Risk for Depression, Neighborhood Characteristics, and Physical Activity

描述（由申请人提供）：提出一项基于人群的纵向研究，以表征老年人身体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。来自临床研究的有启发性但有限的证据表明，运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。也有越来越多但有限的证据表明，环境因素对身体活动水平和抑郁症都有重要影响。社区特征在以后的生活中可能特别重要，因为老年人可能会在他们居住的社区中度过更多的时间，可能更容易受到诸如物理通道等因素的影响，并且更容易受到安全威胁。综合起来，这些证据表明，老年人的身体活动、环境、他们的功能和心理健康之间存在着复杂的相互作用。拟议的研究将通过空间分层随机电话抽样的方式，在3000名年龄在65至75岁之间的纽约市居民中调查这些问题。参与者将在招募时接受访谈，并在大约12个月和36个月后进行两次进一步的访谈，使用经过验证的工具确定抑郁症状、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来客观地测量他们的活动水平。将使用调查员从一系列二手数据源、视觉评估和人口调查中开发的综合地理空间数据库，客观地评估邻里特征。在研究期间，抑郁模式和身体活动水平将被表征，并使用多层次方法来检查抑郁症状和身体活动水平之间的关系，以及对社区和个人水平决定因素的影响。最后，我们将测试环境干预对这些结果的潜在益处，通过评估一项主要计划的影响，该计划将在研究区域的10个社区实施，以改善老年人的行人安全，在研究阶段1和2之间。这项干预将由研究合作伙伴纽约市交通部进行，并被描述为“美国历史上同类干预中规模最大的一次”。我们将前瞻性地评估这一举措在2000名老年居民的干预和可比对照站点的影响。结果将包括参与者的认知、行为和抑郁症状。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，以帮助人们在年老时保持健康和独立。

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. PUBLIC HEALTH RELEVANCE: The proposed study will fill major gaps in our understanding of the relationship between physical activity and depression in older adults. It will also explore how the environment in which an older person lives may influence both these outcomes. Finally, it will test the influence of environmental factors on the health of older adults by evaluating the impact on participants of a major environmental intervention that will be undertaken in the study area. Characterizing these relationships has many potential benefits, and will provide evidence on which to base the development of individual and neighborhood level interventions to foster healthy aging.