AUTHOR=Yang Haoran , Cui Xiangfen , Dijst Martin , Tian Senlin , Chen Jie , Huang Jianhong 

TITLE=Association Between Natural/Built Campus Environment and Depression Among Chinese Undergraduates: Multiscale Evidence for the Moderating Role of Socioeconomic Factors After Controlling for Residential Self-Selection

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.844541

DOI=10.3389/fpubh.2022.844541

ISSN=2296-2565

ABSTRACT=Aim: Although evidence on the association between natural-built environments and depression is largely derived from the general population—and prone to residential self-selection bias because of the nature of cross-sectional research design—studies on this topic focusing on undergraduate students are limited despite adolescence being a critical stage for forming life-long health habits. Moreover, the relevant relationship between environments and depression could be confounded by uncertainties of geographic context. 
Methods: Based on a nationwide representative analytical sample of 22,009 Chinese undergraduates in 2018, we examined multiple-scale associations between depression and participants’ natural and built environments within campuses and in the surrounding areas at multiple scales (0.5 km, 1 km, and 2 km). After disentangling residential self-selection, we explored the moderating role of the socioeconomic attributes of undergraduates. The depression outcome was measured by the nine-item Patient Health Questionnaire (PHQ9). Indicators of exposure to green and blue space, transportation infrastructure, and food environments were objectively assessed using different circular buffers around each campus address. 
Results: Modeling results indicated that campus neighborhoods with more scattered trees (0.5 km), water (0.5 km, 1.0 km, 2.5 km), and intersections (1.0 km and 2.5 km) were protective against depression. In contrast, those living near denser distributions of outlets serving take-away sweets and fast food (0.5 km, 1.0 km, 2.5 km), fast food (0.5 km, 1.0 km, 2.5 km), and coffee products (2.5 km) were susceptible to depression. These associations were modified by undergraduates’ socioeconomic attributes (e.g., duration of exposure, Hukou status, ethnicity, and household income) and varied according to geographical scales and exposure metrics. 
Conclusions: To deliver effective environmental interventions to curb the prevalence of depression among undergraduate students, further planning policies should pay more attention to a more carefully conceived campus-based environment, especially regarding different spatial scales.