Mental Health in context : Impact of social structures and the built environment on mental wellbeing and mental distress

Introduction: Not only individual factors but also factors of the social and built environment influence mental distress and ill-health and mental wellbeing. This dissertation aimed to gain further insight into the relationship between individually attributed factors of the social and built environment and mental distress and mental wellbeing. The first objective was to investigate prevalences and variations in mental health by characteristics at the individual level. The second objective was to assess the relationship between social structures at the macro level (here the focused factor was on welfare regimes) and mental health. The third objective was to investigate the relationship between factors of the built environment at the meso level (here the focused factor was environmental noise) and mental health. Methods: The three objectives were addressed by four conceptually independent but topic wise interrelated studies: i) material, psychosocial and sociodemographic determinants of mental wellbeing in Europe, ii) socioeconomic determinants of mental distress and mental wellbeing in school children iii) association between gender, welfare regimes and mental wellbeing, and iv) noise and mental distress in school-aged children. Data from the third wave of the European Quality of Life Survey (2011-2012) and the Health Monitoring Units in Bavaria served as the basis for these studies. Odds ratios were calculated using multilevel and multivariate logistic regression analyses. Poisson regression analyses were used to calculate relative risks for the incidences. Results: In adults material, psychosocial and sociodemographic factors were independently associated with low levels of mental wellbeing. In children, the analyses showed that several indicators of familiesa social disadvantage were associated with mental distress, in contrast to mental wellbeing, where only a few factors were associated. At the macro level prevalence of good mental wellbeing was in most instances higher among men compared to women at welfare regime level, with the exception of the Former Soviet Union welfare regime, where women report slightly higher prevalence of good mental wellbeing. Gender inequalities in good mental wellbeing were identified independent of further individual sociodemographic variables and independent of the welfare regimes that people lived in. People in the Former Soviet Union and the Central and Eastern European Countries welfare regimes showed statistically significantly lower chances to report good mental wellbeing compared to the Scandinavian welfare regime. Gender inequalities in good mental wellbeing were not modified by welfare regimes. At the individual level of the built environment, exposure to road traffic noise at day or night was the main risk factor for incident mental health problems in children. Exposure to noise by neighbours day and night also appeared to be a risk factor for some subcategories of the strength and difficulties questionnaire. Both noise from construction work and aircraft noise during the day were not associated with incident mental health problems. Discussion: Findings of this dissertation highlight an association between individual factors, aspects of the social and built environment and mental wellbeing and mental distress. The study of mental wellbeing is relatively young, therefore, especially in this field further studies are needed to confirm and expand the findings of this dissertation. To plan effective prevention and health promotion interventions a thorough understanding of the underlying mechanisms and pathways is needed. Further studies are warranted to gain knowledge on the impact of (further aspects of) the social and built environment on mental wellbeing and mental distress in adults and in children to identify underlying mechanisms and to identify vulnerable groups for targeted preventions.