Características da vizinhança e participação social na ocorrência de sintomas depressivos em adultos mais velhos residentes em áreas urbanas: estudo ELSI-Urbe

Abstract

Introduction: Depression symptoms challenge the healthy aging promotion, particularly in countries with low average income where the population is aging, the urban population is growing, and urbanization processes are defined by structural inequalities. Studies have proved it is important to investigate the association of depressive symptoms; and neighborhood perception; and social participation among elders in both low- and average-income countries. It is also important to understand how gender, race, and income inequalities frame these aspects. Objective: To analyze differences in neighborhood perception based on race/color, per capita household income, and gender, and the association of depressive symptoms with neighborhood perception and social participation on Brazilian elders living in urban areas. Method: Information of 7,935 (84.3%) urban area (fifty-year-old or older) residents was gathered from ELSI-Brasil. On the first article, with 7,357 participants, differences of gender, race/color and per capita household income in neighborhood perception were explored through prevalence estimates adjusted by age and/or sex. A matrix of critical processes was created based on the literature and the results. On the second and third articles, the association of depressive symptoms (evaluated through the 8-item Center for Epidemiologic Studies–Depression Scale), the neighborhood perception (7,115 participants), and the levels of social participation (6,903 participants), were studied. Univariate and multiple analyses were performed using Poisson regression, adjusted for sociodemographic and health characteristics for the total sample and by sex. Results: The prevalence of depressive symptoms was 34.9%, 43.8% among women and 24.5% among men. Associations between the increased prevalence of depressive symptoms and problems with urban mobility, noise pollution, physical disorder, violence, insecurity feelings, lack of neighborhood pleasantness and social cohesion were observed for the total sample and among women. Except for insecurity feelings, the other associations were significant among men. Women, brown and black people with both low and average income have shown the worst neighborhood perception. Regarding social participation, a reduction in the prevalence of depressive symptoms was identified among participants who reported level 1 activities (alone, at home), 2 (in parallel with others, outside their homes), 3 (socially oriented collective), 4 (collective oriented towards a common goal), and 6 (collective oriented towards contributing to society in general). When stratified by gender, the association remained significant for women at levels 1 to 4 and for men only at level 1. Conclusion: Healthy aging promotion in Brazil requires urban interventions that address structural inequalities of gender, race/color, and income. The rebuilding of urban spaces must prioritize improvements on mobility and infrastructure in neighborhoods. It is also fundamental to strengthen social cohesion and encourage community participation by creating age-friendly urban environments. These combined actions may promote greater equity regarding the physical and social conditions in different neighborhoods, improve life quality, and contribute to a reduction in the prevalence of depressive symptoms among elders.