Neighborhood cohesion and violence in Port-au-Prince, Haiti, and their relationship to stress, depression, and hypertension: Findings from the Haiti cardiovascular disease cohort study

Lily D Yan, Margaret L McNairy, Jessy G Dévieux, Jean Lookens Pierre, Eliezer Dade, Rodney Sufra, Linda M Gerber, Nicholas Roberts, Stephano St Preux, Rodolphe Malebranche, Miranda Metz, Olga Tymejczyk, Denis Nash, Marie Deschamps, Monica M Safford, Jean W Pape, Vanessa Rouzier, Lily D Yan, Margaret L McNairy, Jessy G Dévieux, Jean Lookens Pierre, Eliezer Dade, Rodney Sufra, Linda M Gerber, Nicholas Roberts, Stephano St Preux, Rodolphe Malebranche, Miranda Metz, Olga Tymejczyk, Denis Nash, Marie Deschamps, Monica M Safford, Jean W Pape, Vanessa Rouzier

Abstract

Neighborhood factors have been associated with health outcomes, but this relationship is underexplored in low-income countries like Haiti. We describe perceived neighborhood cohesion and perceived violence using the Neighborhood Collective Efficacy and the City Stress Inventory scores. We hypothesized lower cohesion and higher violence were associated with higher stress, depression, and hypertension. We collected data from a population-based cohort of adults in Port-au-Prince, Haiti between March 2019 to August 2021, including stress (Perceived Stress Scale), depression (PHQ-9), and blood pressure (BP). Hypertension was defined as systolic BP ≥ 140 mmHg, diastolic BP ≥ 90 mmHg, or on antihypertensive medications. Covariates that were adjusted for included age, sex, body mass index, smoking, alcohol, physical activity, diet, income, and education, multivariable linear and Poisson regressions assessed the relationship between exposures and outcomes. Among 2,961 adults, 58.0% were female and median age was 40 years (IQR:28-55). Participants reported high cohesion (median 15/25, IQR:14-17) and moderate violence (9/20, IQR:7-11). Stress was moderate (8/16) and 12.6% had at least moderate depression (PHQ-9 ≥ 11). Median systolic BP was 118 mmHg, median diastolic BP 72 mmHg, and 29.2% had hypertension. In regressions, higher violence was associated with higher prevalence ratios of moderate-to-severe depression (Tertile3 vs Tertile1: PR 1.12, 95%CI:1.09 to 1.16) and stress (+0.3 score, 95%CI:0.01 to 0.6) but not hypertension. Cohesion was associated with lower stress (Tertile3 vs Tertile1: -0.4 score, 95%CI: -0.7 to -0.2) but not depression or hypertension. In summary, urban Haitians reported high perceived cohesion and moderate violence, with higher violence associated with higher stress and depression.

Conflict of interest statement

Competing interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Map of census blocks sampled…
Fig 1. Map of census blocks sampled in Haiti CVD cohort.
Map of sampled catchment area in Port au Prince. Base layer of map from Humanitarian Data Exchange, https://data.humdata.org/dataset/cod-ab-hti, CC BY IGO.
Fig 2. Distribution of neighborhood cohesion, neighborhood…
Fig 2. Distribution of neighborhood cohesion, neighborhood violence, perceived stress, depression, and hypertension.
X axis represents the scores, or blood pressure categories. Y axis represents the percent of participants with that score.

References

    1. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277: 918–924. doi: 10.1126/science.277.5328.918
    1. Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010;1186: 125–145. doi: 10.1111/j.1749-6632.2009.05333.x
    1. Bronfenbrenner U. Toward an experimental ecology of human development. American Psychologist. 1977;32: 513–531. doi: 10.1037/0003-066X.32.7.513
    1. Kreatsoulas C, Anand SS. The impact of social determinants on cardiovascular disease. Can J Cardiol. 2010;26: 8C–13C. doi: 10.1016/s0828-282x(10)71075-8
    1. Chow CK, Lock K, Teo K, Subramanian SV, McKee M, Yusuf S. Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review. Int J Epidemiol. 2009;38: 1580–1594. doi: 10.1093/ije/dyn258
    1. Lang T, Lepage B, Schieber A-C, Lamy S, Kelly-Irving M. Social Determinants of Cardiovascular Diseases. Public Health Rev. 2011;33: 601–622. doi: 10.1007/BF03391652
    1. Browning CR, Cagney KA. Neighborhood structural disadvantage, collective efficacy, and self-rated physical health in an urban setting. J Health Soc Behav. 2002;43: 383–399.
    1. Murillo R, Echeverria S, Vasquez E. Differences in neighborhood social cohesion and aerobic physical activity by Latino subgroup. SSM Popul Health. 2016;2: 536–541. doi: 10.1016/j.ssmph.2016.08.003
    1. Kandula NR, Wen M, Jacobs EA, Lauderdale DS. Association between neighborhood context and smoking prevalence among Asian Americans. Am J Public Health. 2009;99: 885–892. doi: 10.2105/AJPH.2007.131854
    1. Wen M, Cagney KA, Christakis NA. Effect of specific aspects of community social environment on the mortality of Individuals diagnosed with serious illness. Social Science & Medicine. 2005;61: 1119–1134. doi: 10.1016/j.socscimed.2005.01.026
    1. Ewart CK, Suchday S. Discovering how urban poverty and violence affect health: Development and validation of a neighborhood stress index. Health Psychology. 2002;21: 254–262. doi: 10.1037//0278-6133.21.3.254
    1. Kalichman SC, Simbayi LC, Jooste S, Cherry C, Cain D. Poverty-related stressors and HIV/AIDS transmission risks in two South African communities. J Urban Health. 2005;82: 237–249. doi: 10.1093/jurban/jti048
    1. Suglia SF, Sapra KJ, Koenen KC. Violence and cardiovascular health: a systematic review. Am J Prev Med. 2015;48: 205–212. doi: 10.1016/j.amepre.2014.09.013
    1. Feldmann A. The politics of violence in Latin America. Policzer P, editor. Calgary, Alberta, Canada: University of Calgary Press; 2019.
    1. Pape JW, Rouzier V, Ford H, Joseph P, Johnson WDJ, Fitzgerald DW. The GHESKIO Field Hospital and Clinics after the Earthquake in Haiti—Dispatch 3 from Port-au-Prince. Massachusetts Medical Society; 2010. doi: 10.1056/NEJMpv1001787
    1. Mesidor JK, Sly KF. Religious coping, general coping strategies, perceived social support, PTSD symptoms, resilience, and posttraumatic growth among survivors of the 2010 earthquake in Haiti. Mental Health, Religion & Culture. 2019;22: 130–143. doi: 10.1080/13674676.2019.1580254
    1. Tymejczyk O, McNairy ML, Petion JS, Rivera VR, Dorélien A, Peck M, et al.. Hypertension prevalence and risk factors among residents of four slum communities: population-representative findings from Port-au-Prince, Haiti. Journal of Hypertension. 2019;37: 685–695. doi: 10.1097/HJH.0000000000001966
    1. Lookens J, Tymejczyk O, Rouzier V, Smith C, Preval F, Joseph I, et al.. The Haiti cardiovascular disease cohort: study protocol for a population-based longitudinal cohort. BMC Public Health. 2020;20. doi: 10.1186/s12889-020-09734-x
    1. Edmond YM, Randolph SM, Richard GL. The lakou system: a cultural, ecological analysis of mothering in rural Haiti. Journal of Pan African Studies. 2007;2: 19–33.
    1. WHO. WHO STEPS surveillance manual: The WHO STEPwise approach to chronic disease risk factor surveillance. Geneva: WHO; 2017. Available:
    1. Warttig SL, Forshaw MJ, South J, White AK. New, normative, English-sample data for the Short Form Perceived Stress Scale (PSS-4). J Health Psychol. 2013;18: 1617–1628. doi: 10.1177/1359105313508346
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24: 385–396.
    1. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med. 2001;16: 606–613. doi: 10.1046/j.1525-1497.2001.016009606.x
    1. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al.. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;138: e426–e483. doi: 10.1161/CIR.0000000000000597
    1. NCD Management-Screening, Diagnosis and Treatment. HEARTS Technical Package. WHO; 2018 Jun. Available:
    1. Pellegrini S, Raleigh C, Fuller B, Kamal D, Bozhinova K, Holcomb F, et al.. Haiti: High risk of increased gang violence amid rising authoritarianism. Armed Conflict Location & Event Data Project; 2021. pp. 14–17. Available:
    1. Carver JW, Dévieux JG, Gaston SC, Altice FL, Niccolai LM. Sexual Risk Behaviors Among Adolescents in Port-au-Prince, Haiti. AIDS Behav. 2014;18: 1595–1603. doi: 10.1007/s10461-013-0689-4
    1. Brody DJ, Pratt LA, Hughes JP. Prevalence of Depression Among Adults Aged 20 and Over: United States, 2013–2016. 2019. Jun. Available:
    1. Cénat JM, McIntee S-E, Blais-Rochette C. Symptoms of posttraumatic stress disorder, depression, anxiety and other mental health problems following the 2010 earthquake in Haiti: A systematic review and meta-analysis. J Affect Disord. 2020;273: 55–85. doi: 10.1016/j.jad.2020.04.046
    1. Johnell K, Råstam L, Lithman T, Sundquist J, Merlo J. Low adherence with antihypertensives in actual practice: the association with social participation–a multilevel analysis. BMC Public Health. 2005;5: 17. doi: 10.1186/1471-2458-5-17
    1. Chaix B, Lindström M, Rosvall M, Merlo J. Neighbourhood social interactions and risk of acute myocardial infarction. J Epidemiol Community Health. 2008;62: 62–68. doi: 10.1136/jech.2006.056960
    1. Sundquist J, Johansson S-E, Yang M, Sundquist K. Low linking social capital as a predictor of coronary heart disease in Sweden: a cohort study of 2.8 million people. Soc Sci Med. 2006;62: 954–963. doi: 10.1016/j.socscimed.2005.06.049
    1. Kaiser P, Diez Roux AV, Mujahid M, Carnethon M, Bertoni A, Adar SD, et al.. Neighborhood Environments and Incident Hypertension in the Multi-Ethnic Study of Atherosclerosis. Am J Epidemiol. 2016;183: 988–997. doi: 10.1093/aje/kwv296

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