Further research requires a more systematic use of longitudinal design and a diversity of physical and social environmental measures. Interventions aimed at improving affective resiliency need to be tested.

DAGDirected acyclic graph MACS Manual Ability Classification System REPACQ Registre de la Paralyse C er ebrale de Qu ebec SES Socio-economic status AIM Socio-economic differences in maternal and child health are well recognized, but the role of individual-level and area-level determinants in cerebral palsy (CP) phenotypes is debated. We set out to examine (1) the association between area-level and individual-level measures of socio-economic deprivation and CP phenotype among children, including subtype, severity, and comorbidities; and (2) the direct effect of area-level deprivation not mediated through individual-level deprivation.METHOD Regional data from a provincial CP register were analyzed. The outcome of interest was CP phenotype. The area-level exposure was measured using the Pampalon Deprivation Index. Individual-level socio-economic status (SES) was determined using maternal education. We conducted multiple regression models, stratified by preterm birth, controlling for key covariates, and a mediation analysis of area-level deprivation on the association between individual SES and CP phenotype.RESULTS A socio-economic gradient in mobility was seen in our cohort, above and beyond differences in maternal and perinatal factors. The added direct effect of area-level deprivation was seen only in children whose mothers were educated to a higher level, suggesting no additional contribution of area-level deprivation in children of mothers with a lower level of education.INTERPRETATION Contextual socio-economic factors can impact the severity of CP. These findings indicate important areas for potential community-level or area-level public health intervention (i.e. neighborhood reinvestment, preventive measures), and suggest that neighborhood-level research in maternal and perinatal health should continue to be pursued.Cerebral palsy (CP) is one of the most common motor disabilities in childhood, affecting approximately 2 per 1000 children, creating an important health burden for affected children, their families, and their communities. 1 Biological risk factors for CP include placental abnormalities, major and minor birth defects, and preterm delivery. 2 Beyond these, few studies have examined the social determinants of CP. A recent systematic review 3 found an association between area-level and, to a lesser degree, individual-level socio-economic status (SES) and risk of CP. Socio-economic differences in maternal and child health are well recognized, 4 but their role in CP remains debated. It is unclear if the distribution of CP cases and case severity is associated with environmental exposures.We hypothesize that there exist both individual-level and area-level socio-economic determinants of CP severity. At an individual level, maternal SES is recognized as a robust predictor of child health. 5,6 Studies to date suggest that children with CP, born to disadvantaged families, have more severe phenotypes as defined by spastic quadriparesis, 7 poor mobility, 8-10 and cognitive impairment. 7 We hypothesize that, b...

AimTo investigate the effect of the neighbourhood built environment on trajectories of depression symptom episodes in adults from the general Canadian population.Research Design and MethodsWe used 10 years of data collection (2000/01-2010/11) from the Canadian National Population Health Study (n = 7114). Episodes of depression symptoms were identified using the Composite International Diagnostic Interview Short-Form. We assessed the presence of local parks, healthy food stores, fast food restaurants, health services and cultural services using geospatial data. We used latent class growth modelling to identify different trajectories of depression symptom episodes in the sample and tested for the effect of neighbourhood variables on the trajectories over time.ResultsWe uncovered three distinct trajectories of depression symptom episodes: low prevalence (76.2% of the sample), moderate prevalence (19.2%) and high prevalence of depression symptom episodes (2.8%). The presence of any neighbourhood service (healthy food store, fast-food restaurant, health service, except for cultural service) was significantly associated with a lower probability of a depression symptom episode for those following a trajectory of low prevalence of depression symptom episodes. The presence of a local park was also a significant protective factor in trajectory groups with both low and moderate prevalence of depression symptom episodes. Neighbourhood characteristics did not significantly affect the trajectory of high prevalence of depression symptom episodes.ConclusionsFor individuals following a trajectory of low and moderate prevalence of depression symptom episodes, the neighbourhood built environment was associated with a shift in the trajectory of depression symptom episodes. Future intervention studies are recommended to make policy recommendations.

Characteristics of neighbourhoods were associated with the risk of depression in people with Type 2 diabetes and there were vulnerable subgroups within this association. Clinicians are encouraged to consider the neighbourhood environment of their patients when assessing the risk of depression. Future intervention research is need for health policy recommendations.