Early-Life Neighborhood Resources and Later-Life Mental Health

Living in areas with high walkability and park access has been linked to improved mental health, yet most evidence is based on concurrent exposure and outcome measures. This study examined whether childhood exposure to walkability and park access was associated with better mental health in later adulthood using data from the St. Louis Baby Tooth Later Life Health Study (SLBT). Participants in the SLBT were a subset of individuals who donated a tooth to the St. Louis, MO-based Baby Tooth Survey (1958–1972) and were successfully recontacted starting in 2020. Addresses provided at the time of tooth donation (ages 5–13) were geocoded. Exposures were derived by linking addresses to the 1960 U.S. Census and a digitized historical street map. Walkability was measured using three component measures: intersection density, point-of-interest density, and population density, as well as a composite, taken as the mean of these measures. Park access was measured similarly, using component measures of park density, park proportion, and park proximity. Later-life depressive and anxiety symptoms were assessed via the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder Screener-7, respectively. Probable cases of a common mental disorder (CMD) were defined as meeting clinical cut points of either screener. Generalized estimating equations were used to estimate the association between early-life neighborhood resources and later-life mental health, adjusting for key demographic and socioeconomic covariates. Effect modification by age, sex, and socioeconomic status was assessed through the inclusion of interaction terms and stratification models. Participants (n = 3457) had a mean age of 63.6 years and were 56.7% female. Among these, 251 (7.3%), including 160 (8.2%) females and 91 (6.1%) males, were identified as probable CMD cases. Neither composite measure was associated with later-life CMD; however, park density (OR = 0.86; 95% CI: 0.75–0.98) and point-of-interest density (OR = 0.81; 95% CI: 0.66–0.99) were each associated with lower odds of CMD. Higher population density in childhood was associated with a higher risk of probable later-life CMD in males only (OR = 1.64; 95% CI: 1.13–2.37). This work suggests that walkability and park access in early life may be relevant for later-life mental health. Components of walkability were differentially associated with mental health, suggesting that a single composite measure may not be fully informative for understanding the relationship between walkability and mental health.