Depression among middle-aged adults in Japan: The role of the built environment design

There has been considerable interest in the effect of the built environment design on depressive symptoms. However, there are still few empirical studies on this topic, and there is a dearth of evidence among middle-aged adults. The present study examined the associations of urban design attributes with depressive symptoms among a sample of middle-aged adults in Japan. Cross-sectional data from a random sample of residents (40-64 years old) in two cities in Japan were examined. Depressive symptoms were assessed using the Centre for Epidemi-ological Studies Depression (CES-D) questionnaire. Two types of perceived and objective attributes of the built environment were measured. Covariate-adjusted multivariable linear and binary logistic models were used to estimate associations between perceived and objective built environment attributes and depressive symptoms. Among women, higher perceived access to public transport and total perceived walkability was associated with a decrease in depressive symptoms. Furthermore, there was a significant association between higher safety from traffic and lower odds of having mild depressive symptoms (CES-D >= 16) in women. Among men, higher safety from crime was associated with a decrease in depressive symptoms and with lower odds of having mild depressive symptoms. Total perceived walkability was also associated with lower odds of having mild depressive symptoms in men. None of the objective built environment attributes were associated with depressive symptoms in women or men. Our findings provide empirical evidence that improving perceptions of neighbourhood walkability and, in particular, enhancing access to public transport and safety from crime and traffic are important for improving depressive symptoms among middle-aged men and women.