Living environment and mental health in Hong Kong : longitudinal effects, psychosocial pathways and emotional reactivity

Abstract

The living environment plays a significant role in mental health. Poor-quality living conditions have been associated with psychological distress and mental health problems. Given the growing population living in urban areas, the independent and interactive effects of various residential qualities on mental health should be examined over time. In addition, whether the living environment influences mental health directly or through psychosocial factors, and the individual variation in emotional responses to daily environmental stress remain uncertain. This work aims to study the living environment of Hong Kong with regard to its longitudinal effects on mental health, and the relevant psychosocial pathways and emotional reactivity to stress. Study 1 was a retrospective cohort study that investigated the longitudinal effects of the living environment on mental health outcomes over 3 years. A total of 1005 community-dwelling Chinese adults were recruited, of whom 962 had remained in the same residence over the 3-year interval. Participants were asked to rate their perceived residential qualities over the interval period. Their mental health outcomes at 3 years were measured, including the level of psychological distress, rate of common mental disorders (CMD) and functional impairment. After adjusting for confounders, a better perceived quality of both housing and neighbourhood conditions was associated with a lower risk of CMD, but not functional impairment, at the 3-year point. Better neighbourhood quality was found to buffer the adverse effects of poor housing quality on overall psychological distress. Study 2 was a cross-sectional cohort study of 228 individuals with CMD that evaluated the psychosocial pathways of interest. The participants’ perceived quality of the living environment, personal control over the environment and quality of social support were assessed by questionnaire. Their level of psychological distress was assessed using the Revised Clinical Interview Schedule. Results of structural equation modelling showed that a sense of personal control over the environment mediated the relationship between the living environment and psychological distress, whereas social support had no mediating effect. Study 3 was an exploratory case-control study that examined emotional reactivity to environmental stress in everyday life using an experience sampling method (ESM). Thirty subjects (15 depressed participants and 15 healthy controls) were invited to complete self-reported questionnaires via a smartphone, in response to electronic signals sent to their phones eight times a day for 7 consecutive days. When signalled, participants were required to answer items regarding their environmental stress and emotions at that moment. ESM was shown to be a valid and reliable measure for assessing environmental stress. Multilevel linear regression analyses revealed that the environmental stress levels of the depressed participants were associated with negative emotional reactivity. These participants had less interaction with the environment and a lower perception of control over the environment. This work highlights the role of the living environment in determining mental health. The findings enhance the understanding of the psychosocial pathways of these effects and the emotional reactions to environmental stress, provide insight into the ecological modelling of mental health, and facilitate urban planning that helps to build a healthy city.