Urban environment perceptions and mental well-being in Belgian older adults: differences across neighborhood income levels

Abstract In 2021, ~14% of older adults experienced mental health disorders within the past year. Socio-ecological models highlight the importance of neighborhood characteristics in shaping mental health, particularly for older adults who are often more dependent on their surrounding environment due to diminished physical abilities. Health inequities at the neighborhood level are well-documented, with living in low-income neighborhoods often associated with poorer well-being. However, socioeconomic disparities in access to mental health-promoting environmental characteristics among European older adults remain underexplored. This cross-sectional study investigated differences across neighborhood income levels in (i) the perceived absence of health-promoting neighborhood characteristics, (ii) the perceived importance of these characteristics for mental well-being, and (iii) areas for improvement (=characteristics perceived as important for mental well-being yet absent). A total of 221 older adults (≥65 years) from low-, medium-, and high-income neighborhoods in Ghent (Belgium) were interviewed using a structured questionnaire. Data were analyzed using Generalized Estimating Equations. Key findings revealed several health-promoting characteristics perceived as absent, including clean, litter-free spaces, a feature also perceived as important for mental well-being. Identified areas for improvement included litter management, enhancing pedestrian and bike-friendly infrastructure, traffic control, improving availability of services, and addressing challenges related to youth engaging in anti-social behavior and drug-related activity. Results highlighted significant disparities: areas for improvement were particularly prevalent in low-income neighborhoods. By identifying these key areas for improvement, particularly in low-income neighborhoods, this study provides actionable insights to guide targeted interventions aimed at promoting mental well-being and fostering more equitable urban environments.