Urban neighborhood poverty and the incidence of depression in a population-based cohort study

Abstract

Purpose: It has long been suggested that certain characteristics of the urban environment may influence population mental health. However, evidence from multilevel research addressing the relation between intraurban environments and depression has been conflicting, and prospective evidence in this regard has been limited. We assessed the relation between urban neighborhood poverty and incident depression in a population-based prospective cohort study.

Methods: Using random-digit-dial telephone surveys, we recruited 1570 adult residents of New York City (NYC) in 2002. All persons interviewed at baseline were contacted again for follow-up 6 and 18 months after the initial interview. Eighty-one percent of the sample completed at least one follow-up visit. Analysis was restricted to 1120 persons who could be geocoded to NYC neighborhoods, which were represented by NYC community districts (N=59).

Results: Among persons with no history of major depression at baseline (N=820) there were 113 incident cases of major depression during the 18 months of follow-up; cumulative incidence of depression during the study period was 14.6 per hundred persons (95% confidence interval, 10.9-18.3). In low-socioeconomic status (SES) neighborhoods, the cumulative incidence of depression was 19.4 per hundred persons (95% confidence interval, 13.5-25.3), which was greater than that in high-SES neighborhoods (10.5; 95% confidence interval, 5.9-15.2). In multivariable models adjusting for individual covariates (sociodemographics, individual SES, social support, stressors, traumas, and history of post-traumatic stress disorder), the relative odds of incident depression was 2.19 (95% confidence interval, 1.04-4.59) for participants living in low-SES compared with high-SES neighborhoods.

Conclusions: SES of neighborhood of residence is associated with incidence of depression independent of individual SES and other individual covariates. Additional work needs to characterize the pathways that may explain the observed association between living in low-SES neighborhoods and risk for depression.