Title: Discovering which modifiable characteristics of the built-environment support good adolescent mental health and wellbeing
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Aim I will examine associations between aspects of the built-environment (BE) and adolescent (aged 10- 19 years old) mental health to discover the most modifiable salutogenic aspects of the BE to inform Welsh local authority and government planners and work towards evaluations of interventions. Background Mental ill-health and poor wellbeing is a global public health crisis. Adolescents are a vulnerable demographic with many adolescents who suffer mental ill-health going on to have poor mental health in adulthood. The BE has an impact on mental health but there is a lack of evidence for which aspects of the BE are beneficial and those that are detrimental to adolescent mental health. Questions to be addressed I will evaluate which aspects of the BE impact on adolescent mental health through a number of research questions: Which characteristics of the BE are associated with adolescent common mental health disorders (CMD), such as anxiety and depression, and wellbeing? Are associations between the BE and health mediated by physical activity, house-moves and socioeconomic status? How do relationships between the BE and adolescent CMDs and wellbeing vary by geographical location, including rurality, and socio-economic status? Plan of investigation This quantitative longitudinal record linkage study will use advanced Geographical Information Systems (GIS) modelling techniques and existing electronic health records (EHRs) to evaluate the impact of the BE on adolescent mental health. Using routinely collected administrative datasets (e.g. Local Government audits), mapping agency data and Earth Observation data, I will create individually- tailored measures for specific BE features for adolescents (e.g. access to parks, alcohol outlets, sports facilities, pollution). I will link these measures with anonymised heath, demographic and survey data in secure data linkage safe havens in Wales (Secure Anonymised Information Linkage Databank through the Adolescent Data Platform gateway) and Toronto (Institute for Clinical Evaluative Sciences). I will investigate whether key BE characteristics have an impact on the mental health of adolescents living in Wales and Toronto (Canada). Harmonised and contextually modified BE measures will be linked with health data in Wales and Toronto to provide evidence of where generalisations are appropriate and where tailored policies or interventions should be implemented. Summary of benefits This project will contribute to guideline and planning recommendations for the design of environments that support good mental health and wellbeing in adolescents in Wales, by improving our understanding of specific BE features that have beneficial or detrimental impacts on adolescent mental health. Modifying the BE provides the opportunity to bring about population-level change for a healthier Wales (Future Generations Act) by providing equal access to health promoting elements of the BE. In turn, this will contribute to reducing health inequalities for a more equal Wales.

Lay abstract: The project aims to improve the mental health and wellbeing for adolescents (aged 10-19 years old) in Wales by deepening our understanding of the impact of where we live on mental health and wellbeing. I will explore how relationships vary by urban/rural regions, sex, age, ethnicity and socioeconomic status. The study intends to verify my results for Wales by repeating the analysis for adolescents living in Toronto (Canada). The project will answer research questions including: -Which features of our local neighbourhoods affect adolescent mental health such as anxiety and depression, and wellbeing? -Are the relationships between the features in our neighbourhoods and health influenced by physical activity, individuals moving house and individuals living in poorer areas of Wales? -Are the relationships between where we live and adolescent mental health and wellbeing different between: urban and rural areas; and different countries? In Wales, 1 in 10 children between the ages of 5 and 16 has a mental health problem and 7% of NHS Wales expenditure is spent on adolescent mental ill health (2017-2018). There is growing evidence to support which aspects of the neighbourhoods in which we live support or are detrimental for mental health in adults but there is a lack of evidence for adolescents. Making changes to our neighbourhoods to be supportive of good mental health (such as places to be physically active or quiet tranquil areas which promote mental wellbeing) has the potential to benefit large numbers of people and to see population-level improvements in adolescent mental health. This project focuses on mental health and adolescents including those living in richer and poorer areas and those who live in urban and rural areas in Wales; priority areas defined in the Healthier Wales.

Research activity codes: 2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT
Health categories: MENTAL HEALTH