Longitudinal Associations between Physical Activity, Neighborhood Environments, and Adult Mental Health

Abstract

Mental health is a fundamental component of well-being. The increasing prevalence of depression and anxiety in the Netherlands highlights the need to better understand its determinants. Drawing on Bronfenbrenner’s ecological model, this thesis conceptualizes mental health as an outcome shaped by both intrapersonal factors, such as physical activity, and contextual factors, particularly the physical and social environments of the neighborhood. Existing research has several important limitations. Most studies rely on cross-sectional designs and therefore provide limited insight into how changes in physical activity and neighborhood environments affect mental health over time. Population heterogeneity has also received limited attention, especially regarding whether these associations differ by gender and income. In addition, although physical activity is consistently associated with mental health, the psychological mechanisms underlying this relationship, particularly the mediating role of self-esteem, remain underexplored in longitudinal studies of adults. Neighborhood characteristics are often examined separately, despite physical and social exposures tending to co-occur spatially. Finally, research has largely focused on non-movers, even though residential relocation is a common life event that can substantially alter environmental exposures. To address these gaps, this thesis includes four studies based on Dutch panel data. Chapter 2 examines how changes in physical activity are related to changes in mental health over time, with particular attention to self-esteem and gender differences. Chapter 3 presents a systematic review and meta-analysis of longitudinal studies on neighborhood environments and mental health. Chapter 4 investigates how changes in multiple co-occurring neighborhood physical and social characteristics jointly influence mental health, and whether these associations differ by gender and income. Chapter 5 focuses on residential relocation and examines how environmental changes following a move are associated with subsequent mental health outcomes. The findings show that increases in both the frequency and duration of physical activity across different intensity levels are associated with improved mental health over time. Self-esteem partly explains this relationship, but only for moderate-to-vigorous and vigorous physical activity, not for lower-intensity activity. No gender differences are observed in these mediation pathways. The review and meta-analysis show that composite neighborhood socioeconomic status is negatively associated with mental illness, whereas neighborhood urbanicity is positively associated with it. Other environmental characteristics, such as social cohesion, green space, walkability, and access to services, show no consistent associations with mental health. Empirical analyses further demonstrate that increasing neighborhood air pollution is associated with poorer mental health, whereas increased exposure to blue space is associated with better mental health. These effects are not evenly distributed: women are more adversely affected by increasing air pollution, and lower-income individuals are more vulnerable to neighborhood socioeconomic deprivation. In addition, moving to neighborhoods with lower air pollution, lower population density, and lower socioeconomic deprivation is associated with improved mental health within one year after relocation. Overall, this thesis shows that mental health is shaped not only by levels of behaviors and environments, but also by changes in these factors over time. It also identifies self-esteem as an important mechanism linking physical activity and mental health. The findings suggest that mental health should be considered more explicitly in urban planning, environmental policy, and health promotion.