Relationships, social support, influence and belonging

Two studies found that increased levels of positive social relationships in the community were associated with reduced levels of depression at follow-up. Solmi et al^{Reference Solmi, Colman, Weeks, Lewis and Kirkbride41} found that low levels of neighbourhood interaction (positive relationships) and social support (including trust) reported by parents of children at 13 years of age were associated with an increased risk of depressive symptoms at 18 years of age. Children exposed to high neighbourhood collective efficacy (cooperative behaviour, shared values, close relationships and social control) experienced lower depression and anxiety symptoms at 15 years of age compared with adolescents growing up in a low collective efficacy neighbourhood.^{Reference Donnelly, McLanahan, Brooks-Gunn, Garfinkel, Wagner and Jacobsen5}

Relationships and safety

Five studies found evidence for the effects of positive relationships, social support and a lack of latent social conflict (i.e. safety) on mental health. Wu et al^{Reference Wu, Xie, Chou, Palmer, Gallaher and Johnson45} studied neighbourhood social cohesion, family capital and financial capital among 5164 adolescents. Factors of neighbourhood safety and social support (i.e. whether neighbours care about other neighbours) were associated with lower levels of depressive symptoms at 3-year follow-up. Similarly, Estrada-Martínez et al^{Reference Estrada-Martínez, Caldwell, Bauermeister and Zimmerman37} found that increased fear of violence and lower levels of trust and social support were associated with higher depressive symptoms over time. The presence of a positive role model, alongside safety, social support and positive relationships, was also associated with reduced depressive symptoms in adolescents in a longitudinal cohort study in Canada.^{Reference Abada, Hou and Ram31}

Influence and participation

Social and political participation at the community level includes taking part in locally organised activities such as community groups and sports, as well as activism to affect local and national policy issues.^{Reference Bryk and Driscoll48} Of all extracurricular or community participation for adolescents, engaging in group sports seems to be the only activity that has thus far been associated with reduced depressive symptoms. Viau et al^{Reference Viau, Denault and Poulin42} studied whether participation in cultural, sporting (individual and team) and civic activities, as well as the extent thereof (support from activity leaders, social integration), between ages 14 and 17 years was associated with reduced depressive symptoms at age 18 years in adolescents. Only in the team sports activity group was an association found: the more boys felt integrated into the community peer group (social support), the longer they engaged in activities and the fewer depressive symptoms they reported. Team sports were also available for girls, but there was a lower uptake. Potentially, team sports can be made more attractive, and alternative forms of active participation might be more beneficial for girls.^{Reference Viau, Denault and Poulin42}

Neighbourhood safety

The absence of latent social conflict comprises whether communities are safe and there is little violence.^{Reference Kawachi, Berkman, Berkman and Kawachi9} Only one study evaluated this construct separately, and found that lower levels of perceived safety at age 13 years were associated with higher depressive symptoms at age 18 years.^{Reference Solmi, Colman, Weeks, Lewis and Kirkbride41}

Violence

Young people may be exposed directly to violence in the community, as well as indirectly through parental stress from perceived social disorder.^{Reference Fowler, Tompsett, Braciszewski, Jacques-Tiura and Baltes49} Wu et al^{Reference Wu, Xie, Chou, Palmer, Gallaher and Johnson45} noted an indirect effect of violence on mental health symptoms, namely living in safety relieves parents from stressors, allowing them to spend more time with their children and focus on the child.^{Reference Wu, Xie, Chou, Palmer, Gallaher and Johnson45}

Direct exposure to violence may also be associated with the occurrence of depression, although the evidence is mixed for adolescents and young adults. On the one hand, Cerdá et al^{Reference Cerdá, Tracy, Sánchez and Galea33} found that among adolescents, violent victimisation and witnessing violence were not associated with an increase in depressive symptoms. On the other hand, self-reported victimisation based on sexual orientation or sexual minority and harassment was associated with depressive symptoms in LGBTQ adolescents and young adults.^{Reference Burton, Marshal, Chisolm, Sucato and Friedman47,Reference Hall50} Similarly, perceived racial discrimination in the neighbourhood has been associated with increased symptoms of depression in two longitudinal studies among adolescents^{Reference Basáñez, Unger, Soto, Crano and Baezconde-Garbanati32} and young adults.^{Reference Estrada-Martínez, Caldwell, Bauermeister and Zimmerman37}

The (built) environment

Included studies primarily evaluated neighbourhood racial composition as an environmental factor. There was no evidence to suggest that neighbourhood composition was associated with depressive symptoms in two longitudinal surveys.^{Reference Basáñez, Unger, Soto, Crano and Baezconde-Garbanati32,Reference Hurd, Sellers, Cogburn, Butler-Barnes and Zimmerman39} One longitudinal study did suggest that neighbourhood composition may only be affecting immigrants in contrast to non-immigrants.^{Reference Lee and Liechty40} Lee and Liechty found that, among 2678 Hispanic youth, Latin American immigrant density was associated with lower odds of depression for immigrants, but this association was not found for non-immigrant Latin American adolescents.^{Reference Lee and Liechty40} In contrast, a longitudinal study among Canadian adolescents found that visible minority youth living in areas with a high concentration of minorities had higher symptoms of depression compared with visible minority youth living in largely White neighbourhoods.^{Reference Abada, Hou and Ram31} As the evidence is mixed in this area, further research is needed to unravel drivers for increased risk of depressive symptoms.

Living in large cities did not seem to affect the development of depressive symptoms in one longitudinal study among Canadian adolescents.^{Reference Abada, Hou and Ram31} However, urbanisation may even be protective for some: a longitudinal study in the USA found that that decreases in urbanisation were associated with higher depressive symptoms for sexual minority youth.^{Reference Everett46}

To summarise, neighbourhood factors, including positive relationships and a lack of social conflict and violence, are associated with decreased depressive symptoms, and in one case, symptoms of anxiety. The environmental factors that were studied (neighbourhood composition and urbanicity) show mixed effects. It appears urbanisation could be protective for sexual minority youth, although further research is needed.

Volunteering

One potential avenue to improve neighbourhood social cohesion is increasing community activity in the form of community groups or volunteering. For instance, Ohmer^{Reference Ohmer51} found that volunteering in community groups organised through small non-profit organisations (i.e. neighbourhood beautification, crime prevention and leadership development) was associated with an increased sense of community, self-efficacy and community efficacy for people taking part in the groups.^{Reference Ohmer51} Large-scale national volunteering programmes (i.e. National Citizen Service (NCS), England) for adolescents and young adults (aged 15–17 years) have also found that community involvement and social cohesion increased compared with control groups (participants who expressed interest in taking part in a NCS intervention but did not participate). A quasi-experimental study to evaluate the effects of the NCS (6-week intervention comprising community awareness and planning and delivery of a social action project in the local community) found that local community involvement increased, as did feelings of cohesion versus control. Although the effects on mental health were not measured with a validated measure of depression or anxiety to ascertain its potential preventive effects, a self-report item of ‘% who did not feel anxious at all yesterday’ and increased personal resilience were observed among young people taking part in the NCS (n = 1608) compared with the matched control group (n = 2041) at 3- to 5-month follow-up.^{Reference Cameron, Stannard, Leckey, Hale and Di Antonio52} In the workshops, adolescents and young adults also highlighted how volunteering can help provide a sense of cohesion:

Arts, creativity and culture

Arts and culture may increase positive relationships and participation in neighbourhood activities. Generally, the more arts and cultural activities available in a community, the more participation in community cultural activities can be observed.^{Reference Jeannotte53} Using arts as a community intervention to improve adolescent and young adult mental health may be promising, although most evidence is qualitative.^{Reference Bungay and Vella-Burrows54} For example, Fanian et al^{Reference Fanian, Young, Mantla, Daniels and Chatwood55} studied creative arts projects where five workshops with five to six youth were held to explore community issues and find solutions through the arts (music and film). Initial qualitative reports suggest that the groups helped build positive relationships and empowerment to influence change. From our workshops, the adolescents and young adults felt that having community spaces that provide activity groups would improve connection and a sense of belonging. Finding creative ways to bring these arts and culture groups to the community was important:

Sport groups

Participating in organised group sports activities can be a helpful pathway to form positive networks with peers and adults.^{Reference Langbein and Bess56} Most studies evaluating sports have been conducted in a school rather than neighbourhood context. Langbein and Bess (2002) found that organised sports can help to reduce school disturbances, highlighting that is some preliminary evidence to suggest that organised sports may be effective in this setting to decrease social conflict, by creating the opportunity for repeated social interaction to help reinforce social norms and reduce the development of conflict.^{Reference Langbein and Bess56}

Online spaces

Online platforms or networks can be another avenue to foster (neighbourhood) social cohesion, especially with the COVID-19 pandemic limiting opportunities to meet face to face. Some preliminary qualitative evidence suggests that using social media sites can be helpful to facilitate community interaction and increase participation in (offline) sports activities.^{Reference Braumüller57} To build successful engagement, it has been suggested that such platforms are best created bottom-up (by the community) and rely on community members to maintain and promote the platform to enhance engagement from the community.^{Reference Renyi, Rombach, Teuteberg and Kunze58} In the workshops, adolescents and young people also suggested that online community groups on Facebook and WhatsApp could increase social support in the neighbourhood through offering social support and increased social interaction:

Green space

Increasing green space may provide more opportunities to build relationships with neighbours, in turn increasing neighbourhood social cohesion. For adolescents and young adults (aged 13–19 years), a rapid review observed that adding more natural elements and opportunities for play in outdoor spaces was associated with increased social connectedness.^{Reference Wray, Martin, Ostermeier, Medeiros, Little and Reilly59} A systematic review looking at the fear of crime in urban green spaces found that vandalised or run-down parks are associated with higher levels of crime, and that this fear of crime in poorly maintained green spaces disproportionately affects women, girls and ethnic minorities in terms of their mobility and feelings of safety.^{Reference Sreetheran and van den Bosch60} In the workshops, adolescents and young people emphasised the opportunity of parks for exposure to, and interaction with, different communities and generations:

Neighbourhood regeneration programmes

Neighbourhood regeneration programmes are frequently seen as an opportunity to improve the built environment, which can result in improved social benefits.^{Reference White, Greene, Farewell, Dunstan, Rodgers and Lyons61} Overall, evidence suggests that changes in the built environment via neighbourhood regeneration programmes can be beneficial for mental health in adults. For example, in Communities First, a neighbourhood intervention across deprived neighbourhoods in Wales, White et al^{Reference White, Greene, Farewell, Dunstan, Rodgers and Lyons61} observed a significant reduction in mental health symptoms in the regeneration intervention group (composed mostly of building new community facilities) compared with the propensity-score-matched control group. Further research on this programme suggests that the effect on mental health occurred through increased neighbourhood quality and reduced disorder,^{Reference Greene, Fone, Farewell, Rodgers, Paranjothy and Carter62} which might be valuable target points for future interventions. Alongside parks and spaces, structural elements such as transportation should also be considered for neighbourhood social cohesion. Hart and Parkhurst^{Reference Hart and Parkhurst63} observed that where streets had higher volumes of motor traffic, residents reported fewer friends and acquaintances on the street. In the workshops, it was emphasised that adolescents and young people would be keen to have a say in future developments; for example, by joining council meetings:

Psychosocial interventions

Community groups may increase neighbourhood social cohesion by creating repeated opportunities to connect and share experiences. For example, a quasi-experimental study in Rwanda studied the effects of a group intervention aiming to increase social capital (measuring cognitive social capital), support (receiving financial, instrumental or emotional support) and civic participation (joining in addressing local issues and meetings, engaging with selecting local leadership) in an adult population. It found that, among 200 adults, the intervention had a positive effect on both mental health and civic participation compared with a matched control group, but not on cognitive social capital and support over a 15-month follow-up.^{Reference Verduin, Smid, Wind and Scholte64} Moreover, community-based groups aimed at empowering and teaching life skills to young women in India were associated with reduced depressive and anxiety symptoms and a shift in community attitudes toward violence against women and girls.^{Reference Andrew, Krutikova, Smarrelli, Verma, Gautam and Verma65} Considering gender dynamics when developing community group interventions for social capital is important, as participation in groups can reinforce gender inequality with negative consequences for the mental health of women.^{Reference Osborne, Baum and Ziersch66} In the workshops, it was highlighted that a community centre to host community groups would be beneficial, as it offered different integrations between people who would not usually connect. Particularly, offering an area like a café might offer opportunities for connection between community groups:

Adverse effects

Neighbourhood social cohesion may also have adverse effects. For example, people who move into a community may be excluded if the existing social networks are highly cohesive.^{Reference Portes67} Second, high levels of social control and observation may also limit young people's exploration and mobility^{Reference Portes67} and contribute toward anxiety. Indeed, adolescents in London indicated that they prefer some level of social control (i.e. willingness of neighbours to intervene with challenges) and proximity of caregivers (indirect observation), but not direct control and observation from caregivers or parents.^{Reference Bornat and Shaw28} This means that when designing interventions, the current level of social cohesiveness of a neighbourhood should be considered, especially levels of social control and observation.