Residential road traffic noise and general mental health in youth: The role of noise annoyance, neighborhood restorative quality, physical activity, and social cohesion as potential mediators
Graphical abstract
Introduction
Approximately 30% of the population has experienced a common mental disorder at some point in their life (Steel et al., 2014). Poor mental health accounts for 13% of disability-adjusted life-years of the global burden of disease (Vigo et al., 2016), which is substantial in young age (Whiteford et al., 2013), when most disorders begin (Patel et al., 2007). In Europe, 47 million residents of major agglomerations are exposed to hazardous nighttime noise ≥ 55 dB, 21 million are highly noise-annoyed, and 14 million are severely sleep-disturbed (Houthuijs et al., 2015). Given the ubiquitous nature of both noise pollution and mental ill-health, their potential association has not escaped the spotlight of public health research. Traffic noise has been linked to self-reported mental health and psychological symptoms (Van Kamp and Davies, 2008) and might be considered detrimental in young age due to the still developing and immature coping mechanisms of children (van Kamp and Davies, 2013). However, compared to other, biomedical outcomes (Basner et al., 2014), mental health has received modest attention (Van Kamp and Davies, 2008). In their review of the pertinent literature, Stansfeld and Clark (2015) concluded that the evidence base in children was only sufficient for the association between traffic noise and annoyance, stress (increase in catecholamines), and lower cognitive performance, but it was limited regarding well-being, hyperactivity, anxiety and depression.
The effect of traffic noise on mental health is probably mediated by other factors, which have not been elucidated sufficiently (Van Kamp and Davies, 2008). Noise annoyance is a well-documented mediator (van Kamp et al., 2013), being a correlate of both traffic noise (Guski and Schuemer, 2016) and psychological symptoms in children (Dreger et al., 2015, Stansfeld and Clark, 2015). Still, its interaction with other indirect pathways linking noise to mental health has not been formally tested and remains poorly understood. Traffic noise may act as a constraint on psychological restoration and render the residential environment unappealing as a venue for outdoor activities (von Lindern et al., 2016), thereby impeding physical activity (cf. Hartig, 2008, Barton et al., 2016) and diminishing the sense of community (cf. Kuo et al., 1998). Empirical research lends some support to this hypothesis. For example, Foraster et al. (2016) found negative associations between noise annoyance and physical activity levels, and traffic noise might affect physical activity through other, still not confirmed pathways such as sleep deprivation and stress (Roswall et al., 2017). There is also evidence that traffic noise may negatively impinge on neighborhood social cohesion (e.g., reduce social contacts, willingness to help others, processing of social cues, place attachment) (Cohen and Spacapan, 1984, Honold et al., 2014, Jones et al., 1981). In turn, low social cohesion (Cramm et al., 2013, Fone et al., 2014, Erdem et al., 2015) and sedentary behavior (Biddle and Asare, 2011) may be detrimental for mental health.
In this study, we surveyed a sample of Bulgarians aged 15–25 years. To our knowledge, no research on the subject matter has been done in youth. We aimed to disentangle the pathways linking road traffic noise to general mental health, with a focus on several candidate mediators – noise annoyance, perceived restorative quality of the living environment, physical activity, and neighborhood social cohesion. To achieve this, first we assumed that the candidate mediators worked independently (as single or parallel mediators); then, we specified a more complex theoretically-indicated model taking into account the interdependencies between the mediators.
Section snippets
Study design
This secondary research is based on a cross-sectional sample collected in October – December 2016 in the city of Plovdiv. Plovdiv is the second largest city in Bulgaria, with a population of 341,625 and a territory of around 102 km2 (See Supplementary Fig. S1 for location of the study area). Originally, we collected data to examine the association between urban greenspace and quality of life in youth. The source population consisted of students aged 15–25 years, recruited from two polytechnic
Results
Table 1 summarizes participants' key characteristics. Mean age was 17.89 ± 2.27 years. Most participants were men and Bulgarian. Supplementary Fig. S4 shows the percentage of participants exposed to different Lden bands in the sample compared to official data for Plovdiv in 2012 from the Noise Observation and Information Service for Europe (http://noise.eea.europa.eu/).
Supplementary Table S1 shows the correlations between the variables used for analysis. The direction of the correlations was in
Overall findings
This is one of the few studies exploring different pathways linking road traffic noise to mental health and, to our knowledge, the first one to test restorative quality, physical activity, and social cohesion as potential mediators. We demonstrated that with the increase in Lden the mean GHQ-12 score also increased, indicating worse mental health. However, this association was indirect. More specifically, tests of the single and parallel mediation models indicated independent indirect paths
Conclusion
This study attempted to shed more light on the pathways linking road traffic noise to mental health in Bulgarian youth. Higher noise exposure was associated with worse mental health only indirectly. More specifically, tests of the single and parallel mediation models indicated independent indirect paths through noise annoyance, social cohesion, and physical activity. In addition, the SEM revealed that more noise annoyance was associated with less social cohesion, and in turn with worse mental
Conflict of interests
None.
Acknowledgements
We are grateful to the school directors, students, and their parents for making this study possible. We would like to thank Terry Hartig for the inspiration to explore different approaches to testing multiple pathways in environmental epidemiology and for his help with the translation of the Perceived Restorativeness Scale in Bulgarian. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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