Social cohesion as a mechanism behind neighbourhood effects on mental or physical health

Abstract Background The neighbourhood where an individual resides have become a relevant element in the study of health inequalities. While there is substantial evidence that environmental factors affect health, far less evidence of the hypothesised role of social mechanisms in the causal chain between neighbourhood characteristics and health is available. Methods Using data from the longitudinal German SOEP panel, we built measures of perceived neighbourhood characteristics and a measure of social cohesion for participant living in urban areas. Participants were included in a longitudinal cohort of 4 year observation time starting in 2004. Using linear regression models, we tested the role of social cohesion as a mediator between the neighbourhood characteristics at baseline and a health outcome (mental and physical component of the SF-12) at the end of follow-up adjusted for socio-economic variables. Results For the 4 year follow-up 10 665 participants were included. There was no evidence of a mediation effect of our measure of social cohesion between geographical or institutional characteristics and physical health. The effect of social cohesion on mental health was 2.03 ([1.44, 2.59]) and on physical health 1.78 ([1.27, 2.29]). Social cohesion mediated associations between biological (17%, 11%) or built (11%, 14%) characteristics and both physical and mental health and association between institutional characteristics and mental health (7%). Discussion We found evidence for a possible role of social cohesion in the pathway between neighbourhood characteristics and health. Only perceived characteristics have been used in this work and the respective role of objective and subjective measures of neighbourhood characteristics should be further investigated. Moreover, validated measures of social cohesion should be developed. Key messages The perception of social cohesion mediates the effect of specific perceived characteristics of neighbourhood on mental and physical health. Interventions seeking to improve social cohesion in neighbourhoods might have positive consequences on the health and wellbeing of inhabitants.