Neighbourhood effects on mental health in Hong Kong

Abstract

Characteristics of places where people live can affect their mental health. Although there is a growing body of research into the relationship between neighbourhood context and mental health, evidence is still insufficient. Furthermore, there are limited studies conducted in non-Western settings. The aim of this thesis was to investigate neighbourhood-level factors influencing mental health in Hong Kong by conducting three studies. The first study examined the geographic patterning, socioeconomic correlates, and inequalities of suicide in Hong Kong. Bayesian hierarchical models were used to estimate smoothed standardised mortality ratios for suicide (2005-2010) in small geographic units and their associations with a range of area socioeconomic characteristics. The “city centre” of Hong Kong, a generally non-deprived area, showed low suicide rates. However, there were high rates concentrating in some socioeconomically deprived, densely populated areas. Areas in the most deprived quintile had a suicide rate more than two times higher than the least deprived. Suicide rates were associated with indicators of socioeconomic deprivation and social fragmentation. In the second study, data from a population-based survey was used to investigate the association of individuals’ subjective well-being (measured by life satisfaction) individual-, household- and neighbourhood-level characteristics and any evidence for cross-level interactions. Multilevel models were used for analyses. Neighbourhood-level characteristics accounted for a small but significant proportion (around 5% or less) of the variance of life satisfaction. The area poverty rate and three neighbourhood factors (deprivation, social fragmentation, and ageing) had negative effects. There was evidence for cross-level interactions – the negative impact of neighbourhood poverty and social fragmentation appeared to be attenuated amongst households receiving social welfare allowance and living in public housing. The third study investigated the relationship between the two mental health outcomes examined in the first two studies, i.e. suicide and subjective well-being. The association between regional suicide rates and mean scores of life satisfaction and happiness was assessed using Pearson correlation. There was a very strong inverse association of suicide rate with local levels of both life satisfaction (r = -0.84) and happiness (r =-0.83). The association was markedly attenuated after controlling for area socioeconomic characteristics; this, in parallel to findings from the first two studies, demonstrated the neighbourhood effects on mental health. This thesis provides new evidence for the effects of neighbourhood socioeconomic context on suicide risk and subjective well-being in Hong Kong. The findings have implications for suicide prevention strategies and policies aimed at improving population well-being by focusing on disadvantaged and disconnected neighbourhoods.