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Background: Little is known about the effects of the physical environment on individual health., Aims: The present study tested the hypothesis that the prevalence of depression is associated with independently rated measures of the built environment, after adjusting for individuals' socio-economic status and the internal characteristics of their dwellings., Method: Cross-sectional survey of 1887 individuals aged 16 years and over in two electoral wards in north London. Depression was ascertained using the Center for Epidemiologic Studies Depression scale (CES-D). The built environment was rated independently, using a validated measure., Results: After adjusting for socio-economic status, floor of residence and structural housing problems, statistically significant associations were found between the prevalence of depression and living in housing areas characterised by properties with predominantly deck access (odds ratio=1.28, 95% CI 1.03-1.58; P=0.02) and of recent (post-1969) construction (odds ratio=1.43, 95% CI 1.06-1.91; P=0.02)., Conclusions: The prevalence of depression was associated with independently rated features of the built environment, independent of individuals' socio-economic status and internal characteristics of dwellings.

There are few reliable measures of place with which to study the effects of socio-economic context on health. We report on the development and inter-rater reliability of a 27-item observer-rated built environment site survey checklist (BESSC). Across eleven 'housing areas' (defined as areas of homogeneity in housing form) and two raters, kappa coefficients were > or =0.5 for fifteen categorical items, and intra-class correlation coefficients exceeded 0.6 for a further three continuous measures. Ratings on several BESSC items were associated to a statistically significant degree with the prevalence of depression and residents' dissatisfaction with 'their area as a place to live'. BESSC items may prove to be valuable descriptors of the urban built environment in future studies.