title: Structural neighbourhood conditions, social cohesion and psychological distress in the Netherlands.
abstract: BACKGROUND
  Neighbourhood inequalities in psychological distress are well reported, but underlying mechanisms remain poorly understood. The main purposes of this study were to investigate associations between structural neighbourhood conditions and psychological distress, and to explore the potential mediating role of neighbourhood social cohesion.
  
  
  METHODS
  Cross-sectional questionnaire study on a random sample of 18,173 residents aged ≥ 16 years (response 49%) from the four largest cities in the Netherlands. Psychological distress was measured with the Kessler Psychological Distress Scale (K10). Structural environmental factors under study were neighbourhood socio-economic status (SES), neighbourhood green, urbanity and home maintenance. Neighbourhood social cohesion was measured by five statements and aggregated to the neighbourhood level by using ecometrics methodology. Multilevel linear regression analysis was used to investigate associations of neighbourhoods characteristics with psychological distress, adjusted for individual level characteristics.
  
  
  RESULTS
  High neighbourhood SES and neighbourhood social cohesion were associated with decreased psychological distress. Adjusted for individual level characteristics and neighbourhood SES, only neighbourhood social cohesion remained significantly associated with psychological distress. Neighbourhood social cohesion accounted for 38% of the differences in the association between neighbourhood SES and psychological distress.
  
  
  CONCLUSIONS
  High neighbourhood social cohesion is significantly associated with decreased psychological distress among residents of the four largest cities in the Netherlands. Reducing neighbourhood inequalities in psychological distress may require increasing social interactions among neighbourhood residents.
authors.affiliation: 1 Municipality of Rotterdam, Department Research and Business Intelligence, Rotterdam, The Netherlands 2 Erasmus Medical Center, Department of Public Health, Rotterdam, The Netherlands o.erdem@rotterdam.nl.
authors.forename: Özcan
authors.initials: Ö
authors.lastname: Erdem
authors.affiliation: 2 Erasmus Medical Center, Department of Public Health, Rotterdam, The Netherlands.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Prins
authors.affiliation: 3 Municipality of Rotterdam, Department Health Authority, Rotterdam, The Netherlands 4 University of Applied Sciences, Department of Primary Health Care, Rotterdam, The Netherlands.
authors.forename: Toon A J J
authors.initials: TA
authors.lastname: Voorham
authors.affiliation: 2 Erasmus Medical Center, Department of Public Health, Rotterdam, The Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: van Lenthe
authors.affiliation: 2 Erasmus Medical Center, Department of Public Health, Rotterdam, The Netherlands.
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D055361:Multilevel Analysis; D009426:Netherlands; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult