Built Environment and Its Association with Depression among Older Adults: A Systematic Review

Background: There is an increasing global quest to understand the influence of built environment (BE) on the mental health of people, particularly in later life. Older adults may be more susceptible to environmental factors than other adults for several reasons. Objective: The study aims to provide an overview and synthesis of the scientific literature on the relationships between built environment (BE) and depression among older people and examine possible rural-urban differences in the association. Methods: We conducted a systematic search for articles published in English from 2000-2018 in three electronic databases – PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo. We used the Population, Exposure, Comparator, and Outcomes (PECO) framework to guide the search keywords’ development and inclusion and exclusion criteria. Studies examining associations between built environment attributes and depression were only included if they were original, peer-reviewed, reported at least one objectively measured built environment attribute, any type of depression as an outcome of interest, and the sample included people aged 50 or older. Results: Of 617 citations identified, 13 met our inclusion criteria. BE attributes assessed by studies varied; however, all studies reported a relationship between depression and at least one BE attribute. Four of six papers reported a protective association between green spaces and depression, while other BE attributes did not demonstrate a consistent association with depression. Conclusion: Adverse BE is related to depressive symptoms and should be considered in interventions targeted at preventing depression among older adults who are particularly vulnerable. Future studies focused on the relationship between the urban and rural built environment and depression among older adults are needed.