Relationship between neighborhood resources and mental health in American military Veterans

Abstract

Social determinants such as neighborhood attributes are increasingly recognized as factors shaping mental health in adults. Geographic information systems (GIS) offer an innovative approach for quantifying neighborhood attributes and studying their influence on mental health. A systematic review found that GIS-derived neighborhood attributes using Galster’s categories were significantly associated with mental health outcomes in healthy adult populations. Physical environmental neighborhood attributes were measured by GIS objectively. Studies varied in definitions of neighborhood, GIS-derived measurements of neighborhood attributes and significant effects of neighborhood attributes related to mental health outcomes. Using a modification of Andersen’s Behavioral Model of Health Service Use and GIS methodology, this study targeted a chronic disease population to explore the distribution patterns of neighborhood resources, and examine their availability, accessibility, and association with mental health outcomes. A secondary analysis using data from the Veteran Affairs Proactive Mental Health study and publicly available open data sources identified neighborhood resources and their relationships with psychological distress and depressive symptoms in 1,528 American military Veterans with mental and substance use disorders from four states (FL, MN, NY, TX). The approach aimed to analyze the association of identified neighborhood groups with mental health outcomes adjusting for individual- and neighborhood-related characteristics through: 1) Clustering based on the percentage of neighborhood resources on a 400m buffer; 2) Generalized estimating equations. Four meaningful neighborhood groups were identified. Living in an alcohol-permissive and tobacco-restrictive neighborhood was associated with worsening psychological distress. Neighborhood deprivation significantly decreased psychological distress and depressive symptoms in some areas. Identification of the person-centered neighborhood unit using buffer may be useful in developing community-based interventions to define close neighborhoods that influence mental health. Finding meaningful neighborhood groups may have policy implications to design neighborhoods by providing mental health supportive resources. Future research on how neighborhood resources affect mental health in other chronic disease populations is needed.