title: Neighborhood income and major depressive disorder in a large Dutch population: results from the LifeLines Cohort study.
abstract: Previous studies are inconclusive on whether poor socioeconomic conditions in the neighborhood are associated with major depressive disorder. Furthermore, conceptual models that relate neighborhood conditions to depressive disorder have not been evaluated using empirical data. In this study, we investigated whether neighborhood income is associated with major depressive episodes. We evaluated three conceptual models. Conceptual model 1: The association between neighborhood income and major depressive episodes is explained by diseases, lifestyle factors, stress and social participation. Conceptual model 2: A low individual income relative to the mean income in the neighborhood is associated with major depressive episodes. Conceptual model 3: A high income of the neighborhood buffers the effect of a low individual income on major depressive disorder.
  
  
  
  We used adult baseline data from the LifeLines Cohort Study (N = 71,058) linked with data on the participants' neighborhoods from Statistics Netherlands. The current presence of a major depressive episode was assessed using the MINI neuropsychiatric interview. The association between neighborhood income and major depressive episodes was assessed using a mixed effect logistic regression model adjusted for age, sex, marital status, education and individual (equalized) income. This regression model was sequentially adjusted for lifestyle factors, chronic diseases, stress, and social participation to evaluate conceptual model 1. To evaluate conceptual models 2 and 3, an interaction term for neighborhood income*individual income was included.
  
  
  
  Multivariate regression analysis showed that a low neighborhood income is associated with major depressive episodes (OR (95 % CI): 0.82 (0.73;0.93)). Adjustment for diseases, lifestyle factors, stress, and social participation attenuated this association (ORs (95 % CI): 0.90 (0.79;1.01)). Low individual income was also associated with major depressive episodes (OR (95 % CI): 0.72 (0.68;0.76)). The interaction of individual income*neighborhood income on major depressive episodes was not significant (p = 0.173).
  
  
  
  Living in a low-income neighborhood is associated with major depressive episodes. Our results suggest that this association is partly explained by chronic diseases, lifestyle factors, stress and poor social participation, and thereby partly confirm conceptual model 1. Our results do not support conceptual model 2 and 3.
authors: Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands. b.klijs01@umcg.nl.
authors: Bart
authors: 0000-0001-7543-2287
authors: B
authors: Klijs
authors: Population Research Centre, Faculty of Spatial Sciences, University of Groningen, P.O. Box 800, 9700 AV, Groningen, The Netherlands.
authors: Eva U B
authors: EU
authors: Kibele
authors: Institute of Sociology and Social Psychology, University of Cologne, Albert-Magnus-Platz 50923, Cologne, Germany.
authors: Lea
authors: L
authors: Ellwardt
authors: Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
authors: Marij
authors: M
authors: Zuidersma
authors: Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
authors: Ronald P
authors: RP
authors: Stolk
authors: Institute of Sociology and Social Psychology, University of Cologne, Albert-Magnus-Platz 50923, Cologne, Germany.
authors: Rafael P M
authors: RP
authors: Wittek
authors: Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, 48109-2029, MI, USA.
authors: Carlos M
authors: CM
authors: Mendes de Leon
authors: Department of Epidemiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
authors: Nynke
authors: N
authors: Smidt
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000209:etiology*; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011203:Poverty / Q000523:psychology*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
keywords: Depressive disorder; Income; Psychosocial deprivation; Residence characteristics; Socioeconomic factors