A natural experiment reveals the potential links between perceived built environment, health status and suicidal behaviors: An explanatory network model analysis

- Introduction: The impact of built environment factors on residents’ mental, physical and social health status were demonstrated by previous studies separately. Emerging studies reported the potential links between built environment and suicide rate. Suicidal behaviors as common global health problems were associated with the decreasing of mental health, physical and social health status. As the theoretical and empirical evidence suggested, the protective built environmental factors can help with promoting health status and mitigating the risk of suicide at a low following cost and work in the long term. But few studies have explored the impacts of built environment factors on mental, physical, social health, and suicidal behaviors in a perspective of network in whole. This may lead us to overlook the overall role of certain built environment factors in promoting health and preventing suicidal behaviour. - Methods: A cross-sectional survey was conducted to collect 3350 valid resident samples from over 224 public housing communities in Hong Kong. The regulations of the public housing authority in Hong Kong constituted a natural experiment with minimal self-selection bias. We collected measures of perceived built environment including distance to the city center, accessibility to public transport, diversity of land use, neighborhood interactions, walkability to green space, walkability to blue space, climatic conditions, housing conditions, and healthy lifestyle support. Measures of health status included mental health status, physical health status, and social health status. Measures of suicidal behaviours included suicidal thoughts, suicide planning, and suicide attempts. We constructed a network analysis of 32 perceived built environment items, 9 mental health measures, 8 physical health measures, 22 social health measures, and 3 suicidal behavior measures using the R bootnet package. - Findings: We constructed a network analysis of all measures, indicating a network density of 0.183. Using the R bootnet package, we further computed indices of strength centrality for all measures in the network. The results suggested that accessibility to public transport had the highest standardized strength score (z 1.772). The measure of healthy lifestyle support (z 1.759) had the second to highest strength score, immediately followed by walkability to green space (z 1.722). The network analysis highlights the critical role of accessibility to public transport, healthy lifestyle support, and walkability to green spaces as central factors influencing the interconnectedness between built environment and health outcomes, reflecting their significant impact on mental, physical, and social health, as well as suicidal behaviors.