Risk for Depression, Neighborhood Characteristics, and Physical Activity

描述（由申请人提供）：拟定的是一项基于人群的纵向研究，旨在描述老年人体力活动水平与随后抑郁风险之间的关系。该研究还将确定老年人生活环境对这些因素的影响，并评估旨在改善步行性的主要环境干预措施的影响。身体活动和心理健康是老年人幸福的基础，在横断面研究中密切相关。有暗示性的，但有限的，来自临床研究的证据表明，活动可能对抑郁症的症状有保护作用。然而，这是否适用于一般人群还远不清楚。还有越来越多但有限的证据表明，环境因素对身体活动和抑郁水平都有重要影响。邻里特征可能在晚年生活中特别重要，因为老年人可能会在他们的居住区花费更多的时间，可能会受到物理访问等因素的影响，并且更容易受到安全威胁。综合起来，这一证据表明，老年人的身体活动、环境及其功能和心理健康之间存在复杂的相互作用。拟议的研究将探讨这些问题在一个不同的队列的3000名居民的纽约市（NYC）年龄在65岁和75岁之间的空间分层随机电话抽样招募。参与者将在招募时接受采访，并在大约12个月和36个月后的两个波中，使用经验证的工具来确定抑郁症状，身体活动水平和关键的个人水平协变量。参与者还将使用计步器客观地测量他们的活动水平。将利用调查员从一系列二级数据来源、目视评估和人口调查中开发的综合地理空间数据库，客观评估居民区的特征。在研究期间的抑郁症和体力活动水平的模式的特点，和多层次的方法来检查抑郁症的症状和体力活动水平之间的关系，以及对邻居和个人水平的决定因素的影响。最后，我们将测试环境干预对这些结果的潜在好处，通过评估一个主要项目的影响，以改善老年人的行人安全，在研究区域内的10个社区之间的研究波1和2。这项干预措施将由纽约市交通部的研究伙伴进行，并被描述为“国家历史上最大的干预措施”。我们将前瞻性地评估这一举措的影响，在2000年的干预和可比对照网站的老年居民的过抽样。结果将包括参与者的看法，行为和抑郁症的症状。这项创新研究的结果将指导未来的投资和基于证据的政策，以帮助人们随着年龄的增长保持健康和独立。

DESCRIPTION (provided by applicant): Proposed is a population-based longitudinal study to characterize the relationship between levels of physical activity and subsequent risk of depression in the elderly. The study will also determine the influence on these factors of the environment in which an older adult lives, and evaluate the impact of a major environmental intervention designed to improve walkability. Physical activity and mental health are fundamental to well-being in the elderly and are closely related in cross sectional research. There is suggestive, but limited, evidence from clinical studies that activity may be protective against symptoms of depression. However, whether this is true in the general population is far from clear. There is also mounting, but limited, evidence to suggest that environmental factors are an important influence on both levels of physical activity and depression. Neighborhood characteristics may be particularly important in later life as older adults are likely to spend more time in their neighborhood of residence, may be more affected by factors such as physical access, and more vulnerable to threats to their safety. Combined, this evidence suggests a complex interaction in older people between physical activity, the environment, and their functional and mental health. The proposed study will examine these issues in a diverse cohort of 3000 residents of New York City (NYC) aged between 65 and 75 years of age recruited by spatially stratified randomized telephone sampling. Participants will be interviewed at recruitment and at two further waves approximately 12 months and 36 months later, using validated instruments to ascertain symptoms of depression, physical activity levels and key individual level covariates. Participants will also use pedometers to objectively measure their activity levels. Neighborhood characteristics will be objectively assessed using a comprehensive geospatial database already developed by the Investigators from a range of secondary data sources, visual assessment and population survey. Patterns of depression and levels of physical activity over the study period will be characterized, and multilevel methods used to examine the relationships between symptoms of depression and physical activity levels, and the influence on both of neighborhood and individual level determinants. Finally, we will test the potential benefits of environmental intervention on these outcomes by evaluating the impact of a major program to improve pedestrian safety for older adults to be implemented in 10 neighborhoods within the study area between study waves 1 and 2. This intervention will be undertaken by study partners the NYC Department of Transportation and has been described as "the largest intervention of its kind in the nation's history". We will prospectively evaluate the impact of this initiative in an oversample of 2000 older residents of intervention and comparable control sites. Outcomes will include participant perceptions, behaviors and symptoms of depression. The findings of this innovative research will guide future investment and evidence based policies to help people remain healthy and independent as they age.