Chapter 6: Urban built environment configuration and psychological distress in later life: cross-sectional results from the Caerphilly Prospective Study (CaPS)
Psychological disorders account for substantial proportions of the burden of disease worldwide. Approximately 14 per cent of the global disease burden has been attributed to neuropsychiatric disorders, mostly depression, alcohol and substance abuse and psychoses, accounting for 28 per cent of all disability-adjusted life-years (Murray and Lopez, 1996; Prince et al., 2007). The World Health Organization (WHO) identified depression as the cause of the greatest proportion of the non-fatal health burden, contributing to almost 12 per cent of total years lived with disability (‹stün et al., 2004). An estimate puts the total cost of adult depression in England at over £9 billion, with £370 million accrued towards direct treatment costs to the NHS (C.M. Thomas and Morris, 2003). The impact of psychological disorder is all the more significant in the case of older adults, for whom cognitive functioning forms the primary determinant of functional capacity and quality of life (Lebowitz et al., 1997). In recent years, several studies have highlighted the associations between psychological disorders and contextual urban environment characteristics. In addition to the impact of socio-economic inequality and residential stability of urban neighbourhoods (Faris and Dunham, 1939; W.J. Wilson, 1991; Kubzansky et al., 2005; Propper et al., 2005; Fone and Dunstan, 2006; Subramanian et al., 2006; Aneshensel et al., 2007; Wight et al., 2009) upon mental health, myriad built environmental factors have been implicated.
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