting for baseline individual socio-economic risk factors and transitions in life events. This negative effect was significantly reduced in high social cohesion neighbourhoods. The predicted change in mental health score was calculated for the 10th and 90th centiles of the household low-income distribution. The difference between them was -2.8 in the low social cohesion group and 1.1 in the high cohesion group. The difference between the groups was 3.9 [95% confidence interval (CI) 0.2-7.6].


CONCLUSIONS
The public health burden of poor mental health and mental health inequality could potentially be reduced by strengthening social cohesion in deprived neighbourhoods. This offers a mechanism to address the adverse effect of neighbourhood deprivation on population mental health.
Institute of Primary Care and Public Health, School of Medicine,Cardiff University,Cardiff, Wales,UK.
D
D
Fone
Centre for the Development and Evaluation of Complex Public Health Interventions, School of Medicine,Cardiff University,Cardiff, Wales,UK.
J
J
White
Institute of Primary Care and Public Health, School of Medicine,Cardiff University,Cardiff, Wales,UK.
D
D
Farewell
Institute for Translation, Innovation, Methodology and Engagement, School of Medicine,Cardiff University,Cardiff, Wales,UK.
M
M
Kelly
NHS Wales Informatics Service,Cardiff, Wales,UK.
G
G
John
College of Medicine,Swansea University,Swansea, Wales,UK.
K
K
Lloyd
School of Social Sciences,Cardiff University,Cardiff, Wales,UK.
G
G
Williams
Institute of Primary Care and Public Health, School of Medicine,Cardiff University,Cardiff, Wales,UK.
F
F
Dunstan
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D012111:Residence Characteristics; D012923:Social Class; D012931:Social Environment; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult