Urban environment and mental wellbeing in Belgian older adults by neighborhood income level

Abstract Background 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 wellbeing. However, socio-economic disparities in access to mental health-promoting environmental characteristics among European older adults remain underexplored. This cross-sectional study investigated differences by neighborhood income level in (1) perceived absence of health-promoting neighborhood characteristics, (2) perceived importance of these characteristics for mental wellbeing, and (3) areas for improvement (= characteristics perceived as important for mental wellbeing yet absent). Methods A total of 221 older adults (≥ 65 years) from low-, medium-, and high-income neighborhoods in Ghent (Belgium) were interviewed about their neighborhood environment and well-being using a structured questionnaire. Data were analyzed using Generalized Estimating Equations. Results Key findings revealed several health-promoting characteristics perceived as absent, particularly in low-income neighborhoods (ORs between 0.3 and 7.1, p < 0.05), despite being considered important for mental wellbeing. Identified areas for improvement included litter management, pedestrian and bike-friendly infrastructure, traffic control, service availability, and issues related to youth engaging in anti-social behavior and drug-related activity. Results highlighted significant disparities: areas for improvement were most pronounced in low- income neighborhoods (ORs between 1.7 and 8.4, p < 0.05). Conclusions By identifying these priority areas, this study offers actionable insights for targeted interventions that support mental wellbeing and contribute to more equitable urban environments. Key messages • Urban neighborhoods, especially those with low income, often lack key features that support older adults’ mental wellbeing, such as clean spaces, safe mobility infrastructure, and accessible services. • Targeted urban improvements might reduce mental health inequities among older adults by prioritizing low-agency interventions in low-income neighborhoods where health disparities are more pronounced.