Assessing neighborhood characteristics and their association with maternal stress, depressive symptoms, and well-being in eight culturally diverse cities: A cross-sectional study

Abstract

Abstract Understanding the impact of neighborhood characteristics is crucial given its multigenerational impact. However, there is low availability of validated instruments measuring neighborhood dimensions, particularly in pregnant women, and a lack of cross-country validation of neighborhood-related scales. In this study, we used data from the [masked] study to assess the conceptual and measurement equivalence of the community domains of neighborhood cohesion, intergenerational closure, and neighborhood and social disorder, testing for measurement invariance across eight low- and middle-income countries (LMICs). Following this, we examined patterns of associations with prenatal maternal stress, well-being, and depressive symptoms through the use of nomological networks. We found that the conceptual and measurement equivalence of the neighborhood domains were good across the eight LMICs, although some adjustments had to be made to improve the model fit in two of the sites. Moreover, our results suggest that, in general, higher levels of neighborhood and social disorder, and lower levels of cohesion and intergenerational closure in the community were similarly associated with adverse maternal outcomes across the included sites. The results of this study emphasize the importance of exploring the community context when assessing maternal well-being and supports the need to advocate for community-based interventions that promote safer physical and social environments within maternal programs.