Socioeconomic Inequalities in Psychological Distress among Urban Adults: The Moderating Role of Neighborhood Social Cohesion.
BACKGROUND
Various studies have reported socioeconomic inequalities in mental health among urban residents. This study aimed at investigating whether neighborhood social cohesion influences the associations between socio-economic factors and psychological distress.


METHODS
Cross-sectional questionnaire study on a random sample of 18,173 residents aged 16 years and older from 211 neighborhoods in the four largest cities in the Netherlands. Psychological distress was the dependent variable (scale range 10-50). Neighborhood social cohesion was measured by five statements and aggregated to the neighborhood level using ecometrics methodology. Multilevel linear regression analyses were used to investigate cross-level interactions, adjusted for neighborhood deprivation, between individual characteristics and social cohesion with psychological distress.


RESULTS
The mean level of psychological distress among urban residents was 17.2. Recipients of disability, social assistance or unemployment benefits reported higher psychological distress (β = 5.6, 95%CI 5.2 to 5.9) than those in paid employment. Persons with some or great financial difficulties reported higher psychological distress (β = 3.4, 95%CI 3.2 to 3.6) than those with little or no financial problems. Socio-demographic factors were also associated with psychological distress, albeit with much lower influence. Living in a neighborhood with high social cohesion instead of low social cohesion was associated with a lower psychological distress of 22% among recipients of disability, social assistance or unemployment benefits and of 13% among citizens with financial difficulties.


CONCLUSIONS
Residing in socially cohesive neighborhoods may reduce the influence of lack of paid employment and financial difficulties on psychological distress among urban adults. Urban policies aimed at improving neighborhood social cohesion may contribute to decreasing socio-economic inequalities in mental health.
Erasmus Medical Center, Department of Public Health, Rotterdam, The Netherlands.|Municipality of Rotterdam, Department Research and Business Intelligence, Rotterdam, The Netherlands.
Özcan
Ö
Erdem
Erasmus Medical Center, Department of Public Health, Rotterdam, The Netherlands.
Frank J
FJ
Van Lenthe
Erasmus Medical Center, Department of Public Health, Rotterdam, The Netherlands.
Rick G
RG
Prins
Municipality of Rotterdam, Department Health Authority, Rotterdam, The Netherlands.|University of Applied Sciences, Department of Primary Health Care, Rotterdam, The Netherlands.
Toon A J J
TA
Voorham
Erasmus Medical Center, Department of Public Health, Rotterdam, The Netherlands.
Alex
A
Burdorf
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012931:Social Environment; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult