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A cohort study examining factors associated with improvement in mental health symptoms among residents of a low-income neighborhood facing multiple axes of marginalization
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DOI：10.1186/s12889-026-28803-1.png)
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Abstract
En 中文
Structurally marginalized populations living with poverty in the urban core of large cities are disproportionately affected by mental health problems. We undertook an analysis to determine what factors are associated with improvements in mental health symptoms over time among clients of a primary care clinic in the Downtown Eastside of Vancouver, Canada. Beginning in June 2021, we enrolled clients of a low-barrier integrated primary care clinic, and administered surveys every six months until December 2023. Symptoms for depression and anxiety were measured using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and Generalized Anxiety Disorder-7 (GAD-7) scales. We used logistic regression with Generalized Estimating Equations to examine associations between sociodemographic and structural factors, substance use and clinical factors and improvements in mental health symptoms. We included 455 participants, with complete GAD-7 and CESD-10 assessments at baseline. Of these, 67.2% identified as men, 30.9% as women, and 1.7% as other gender identities. The median age was 46 years (IQR: 38–54) and 23.6% were currently homeless and 61.4% had a past history of homelessness. At baseline, 69.0% had CESD-10 scores ≥10 and 44.8% had GAD-7 scores ≥10. Of participants with at least one visit with a CESD-10 or GAD-7 score ≥10, 43.3 of those with high CESD-10 scores and 54.5% of those with high GAD-7 scores had at least one visit where their score was subsequently <10. Depression score improvement was less likely among participants with food insecurity (adjusted odds ratio [aOR]=0.54; 95% CI 0.37-0.78), higher loneliness scores (aOR =0.77; 95% CI 0.65-0.92), and self-reported depression diagnosis (aOR=0.40; 95% CI 0.19-0.85), while higher odds were observed among Indigenous participants (aOR=1.36; 95% CI 1.02-1.82). Anxiety improvement was less likely among women (aOR=0.71; 95% CI 0.53-0.97), participants reporting recent injection drug use (aOR=0.61; 95% CI 0.43-0.84), or food insecurity (aOR=0.50; 95% CI 0.31-0.77) and those who ranked mental health as a top health priority (aOR=0.41; 95% CI 0.25-0.67). A substantial proportion of clients demonstrated improvements in depression and anxiety symptoms over time. However, persistent barriers including food insecurity, substance use, and loneliness underscore the need for structural interventions.
Keywords:
Mental health
Depression
Anxiety
Food insecurity
Homelessness
Substance use
Structural vulnerability
Low-barrier care
Trauma-informed care
Journal
IF:
3.6
Papers:
3.2W
Citations:
8.5W
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Cited Papers