title: Place and health in diabetes: the neighbourhood environment and risk of depression in adults with type 2 diabetes.
abstract: BACKGROUND
  Depression is a common co-illness in people with diabetes. Evidence suggests that the neighbourhood environment impacts the risk of depression, but few studies have investigated this effect in those with diabetes. We examined the effect of a range of neighbourhood characteristics on depression in people with Type 2 diabetes.
  
  
  METHODS
  This cohort study used five waves of data from 1298 participants with Type 2 diabetes from the Diabetes Health Study (2008-2013). We assessed depression using the Patient Health Questionnaire. We measured neighbourhood deprivation using census data; density of services using geospatial data; level of greenness using satellite imagery; and perceived neighbourhood characteristics using survey data. The effect of neighbourhood factors on risk of depression was estimated using survival analysis, adjusting for sociodemographic variables. We tested effect modification by age, sex and socio-economic characteristics using interaction terms.
  
  
  RESULTS
  More physical activity facilities, cultural services and a greater level of greenness in the neighbourhood were associated with a lower risk of depression in our sample, even after adjusting for confounders. Material deprivation was associated with increased risk of depression, particularly in participants who were older or retired.
  
  
  CONCLUSIONS
  Characteristics of neighbourhoods were associated with the risk of depression in people with Type 2 diabetes and there were vulnerable subgroups within this association. Clinicians are encouraged to consider the neighbourhood environment of their patients when assessing the risk of depression. Future intervention research is need for health policy recommendations.
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec.|Douglas Mental Health University Institute, Montreal, Quebec.
authors.forename: G
authors.initials: G
authors.lastname: Gariepy
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec.
authors.forename: J S
authors.initials: JS
authors.lastname: Kaufman
authors.affiliation: Douglas Mental Health University Institute, Montreal, Quebec.|Department of Psychiatry, McGill University, Montreal, Quebec.
authors.forename: A
authors.initials: A
authors.lastname: Blair
authors.affiliation: Department of Social and Preventative Medicine, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Y
authors.initials: Y
authors.lastname: Kestens
authors.affiliation: Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec.|Douglas Mental Health University Institute, Montreal, Quebec.|Department of Psychiatry, McGill University, Montreal, Quebec.
authors.forename: N
authors.initials: N
authors.lastname: Schmitz
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011792:Quebec / Q000453:epidemiology; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D016019:Survival Analysis