Abstract
BACKGROUND: Few studies have examined the impact of the built environment configuration upon mental health. The study examines the impact of objectively assessed land use and street network configuration upon psychological distress and whether this association is moderated by the natural environment and area-level deprivation. METHODS: In a community sample of 687 older men from the Caerphilly Prospective Study, built environment morphological metrics (morphometrics) were related to differences in psychological distress as measured by the General Health Questionnaire. Cross-sectional data were taken from the most recent (5th) phase. A multi-level analysis with individuals nested within census-defined neighbourhoods was conducted. Environmental measures comprised GIS-constructed land use and street network metrics, slope variability and a satellite derived measure of greenness. RESULTS: Reduced psychological distress was associated with residing in a terraced dwelling (OR=0.48, p=0.03), higher degrees of land-use mix (OR=0.42, p=0.03 for the high tertile) and having higher local-level street-network accessibility ('movement potential') (OR=0.54, p=0.03). Hillier topography with higher slope variability was associated with increased risks of psychological distress (OR=1.38, p=0.05). CONCLUSIONS: The findings support our hypothesis that built environment configuration is independently associated with psychological distress. The study underscores the need for effective intervention in the planning and design of residential built environment to achieve the goal of health-sustaining communities.