Yung-Chia Hsueh, UCL Division of Psychiatry and Dr Alexandra Pitman, UCL Division of Psychiatry; Camden and Islington NHS Foundation Trust summarise findings from their systematic review which aimed to bring together the research literature describing the effectiveness, acceptability and potential harms of community interventions that target place-based factors to address loneliness and mental health. 

Humans are social animals

Humans are social animals. We function better when we connect with others. However, 33% of the 55,000 people who participated in the 2018 BBC Loneliness Experiment reported feeling lonely “often” or “very often”. We now know that loneliness is a critical public health issue. Evidence shows that loneliness is associated with poor physical health, sleep problems, low satisfaction with life, mental health problems (such as depression and anxiety), and suicide.

One potential approach to addressing loneliness is by improving the environments in which we live, work and take time off. We know that features of the local environment (such as access to green space) can influence mental health but few studies have investigated whether this also impacts on loneliness, and this is an important gap in our knowledge. Local authorities and local communities need to know whether investment in the physical layout of local areas might improve opportunities for social connectedness and, in turn, mental health.

Background to the review

Our systematic review aimed to bring together the research literature describing the effectiveness, acceptability and potential harms of community interventions that target place-based factors to address loneliness and mental health. By place-based factors we mean characteristics of the local built environment (e.g. access to green spaces, buildings, and parks; street network connectivity; transport connectivity with the wider area) and related socio-spatial factors (e.g., wealth of an area, social cohesion, ethnic or age composition, and perceptions of neighbourhood safety). We were interested in summarizing evidence from different types of studies: trials assessing whether these interventions were effective at improving loneliness and mental health (effectiveness), survey or interview studies assessing whether the people who received these interventions felt that they were helpful (acceptability), and any studies identifying drawbacks of place-based interventions (potential harms).  The intention was that this review would guide future research and policymaking, to help create socially connected and healthy neighbourhoods.

Methods

We searched three research study databases for English language studies evaluating place-based approaches at the community level. We included papers that evaluated the impact of place-based approaches on both loneliness and mental health, whether in a sample of people in the general population or in a sample of people with mental health problems. We included studies that used quantitative approaches (count data) or qualitative approaches (gathering subjective views from surveys or interviews) to gain a picture of the effectiveness, acceptability, and potential harms of those interventions.

Results

Our review found seven studies describing the benefits or potential harms of place-based factors. We grouped them into three categories: provision of community facilities (3 studies), (ii) active engagement in local green spaces (3 studies) and (iii) housing regeneration (one study).  None of the studies we found were trials, so we could not conclude anything about their relative effectiveness.

The category of provision of community facilities included studies evaluating community activities centred around park equipment for older adults, community canteens for older adults, and community clubhouses for people with mental health problems. The quantitative evidence showed that older adults in Australia and China using community park equipment or community canteens were better connected socially and had better mental health. better social connectedness and mental health. The qualitative evidence showed that adults with mental health problems in the US found community clubhouses to be beneficial in improving their social connectedness and mental health.

The category of active engagement in local green spaces included studies that evaluated community gardening projects and a school-based participatory gardening project. The quantitative evidence showed that Bhutanese refugees taking part in a community gardening project in the US reported a higher level of social support than those not involved, but were not different in terms of their mental health. Qualitative evidence showed that those taking part in the refugee gardening project perceived improvements in their social connectedness, mental health, physical health, and nutrition. Qualitative evidence also showed that people with mental health problems participating in a socially inclusive community gardening project in Australia perceived multiple advantages in social connection and wellbeing. Although the anxiety created by the responsibility of running a market stall was identified by some participants as a potential drawback, this seemed to be offset by the social connections created through this component of the project. In a study of British schoolchildren taking part in a school-based participatory gardening project, although there was no quantitative evidence of improvements in mental health or social connectedness, the qualitative evidence suggested that they perceived group-based horticulture activities as beneficial to their emotional wellbeing and social connectedness.

In the category of housing regeneration, a quantitative study evaluated an urban renewal program in an area of Sydney, Australia, involving internal and external improvements to housing, and the introduction of social interventions such as community engagement activities, learning and employment initiatives, and provision of a community meeting place. However, this found no clear evidence of an improvement in the mental health or social connectedness of residents.

Overall, the studies we identified in our systematic search presented evidence to suggest some positive effects of six place-based interventions in improving mental health and social connectedness, with minimal potential harms. However, because we found no trials, we did not find any evidence demonstrating their effectiveness.  The low number of studies we identified overall indicated a clear need for more research to be conducted investigating the effectiveness, acceptability and potential harms of place-based interventions that address loneliness and mental health in local communities.

Strengths and limitations

Our review was the first to synthesize all studies on this topic, and involved a team of collaborators from diverse backgrounds, including psychiatry, psychology, and architecture. We combined quantitative and qualitative findings to provide a broader understanding of the impact of interventions on participants’ mental health and connectedness, and how they felt about taking part.  However, because we limited our search to studies published in English or Chinese, we may have missed some relevant studies published in other languages. Our review included a low number of studies and these had small sample sizes, with a need for larger studies using rigorous methods.

Importance of these findings

These findings are relevant to anyone interested in the potential for changing the physical features of local communities to improve social connectedness and mental health. This includes local and national policymakers, urban and rural planners, housing organisations, and local communities, who can read about the potential for the limited range of interventions summarized. The review also helps academics, clinicians and practitioners map the current state of the literature, identifying how few interventions have been evaluated to date, and where there is further work to do. To help policymakers and communities make decisions about what they can modify in their local neighbourhoods, we need more evaluations of place-based interventions to assess their impact on loneliness and mental health.

Original study

Hsueh, Y.-C.; Batchelor, R.; Liebmann, M.; Dhanani, A.; Vaughan, L.; Fett, A.-K.; Mann, F.; Pitman, A. A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems. Int. J. Environ. Res. Public Health 2022, 19, 4766. https://doi.org/10.3390/ijerph19084766