How does the neighborhood environment affect the mental health of suburban rural residents in China?

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Lingling Su, Jie Song, Jianbin Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6835365/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Environmental health research focuses primarily on the influence of the urban geographical environment on the mental health of urban residents, whereas few studies have considered the effect of the neighborhood on rural residents' mental health. In particular, suburban rural areas of large cities face serious challenges in terms of neighborhood environments and mental health in the context of rapid urbanization. Methods Data were collected in 2024 from 816 respondents living in 33 suburban villages of Zhengzhou China. This study used the structural equation model to explore the pathways of multi-dimensional neighborhood environments on the mental health of suburban rural residents. Results The results show that the social environment is closely related to the mental health of suburban rural residents, and that the objective social environment not only directly affects the mental health, but also affects the mental health through the subjective social environment. The built environment does not directly affect mental health but can indirectly affect mental health through the social environment. From the perspective of neighborhood effect, the mental health of suburban rural residents is more affected by subjective environment than objective environment, and social environment than built environment. Conclusions Considering the psychological needs of suburban rural residents to improve the neighborhood environment can improve their mental health and promote high-quality urban-rural integration. suburban rural neighborhood environment mental health Zhengzhou Figures Figure 1 Figure 2 Introduction The World Health Organization (WHO) has reported that 24% of deaths are related to modifiable environmental factors [ 1 ]. Several countries have developed environmental health promotion measures to mitigate the negative effects of the geographical environment on health. Mental health, a key dimension of health, has become an important public health issue in some countries, resulting in significant social and economic burdens. The proportion of Chinese adults at risk of depression is 10.6%, whereas the proportion for anxiety is 15.8% [ 2 ]. National mental health problems are prominent and pose severe challenges to the Healthy China Strategy. China is a large agricultural country, with 500 million people living in rural areas at the end of 2021. As important promoters of socialist modernization, their health status is not only related to their own survival and development but also to the implementation of the strategy of rural revitalization and Healthy China. However, the health status of rural residents is worse than that of urban residents. According to the China Health Statistics Yearbook, the suicide rate in rural China in 2021 was 7.09 per 100,000 people, which is much higher than the 4.31 per 100,000 people in urban areas. According to the China National Mental Health Development Report (2019–2020), the mental health of rural residents is significantly poorer than that of urban residents, and 16.5% of rural households are affected by depression, versus 14% of urban households. The overall mental health status of rural residents is poor; in particular, anxiety, depression, and other psychological problems are prominent [ 3 ]. Improving the mental health of rural residents is an important part of rural revitalization and a requirement for a healthy China. Rural areas in the peri-urban areas of large cities, where many economic, social, and cultural elements of urban and rural areas interact and interpenetrate, are intermediate zones that differ from both urban and rural areas in general and where various social contradictions are more concentrated and prominent [ 4 ]. In the context of China's rapid urbanization transition, urban spaces are expanding and rural spaces are being squeezed. Suburban rural areas are in the transition zone from traditional rural to urban areas, where physical and social spaces are constantly being dismantled and reconstructed, and rural residents are forced into different lifestyles and behavioral patterns [ 5 , 6 ]. The built environment in the suburbs is constantly updated, and although the facilities and services are continually improved, this necessitates a greater requirement for rural residents to adapt to the rapidly changing environment. The traditional rural neighborhood network built by family and clan bonds has been broken; incoming migrants and a lack of belonging and sense of identity have increased the sensitivity of rural dwellers to the neighborhood environment [ 7 ]. The acceleration of urbanization has led to changes and challenges in the geographical environment and social structure of suburban rural areas, intensifying social inequality [ 8 , 9 ]. The suburban rural neighborhood environment—the village in which rural residents live—remains the most important working space for suburban rural residents. Rural areas near cities are also key for urban and rural integration. Rural suburban residents have both a traditional and contemporary urban life. Under the dual influence of urban and rural areas, the mental health problems faced by rural residents in the suburbs are more severe. Therefore, this study focused on rural residents in the suburbs of large cities, analyzed the mechanism of impact of the geographical environment on mental health, and explored environmental measures and spatial planning strategies to promote the mental health of rural residents to provide a scientific basis for promoting high-quality urban-rural integrated development and building a healthy China. Theoretical framework Research on neighborhood environment and mental health The WHO defines “health” as the state of physical, mental, and social well-being rather than the mere absence of disease, thereby extending the traditional biomedical meaning of “health without disease" [ 10 ]. Early research focused on chronic diseases, infectious diseases, and physical illnesses caused by environmental influences, with insufficient attention paid to mental health. In recent years, there has been growing recognition of the important role of mental health in achieving global development goals and the inclusion of mental health in the Sustainable Development Goals. The neighborhood is the most important spatial unit in residents’ daily lives, and their daily activities are anchored primarily in the neighborhood. Numerous studies have confirmed that neighborhood environments are related to residents' mental health. Studies have found that the availability of neighborhood facilities or services and the number of related facilities have a direct or indirect positive contribution to residents [ 11 ]. Perceived transportation disadvantages can negatively affect life satisfaction [ 12 ]. Studies have also found that green spaces have important restorative and recreational functions, and that exposure to green spaces can help improve mood and cognitive function; therefore, neighborhood greening can help improve mental health problems [ 13 , 14 ]. In addition, the sanitary environment, housing conditions, and similar issues also affect health [ 15 ]. In the social environment, community mobility and neighborhood poverty are detrimental to residents’ health [ 16 ]. Living in a disorderly neighborhood can cause anxiety and discomfort to residents, affecting their quality of daily life [ 17 ]. Neighborhood interaction and cohesion are also important factors in residents' health, and studies have emphasized the importance of social trust and local community networks, indicating that the social environment is an important factor in residents' mental health [ 18 , 19 ]. However, most previous studies measured the neighborhood environment from an objective rather than a subjective perspective. Due to differences in people's perceptions of the objective environment, it may be more accurate to explore the mental health effects of neighborhood environments by combining objective measures and subjective perceptual perspectives. In addition, the relationship between the geographical environment and mental health is complicated, and the pathways and mechanisms linking the two are largely black boxes in cognition. The effect of the geographical environment on mental health and whether the geographical environment impacts mental health through potential mediating factors need to be further explored. Factors associated with mental health of rural residents The mental health outlook of rural populations is not optimistic [ 20 ]. Studies have generally found that the mental health of rural residents is significantly poorer than that of urban residents [ 21 , 22 ]. In addition, there are significant differences in mental health not only between urban and rural areas but also within rural areas [ 23 ]. While previous studies have confirmed the association between the geographical environment and mental health, most have been conducted in urban areas. Compared to urban areas, the living environment, services, and facilities in rural areas are relatively poor [ 24 , 25 ]. For example, irrational road network planning significantly reduces the efficiency of rural transport services. Healthcare in rural areas has weaknesses in health awareness and medical resource allocation. Unlike the closed living environments in cities, rural areas in China are typical acquaintance-based societies, where communication between neighbors is more frequent and closer [ 26 ]. Due to the differences between urban and rural geographical environments, there may also be different effects on mental health. Studies have indicated that the stressors of rural older persons are primarily related to the built environment, whereas those of urban older persons relate more to the social environment of their neighborhoods [ 27 ]. The same environmental characteristics may have different effects on the mental health of urban and rural residents. In rural areas, closer neighborhoods are associated with better mental health, whereas in urban areas, this association is not significant [ 22 ]. Owing to the history and practices associated with green spaces (such as farming), the symbolic dimensions of green spaces in rural areas are, in some ways, completely different from those of urban green spaces, and the impact on residents' mental health may also be different [ 28 ]. Researchers have found that rural residents who live in a good neighborhood environment have better mental health, and those who are exposed to air pollution, noise pollution, and inadequate facilities have worse mental health [ 29 , 30 ]. Health geography primarily focuses on the influence of the urban geographical environment on the mental health of urban residents, whereas the influence of the neighborhood environment on the mental health of rural residents has not been considered in sufficient depth. Rural residents, especially in suburban rural areas in the context of urban-rural integration, are experiencing rapid spatial and social transformations. Therefore, it is necessary to pay attention to the influence of the neighborhood environment on the mental health of suburban rural residents. Conceptual framework and hypotheses The suburban rural area is the transition zone of urban-rural integration development, and rural residents in suburban areas are affected by both urban and rural areas. From an administrative perspective, suburban rural areas are within urban jurisdictions. From a geospatial perspective, suburban rural areas refer to rural areas on the periphery of built-up and adjacent urban areas [ 31 , 32 ]. As urban-rural integration continues to advance, the population structure of suburban rural areas becomes more diversified, and the geographical environment becomes more complicated. The neighborhood environment consists of a built environment and a social environment. The built environment shapes the social environment, and it is generally assumed that a positive built environment provides residents with places and opportunities for neighborhood interaction and community engagement [ 33 ]. When residents are satisfied with their neighborhood environment, they are more connected to neighbors, and this close neighborhood relationship positively affects their mental health [ 34 , 35 ]. However, other studies have suggested that neighborhood social relationships are unlikely to act as mediating variables between the built environment and mental health [ 36 ]. Research on the health effects of neighborhood environments involves the use of objective and subjective perceived geographical environmental indicators [ 37 , 38 ]. Objective neighborhood environments reflect the objective characteristics of neighborhoods and can provide a reference for policymaking and environmental interventions. Subjective neighborhood environments are influenced by individual preferences and environmental experiences, which can reflect the degree of matching between individual needs and the geographical environment and highlight a human-centered perspective of the environment. Objective and subjective neighborhood environments may affect mental health independently, and objective neighborhood environments may indirectly affect mental health through subjective perceptions of the neighborhood environment [ 39 – 41 ]. Based on the above discussion, the theoretical research framework and hypothesized relationships are shown in Fig. 1 . Hypothesis 1 The neighborhood environment, framed by built and social aspects, and objective and subjective aspects, is significantly associated with the mental health of suburban rural residents. Hypothesis 2 Perceived neighborhood environments mediate the relationship between the objective neighborhood environment and the mental health of suburban rural residents. Hypothesis 3 The neighborhood social environment mediates the relationship between the built environment and the mental health of suburban rural residents. Methods Data Collection and the Sample The study area was Zhengzhou, the capital of Henan Province, which has the largest agricultural population in China. Zhengzhou is located in the central plain of China and is a megacity. The development level of Zhengzhou is close to the overall development level of China, showing typical Chinese social, economic, and cultural characteristics. In recent years, urbanization in Zhengzhou has developed rapidly. In the decade from 2013to 2023, the urbanization rate increased from 43.8–80%, and the built-up area of the central urban area increased from 382.66 square kilometers to 796.70 square kilometers. According to the 7th National Census, there were still 2,721,545 people living in rural areas of Zhengzhou by the end of 2020. The suburban rural areas of Zhengzhou are transitioning from traditional rural areas to modern cities. Suburban rural residents in Zhengzhou are affected and squeezed by both urban and rural areas, and their mental health problems pose severe challenges. The data used in this study were obtained from a questionnaire survey conducted in the rural suburbs of Zhengzhou from March to April, 2024. Multi-stage probability proportional sampling (PPS) was used. The survey first selected 10 towns around the built-up area and adjacent to the urban area of Zhengzhou central city. Then, 33 sample villages were selected from 10 suburban towns. A total of 816 valid samples were collected through random sampling of rural residents in each sample village. The sample structure was consistent with that of the Seventh National Census. The questionnaire included individual and family socioeconomic attributes, perceived neighborhood environment, and mental health assessments. For the full questionnaire content, please refer to Appendix 1. Each sample signed an informed consent form. Table 1 presents the socioeconomic characteristics of the sample. In the sample of suburban rural residents in Zhengzhou, 49.75% were female and the average age was 46 years. The population with a high school education or above accounted for 40.19, which is slightly lower than the national urban and rural average of 43.79%. Most respondents were married (87.01%). According to the stratification of household income, a monthly income between 2500 and 6000 yuan accounted for 41.42% of the population, and the proportion below 2500 yuan was the smallest. In terms of family structure, three generations of rural residents in the suburbs dominated, accounting for 60.66% of the total. Table 1 Socio-economic characteristics of the sample. Variable Categories Frequency Proportion (%) Gender Male 406 49.75 Female 410 50.25 Age 18–35 204 25 36–55 388 47.55 > 55 224 27.45 Education Middle school and below 488 59.80 High school 182 22.30 University and above 146 17.89 Marital status Married 710 87.01 Others 106 12.99 Monthly household income (RMB) 6000 267 32.72 Family intergenerational structure One-generation family 38 4.66 Two-generation family 256 31.37 Three-generation family 495 60.66 Families of four generations and above 27 3.31 Variable Definition This study focuses on two mental health outcomes: depression (negative dimension) and life satisfaction (positive dimension). Depression was assessed using the CESD-10, a ten-item self-report scale designed to identify depressive symptoms in the general population. All items are rated on a 4-point Likert scale based on the frequency of negative mental experiences, from “always” (score 1) to “never” (score 4). The scores of the 10 items are summed to produce the depression score. The scale has shown good internal consistency (Cronbach's α = 0.816). Mental health is not just the absence of mental disorders. Therefore, in addition to depression, we used Diener’s Life Satisfaction Scale to measure mental health. This scale scores the degree of five positive psychological experiences from “strongly disagree” (score 1) to “strongly agree” (score 7). In this study, the Cronbach's α was 0.853. The scores of the five items are summed; higher scores indicate better mental health. These scales have been widely used in mental health research and demonstrated good reliability and validity [ 42 ]. The neighborhood environment may be described by both objective measurements and subjective perception data (Table 2 ). In the built environment of neighborhoods, the dual system of urban and rural areas has resulted in rural residents becoming more dependent on their neighborhoods for amenities. Transportation, education, and healthcare facilities, which are important components of life, are the most fundamental neighborhood facilities. The diversification of shopping facilities can provide more shopping choices in residents' daily lives, which, to a certain extent, enhances the quality of life of rural residents. The distance from the city center reflects the locational conditions of the residential neighborhood. Therefore, we chose the number of bus stops and schools, the density of health and shopping facilities within 1 square kilometer of the geometric center of the village, and the straight-line distance to the city center as objective built environment indicators of the neighborhood. We also included subjective perceived assessments of housing quality, accessibility of transportation, shopping convenience, sanitary conditions, and neighborhood greenery. In a neighborhood’s social environment, under the influence of urban expansion, the original social network formed by clan and family relationships in suburban rural areas is deconstructed and residents are forced to establish new social relations. During the processes of deconstruction and reconstruction, the mental health of rural residents may fluctuate accordingly. Therefore, we chose the number of friends in the neighborhood, neighborhood interactions, and the proportion of the population that was not originally from the area as objective social environment indicators. As subjective social environment indicators we chose subjective perception and evaluation of neighborhood relationships, neighborhood safety, and neighborhood services. Table 2 lists the variables selected and assigned to the models. Table 2 Variable measurement. Latent variable Observed variable Code Description Mental health (MH) Depression Y1 Psychological state over the last month: Total scores range from 10 to 40 Life satisfaction Y2 Overall satisfaction with life: Total scores range from 5 to 35 Objective built environment (OBE) Number of bus stops A1 Number of bus stops in a 1-km buffer zone of the neighborhood where respondents live Number of schools A2 Number of schools in a 1-km buffer zone of the neighborhood where respondents live Health facility density A3 Health facility density in a 1-km buffer zone of the neighborhood where respondents live Shopping facility density A4 Shopping facility density in a 1-km buffer zone of the neighborhood where respondents live Distance to city center A5 The straight-line distance from the neighborhood to the city center Subjective built environment (SBE) Housing quality B1 The housing quality is very satisfactory: 1 (strongly disagree) to 5 (strongly agree) Transportation accessibility B2 The neighborhood transportation is very convenient, it is easy to go anywhere: 1 (strongly disagree) to 5 (strongly agree) Shopping convenience B3 The neighborhood shopping facilities are convenient: 1 (strongly disagree) to 5 (strongly agree) Sanitary conditions B4 The public space in the neighborhood is clean and tidy: 1 (strongly disagree) to 5 (strongly agree) Neighborhood greening B5 The greening in the neighborhood is well designed: 1 (strongly disagree) to 5 (strongly agree) Objective social environment (OSE) Neighborhood friends C1 Number of friends living in the same neighborhood: 1 (≤ 10), 2 ( 10–25), 3 ( 26–50), 4 ( 51–70), 5(≥ 70) Neighborhood interactions C2 Frequency of interactions with neighbors: 1 (infrequent) to 5 (frequent) Proportion of population not originally from the area C3 The proportion of immigrants and natives in the daily life of the neighborhood: 1 (fewer migrants) to 5 (fewer locals) Subjective social environment (SSE) Neighborhood relationships D1 Evaluation of satisfaction with neighborhood relationships: 1 (unsatisfactory) to 5 (satisfactory) Neighborhood safety D2 Evaluation of satisfaction with neighborhood safety: 1 (unsatisfactory) to 5 (satisfactory) Neighborhood services D3 Evaluation of satisfaction with neighborhood services: 1 (unsatisfactory) to 5 (satisfactory) This study adjusted the study for covariates of suburban rural residents’ sociodemographic and family structure characteristics. For individual-level covariates, this study included gender (binary variable: male vs. female), age (continuous variable), education (categorical variable), and marital status (binary variable: married vs. not married). These are common indicators in mental health research. For covariates of family characteristics, this study used monthly household income (continuous variable) and family intergenerational structure (categorical variable). Household income affects the material living conditions and also represents the family's ability to resist risks. Family intergenerational structure can reflect the needs of the family's neighborhood environment, and living with family members can increase family support. Statistical Analysis This study used structural equation modeling (SEM) to analyze the relationship between the neighborhood environment and the mental health of suburban rural residents. The neighborhood environment is a comprehensive multi-dimensional concept that includes both built and social environments, as well as subjective and objective neighborhood environments. Each dimension of the neighborhood environment is a latent variable constructed by a series of observable variables, and the relationship between these latent variables. Mental health is a multidimensional concept that must be characterized by observational variables. SEM primarily uses a covariance matrix of variables, including measurement and structure models. Measurement models fit the relationship between observed and latent variables to model constructs that cannot be directly measured. Structural models primarily deal with causality between different variables, allowing the dependent variable to act as both an outcome and an explanatory variable. SEM can also be used to estimate the regression effects between independent and dependent variables, facilitating the analysis of complex direct and indirect effects [ 43 , 44 ]. Results Analysis of structural equation model estimation and test results We conducted goodness-of-fit measurements for the SEM (Table 3 ). All indicators met the recommended standards, indicating that the model fit the data well. Table 4 presents the results of the measurement model analysis. The loadings of each measurement variable were between 0.643 and 0.916, indicating that each measurement item reflected well the score of the latent variable. The combined reliability (CR) of each latent variable was between 0.895 and 0.932, which was greater than the criterion of 0.7, indicating good internal consistency of each measured variable. The average variance extracted (AVE) of each latent variable was between 0.733 and 0.820, which was greater than the criterion of 0.5, indicating good convergent validity of each item. In summary, the measurement models of subjective and objective built and social environments were reasonable and could be included in structural equation models as latent variables. Table 3 Indicators of model fit. χ 2 /df GFI RMSEA CFI NFI Idealized goodness of ft 1–3 > 0.90 0.90 > 0.90 Goodness of ft 2.230 0.929 0.046 0.928 0.933 Table 4 Constructs, measurement items, and reliability and validity tests. Latent variable Observed variable Factor loadings T-value CR AVE MH Y1 0.714 Fixed 0.895 0.733 Y2 0.892 6.042 OBE A1 0.689 Fixed 0.932 0.816 A2 0.905 8.061 A3 0.916 8.117 A4 0.910 8.056 A5 -0.683 -4.318 SBE B1 0.732 Fixed 0.912 0.820 B2 0.671 8.213 B3 0.643 8.145 B4 0.848 8.576 B5 0.782 8.462 OSE C1 0.713 fixed 0.923 0.798 C2 0.752 5.999 C3 -0.667 -4.655 SSE D1 0.662 Fixed 0.899 0.801 D2 0.731 15.795 D3 0.704 11.563 Path analysis results: The direct path of the impact of the neighborhood environment on the mental health of suburban rural residents The neighborhood environment was differentially associated with the mental health of suburban rural residents (Fig. 2 ). The objective social environment had a significant positive effect on mental health, with a direct effect of 0.273. With increased neighborhood interactions and friends in the neighborhood, rural residents can build their social networks and neighborhood support, which can alleviate negative emotions in daily life and enhance the sense of neighborhood belonging, thus promoting mental health. Incoming migrant populations can break up existing social networks and cause uncertainty, which is not conducive to harmonious social relationships and has a negative impact on mental health. The subjective social environment had a positive direct effect on mental health, with a direct effect of 0.323. The subjective social environment had a greater impact on mental health than did the objective social environment. This may be because the perceived assessment of neighborhood relations, neighborhood safety, and neighborhood services reflect the degree to which the neighborhood environment meets the needs of residents. Building a harmonious neighborhood context and enhancing residents' positive perceptions of the social environment can promote their mental health. Neighborhood facilities, such as bus stops, schools, and health and shopping facilities, can significantly improve the neighborhood built environment, whereas the distance from the city center is significantly negatively correlated with the built environment. However, the relationship between the objective neighborhood environment and mental health did not reach statistical significance. Similarly, subjective assessment of the built environment in the neighborhood a positive but nonsignificant effect on mental health. This may be because of the proximity of suburban rural areas to urban areas and the ease of access to townships and urban areas for relevant services and facilities. Moreover, the physical environment of the suburban rural areas changes rapidly in the context of rapid urbanization, and mental health tends to be the result of a long-term cumulative effect, short-term built environment experience is not enough to have a significant impact on mental health [ 45 ]. Our study confirmed that the mental health of suburban rural residents is affected by the neighborhood environment, and that improving the neighborhood environment can improve the mental health of residents. Thus, Hypothesis 1 was partially verified (Table 5 ). However, different dimensions of the neighborhood environment had different effects on mental health. Compared with the objective neighborhood environment, the subjective perceived neighborhood environment had a greater impact on mental health. The perceived neighborhood environment assessment not only reflects the status of the neighborhood environment but also reveals the extent to which the neighborhood environment meets the needs and expectations of rural residents. The subjective and objective neighborhood social environments had a direct effect on the mental health of suburban rural residents, whereas the effect of the built environment was not significant. Table 5 Path analysis for SEM. Pathways Direct effect Hypothesis test OBE→MH 0.007 Unsupported SBE→MH 0.101 Unsupported OSE→MH 0.273 Supported SSE→MH 0.323 Supported Indirect effects: Mediation effects of the neighborhood environment on the mental health of suburban rural residents The neighborhood environment not only has a direct impact on mental health, but may also affect mental health through indirect pathways [ 46 – 48 ]. This study comprehensively examined the potential mediating effects of the different dimensions of the neighborhood environment (Table 6 ). The objective social environment positively affected the mental health of rural suburban residents through the subjective social environment, with an indirect effect of 0.519. This may be because the objective social environment can enhance residents’ sense of identity with their neighborhood, which further enhances the solidity of the neighborhood's social environment and improves residents' mental health. Thus, Hypothesis 2 was verified. This study further validated that the social environment mediates the effects of the built environment on mental health. The objective built environment affected mental health through the objective social environment, with an indirect effect of 0.070. The objective built environment has a significant negative impact on the objective social environment, which ultimately has a positive impact on mental health. Neighborhoods with a higher quality objective built environment tend to be more affected by urbanization, which has a greater impact on traditional social neighborhoods. The subjective built environment positively affected mental health through the subjective and objective social environments, with indirect effects of 0.568 and 1.133, respectively. Convenient neighborhood facilities and services can enhance residents' social interactions and neighborhood relations, improve their evaluation of neighborhood social environments, and promote mental health. In the chain mediation process, both the objective and subjective built environments affected the objective social environment, the subjective social environment, and, ultimately, mental health. This finding is consistent with previous studies that emphasized the mediating role of the social environment in the relationship between the built environment and mental health [ 49 ]. Thus, Hypothesis 3 was supported. Table 6 Mediation effects of structural equation model. Pathways Indirect effect Hypothesis test OBE→SBE→MH 0.009 Unsupported OSE→SSE→MH 0.519 Supported OBE→OSE→MH 0.070 Supported OBE→OSE→SSE→MH 0.316 Supported OBE→SSE→MH 0.271 Unsupported SBE→OSE→MH 0.568 Supported SBE→OSE→SSE→MH 0.814 Supported SBE→SSE→MH 1.133 Supported Discussion and conclusions With the continuous advancement of urban-rural integration, China has made remarkable progress in coordinating urban and rural development and promoting new urbanization. However, problems remain prominent, such as difficulties in integrating urban and rural factors, the irrational allocation of public resources, and the wide gap between urban and rural development [ 50 , 51 ]. These problems can easily lead to anxiety, depression, injustice, and other negative emotions, which can cause significant damage to the mental health of rural residents. The suburban rural areas of large cities, where many factors of the urban and rural economy, society, and culture interact and interpenetrate, are intermediate zones that differ from both the city and the general countryside and regions and where a variety of social contradictions are concentrated and prominent. Suburban rural residents, who are affected by both rural habits and contemporary urban lifestyles, are experiencing rapid disintegration and reconstruction of the traditional physical and social environment and are facing an increasing risk severe mental health problem. Therefore, this study considered residents of Zhengzhou City to explore the relationship between the multi-dimensional neighborhood environment and mental health of suburban rural residents. We found that for suburban rural residents, improving the neighborhood environment can promote mental health. Both the objective and subjective neighborhood social environments can directly promote mental health, which is consistent with existing environmental health studies [ 52 ]. China's traditional rural society relies primarily on family and kinship to construct social networks and identities. However, with urbanization, the traditional neighborhood relationships in suburban rural areas have been destroyed and replaced by a weak relationship network composed of neighbors in modern society. Building stable social relations and strengthening neighborhood cohesion and the social network of rural residents in the suburbs can enhance their sense of neighborhood belonging and identity, and thus promote their mental health. In contrast to previous studies of urban environmental health, the direct effect of the built environment on the mental health of suburban rural residents was not significant. This may be because, in the rapid process of urbanization in China, some suburban areas have been continuously incorporated into the scope of urban built-up areas through urban expansion, and urban space continues to expand, while rural space continues to be squeezed [ 53 ]. Although suburban rural areas still have a rural identity, they are profoundly influenced by cities. The gradual modernization of the traditional rural physical landscape has brought about rapid changes in the built environment, and people's experiences of it have not been deep or sustained enough to have a direct impact on their mental health. Our research also found that the neighborhood environment not only directly affected the mental health of rural residents in the suburbs but also indirectly affected mental health through mediation. First, the subjective social environment played a significant mediating role between the objective social environment and mental health. That is, the objective social environment affected residents' subjective assessments of the social environment and their mental health. The objective neighborhood environment includes many friends in the neighborhood, close neighborhood interactions, and a smaller incoming migrant population, which can promote the formation of a stable neighborhood social structure. This stable social structure can increase residents’ perception of neighborhood relations as well as their evaluation of neighborhood safety and management, enhancing their belonging to and identification with their neighborhood, which further improves their mental health. Second, although the built environment did not directly affect mental health, it did so indirectly through the social environment. The objective built environment is negatively correlated with the social environment because improvement of the built environment in suburban rural areas accelerates the disintegration of the traditional social environment. However, the social environment was significantly positively correlated with mental health, offsetting some of the negative effects of the built environment and ultimately realizing the objective contribution of the built environment to mental health. Improvements in the subjective built environment can promote the social environment and improve the mental health of suburban rural residents. To some extent, the subjective built environment reflects residents' satisfaction with neighborhood facilities [ 54 ]. Improvement of the subjective built environment can increase neighborhood interactions and promote social relations, thus improving mental health. In the context of rapid urbanization in China, this study focused on the suburban rural areas of large cities to explore the influence of multi-dimensional neighborhood environments on the mental health of suburban rural residents. The findings have important implications for the development of policy interventions that promote rural residents’ mental health. In contrast to the single-dimensional neighborhood environment that has been considered in previous studies, this study focused on the subjective and objective neighborhood built and social environments, respectively, and analyzed the complex pathways through which different dimensions of the neighborhood environment affect mental health. This study also increases the understanding of the mental health status of rural residents in the suburbs and contributes to understanding the special geographical environment of suburban rural areas and the unique life changes of their residents in the context of urban-rural integration. Urbanization not only affects urban areas but also profoundly affects rural areas, especially suburban rural areas [ 55 ]. Neighborhood environments in suburban rural areas continue to disintegrate and restructure. In this rapid, dynamic change, residents are faced with constant adjustment and adaptation to the new environment, which affects their mental health [ 56 ]. Improving the built and social environments of neighborhoods can effectively enhance the mental health of rural and suburban residents. The social environment can not only directly affect mental health but can also mediate between the built environment and mental health. In addition to providing an objectively beneficial neighborhood environment, it is necessary to combine this with the psychological needs of rural residents in the suburbs and provide them with differentiated and targeted neighborhood environments based on their subjective perception and evaluation of the neighborhood environment to improve their mental health. Our study had several limitations. First, this study used cross-sectional data analysis and therefore cannot determine causal paths. For example, residents with better mental health may choose to live in communities with better neighborhood environments. Future research should also consider the impact of residential self-selection on environmental health effects. Second, this study focused on rural residents in the suburbs; whether the findings of this study are applicable to all rural residents requires further verification. Despite these limitations, this study enriches environmental health research and increases understanding of the relationship between the neighborhood environment and the mental health of suburban rural residents. Future studies should conduct longitudinal investigations to explore the causal mechanisms between the environment and health, further expanding the scope of research to analyze the relationship between mental health and the neighborhood environment of rural residents in different spatial locations. Abbreviations MH Mental health OBE Objective built environment SBE Subjective built environment OSE Objective social environment SSE Subjective social environment SEM structural equation modeling Declarations Ethical Approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki. This study does not involve clinical trials and individual privacy. The survey was approved by the Academic Committee of Henan University. Written informed consent was obtained from all participants before data collection. All methods of this study were performed in accordance with the relevant guidelines and regulations. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare no competing interests. Funding This research was supported by National Natural Science Foundation of China (grant number: 42301282, 42401298, 42201265). Authors' contributions The conceptualization of this study was driven by SLL. Data collection was performed by SLL and SJ. Subsequently, data analyses were completed by SLL and XJB. The manuscript was written by SLL. Additionally, critical revisions for important intellectual content were carried out by SLL. Ultimately, all authors have read and agreed to the published version of the manuscript. Acknowledgements The authors would like to thank those who participated in this study. Data availability After publication, anonymized data underlying the results and analysis can be made available to researchers upon reasonable request to the corresponding author. References World Health Organization. Preventing Disease through Healthy Environments: A Global Assessment of the Burden of Disease from Environmental Risks. 2016. Geneva: World Health Organization. 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Wong FY, Yang L, Yuen JWM, Chang KKP, Wong FKY. Assessing quality of life using WHOQOL-BREF: a cross-sectional study on the association between quality of life and neighborhood environmental satisfaction, and the mediating effect of health-related behaviors. BMC Public Health. 2018; 18: 1113. Xu L, Han H, Yang C, Liu Q. The influence mechanism of the community subjectively built environment on the physical and mental health of older adults. Sustainability. 2023; 15(17):13211. Ettema D, Schekkerman M. How do spatial characteristics influence well-being and mental health? Comparing the effect of objective and subjective characteristics at different spatial scales. Travel Behav. Soc. 2015; 5(11): 56-67. Morrison PS. Local expressions of subjective well-being: The New Zealand experience. Reg. Stud. 2011; 45(8): 1039–1058. Barnett A, Van Dyck D, Van Cauwenberg J, Zhang CJP, Lai PC, Cerin E. Objective neighbourhood attributes as correlates of neighbourhood dissatisfaction and the mediating role of neighbourhood perceptions in older adults from culturally and physically diverse urban environments. Cities. 2021;107: 102879. Parra DC, Gomez LF, Sarmiento OL, Buchner D, Brownson R, Schimd T, Gomez V, Lobelo F. Perceived and objective neighborhood environment attributes and health related quality of life among the elderly in Bogotá, Colombia. Soc. Sci. Med. 2010; 70(7): 1070-1076. Yue YF, Yang DF, Owen N, Van Dyck D. The built environment and mental health among older adults in Dalian: The mediating role of perceived environmental attributes. Soc. Sci. Med. 2022; 311: 115333. Yue ZS, Wang BW, Li SZ, Fong E, Feldman MW. Advantages of being bicultural: Acculturation and mental health among rural-urban migrants in China. Cities. 2021; 119: 103357. Ji QF, Yin MY, Li YX, Zhou XL. Exploring the influence path of high-rise residential environment on the mental health of the elderly. Sust. Cities Soc. 2023; 98: 104808. Wu R, Huang X, Li ZG, Liu Y, Liu YQ. Deciphering the meaning and mechanism of migrants' and locals' neighborhood attachment in Chinese cities: Evidence from Guangzhou. Cities. 2019; 85:187-195. Youngbloom AJ, Thierry B, Fuller D, Kestens Y, Winters M, Hirsch JA, Michael YL, Firth C. Gentrification, perceptions of neighborhood change, and mental health in Montréal, Québec. SSM-Popul. Health. 2023; 22: 101406. Hadavi S. Direct and indirect effects of the physical aspects of the environment on mental well-being. Environ. Behav. 2017; 49(10): 1071-1104. Liu Y, Dijst M, Faber J, Geertman S, Cui C. Healthy urban living: Residential environment and health of older adults in Shanghai. Health Place. 2017; 47: 80-89. Yang M, Dijst M, Faber J, Helbich M. Effect of pre- and post-migration neighborhood environment on migrants' mental health: the case of Shenzhen, China. Int. J. Environ. Health Res. 2024. DOI10.1080/09603123.2024.2421827. Matthews SA, Tse-Chuan Y. Exploring the role of the built and social neighborhood environment in moderating stress and health. Ann. Behav. Med . 2010; 2:170-183. Wu X, Zhao N, Wang Y, Zhang LQ, Wang W, Liu YS. Cropland non-agriculturalization caused by the expansion of built-up areas in China during 1990–2020. Land Use Pol. 2024; 146: 107312. Wu W, Li Y, Liu Y. What constrains impoverished rural regions: A case study of Henan Province in central China. Habitat Int. 2022; 119:102477. Gu M, Tang S, Feng J. Exploring the impact of neighborhood environment on the mental health of rural migrant women: A case study in Nanjing, China. Cities. 2024; 155: 105434. Qin X, Wei YD, Yu Z, Xiong N. Urbanization, suburbanization, and population redistribution in urban China: A case study of Nanjing. J. Urban Plan. Dev. 2022; 148(4). DOI:10.1061/(ASCE)UP.1943-5444.0000882. Lin L, Moudon AV. Objective versus subjective measures of the built environment, which are most effective in capturing associations with walking? Health Place. 2010; 16(2): 339-348. Zhang J, Xiao WY, Chen W. Transformation from rural industrialization to suburban industrialization in Guangzhou: Pattern and Mechanism. Land. 2024; 13(9): 1485. Eberhardt MS, Pamuk ER. The importance of place of residence: Examining health in rural and nonrural areas. Am. J. Public Health. 2004; 94(10): 1682-1686. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6835365","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":482436154,"identity":"2ed15caa-959a-4961-8194-88c04a83b095","order_by":0,"name":"Lingling Su","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYFAC5oYDQJKHn5mx8UFCRQ0xWhjBWuQk25ubDR6cOUacFhBpbHDmeJvkwxZmwhrkZyQ2Hi74xZC44UZiW0ViAxsDf3t3Al4tBjcSGw7P7GNInAnUciNxhwyDxJmzG/BrkQBq4e1hSOwDaznDBhTJxa8F6DCIlgagloLENmbCWhhADuP5wWAscOZgGwNRWgzOPATa0gAK5MZmiYQzx3gI+kW+PfnwZ54/oKhkf/jxR0WNHH97LwGHgQBj2384m4ewcjD4Q6S6UTAKRsEoGJkAAO0VUdeGpsk2AAAAAElFTkSuQmCC","orcid":"","institution":"Henan University","correspondingAuthor":true,"prefix":"","firstName":"Lingling","middleName":"","lastName":"Su","suffix":""},{"id":482436159,"identity":"5a29c743-5a3f-4039-bf26-2b4a28e2ce01","order_by":1,"name":"Jie Song","email":"","orcid":"","institution":"Taiyuan Normal University","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Song","suffix":""},{"id":482436160,"identity":"087f3ad0-3470-43c3-af5c-05fe0653d771","order_by":2,"name":"Jianbin Xu","email":"","orcid":"","institution":"Shanxi University of Finance and Economics","correspondingAuthor":false,"prefix":"","firstName":"Jianbin","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2025-06-06 08:53:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6835365/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6835365/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86391866,"identity":"840cc5c2-dd74-4e20-92bd-82e74c70acad","added_by":"auto","created_at":"2025-07-10 07:03:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":58534,"visible":true,"origin":"","legend":"\u003cp\u003eTheoretical research framework.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6835365/v1/61768273d18e14866cfd2687.png"},{"id":86391873,"identity":"ba731103-f076-4f78-852c-011a6dce57f5","added_by":"auto","created_at":"2025-07-10 07:03:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85960,"visible":true,"origin":"","legend":"\u003cp\u003eStructural equation model linking neighborhood environment to mental health suburban rural residents. (Note: Solid lines indicate significant, dashed lines indicate non-significant.)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6835365/v1/05454d73902ff5546a035b6f.png"},{"id":86392824,"identity":"2e6d5e34-f11f-4291-a7d0-1fd05b4ba5f3","added_by":"auto","created_at":"2025-07-10 07:11:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1209874,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6835365/v1/8f4923c0-14bc-4517-a010-32160b4350cf.pdf"},{"id":86391863,"identity":"e155942c-e458-4abc-bc4e-9fa4ae16c9fe","added_by":"auto","created_at":"2025-07-10 07:03:45","extension":"doc","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":67072,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.doc","url":"https://assets-eu.researchsquare.com/files/rs-6835365/v1/f492ae5f3ddcf572b6386345.doc"}],"financialInterests":"No competing interests reported.","formattedTitle":"How does the neighborhood environment affect the mental health of suburban rural residents in China?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe World Health Organization (WHO) has reported that 24% of deaths are related to modifiable environmental factors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Several countries have developed environmental health promotion measures to mitigate the negative effects of the geographical environment on health. Mental health, a key dimension of health, has become an important public health issue in some countries, resulting in significant social and economic burdens. The proportion of Chinese adults at risk of depression is 10.6%, whereas the proportion for anxiety is 15.8% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. National mental health problems are prominent and pose severe challenges to the Healthy China Strategy.\u003c/p\u003e\u003cp\u003eChina is a large agricultural country, with 500\u0026nbsp;million people living in rural areas at the end of 2021. As important promoters of socialist modernization, their health status is not only related to their own survival and development but also to the implementation of the strategy of rural revitalization and Healthy China. However, the health status of rural residents is worse than that of urban residents. According to the China Health Statistics Yearbook, the suicide rate in rural China in 2021 was 7.09 per 100,000 people, which is much higher than the 4.31 per 100,000 people in urban areas. According to the China National Mental Health Development Report (2019\u0026ndash;2020), the mental health of rural residents is significantly poorer than that of urban residents, and 16.5% of rural households are affected by depression, versus 14% of urban households. The overall mental health status of rural residents is poor; in particular, anxiety, depression, and other psychological problems are prominent [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Improving the mental health of rural residents is an important part of rural revitalization and a requirement for a healthy China.\u003c/p\u003e\u003cp\u003eRural areas in the peri-urban areas of large cities, where many economic, social, and cultural elements of urban and rural areas interact and interpenetrate, are intermediate zones that differ from both urban and rural areas in general and where various social contradictions are more concentrated and prominent [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In the context of China's rapid urbanization transition, urban spaces are expanding and rural spaces are being squeezed. Suburban rural areas are in the transition zone from traditional rural to urban areas, where physical and social spaces are constantly being dismantled and reconstructed, and rural residents are forced into different lifestyles and behavioral patterns [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The built environment in the suburbs is constantly updated, and although the facilities and services are continually improved, this necessitates a greater requirement for rural residents to adapt to the rapidly changing environment. The traditional rural neighborhood network built by family and clan bonds has been broken; incoming migrants and a lack of belonging and sense of identity have increased the sensitivity of rural dwellers to the neighborhood environment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The acceleration of urbanization has led to changes and challenges in the geographical environment and social structure of suburban rural areas, intensifying social inequality [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe suburban rural neighborhood environment\u0026mdash;the village in which rural residents live\u0026mdash;remains the most important working space for suburban rural residents. Rural areas near cities are also key for urban and rural integration. Rural suburban residents have both a traditional and contemporary urban life. Under the dual influence of urban and rural areas, the mental health problems faced by rural residents in the suburbs are more severe. Therefore, this study focused on rural residents in the suburbs of large cities, analyzed the mechanism of impact of the geographical environment on mental health, and explored environmental measures and spatial planning strategies to promote the mental health of rural residents to provide a scientific basis for promoting high-quality urban-rural integrated development and building a healthy China.\u003c/p\u003e"},{"header":"Theoretical framework","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eResearch on neighborhood environment and mental health\u003c/h2\u003e\u003cp\u003eThe WHO defines \u0026ldquo;health\u0026rdquo; as the state of physical, mental, and social well-being rather than the mere absence of disease, thereby extending the traditional biomedical meaning of \u0026ldquo;health without disease\" [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Early research focused on chronic diseases, infectious diseases, and physical illnesses caused by environmental influences, with insufficient attention paid to mental health. In recent years, there has been growing recognition of the important role of mental health in achieving global development goals and the inclusion of mental health in the Sustainable Development Goals.\u003c/p\u003e\u003cp\u003eThe neighborhood is the most important spatial unit in residents\u0026rsquo; daily lives, and their daily activities are anchored primarily in the neighborhood. Numerous studies have confirmed that neighborhood environments are related to residents' mental health. Studies have found that the availability of neighborhood facilities or services and the number of related facilities have a direct or indirect positive contribution to residents [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Perceived transportation disadvantages can negatively affect life satisfaction [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Studies have also found that green spaces have important restorative and recreational functions, and that exposure to green spaces can help improve mood and cognitive function; therefore, neighborhood greening can help improve mental health problems [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition, the sanitary environment, housing conditions, and similar issues also affect health [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In the social environment, community mobility and neighborhood poverty are detrimental to residents\u0026rsquo; health [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Living in a disorderly neighborhood can cause anxiety and discomfort to residents, affecting their quality of daily life [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Neighborhood interaction and cohesion are also important factors in residents' health, and studies have emphasized the importance of social trust and local community networks, indicating that the social environment is an important factor in residents' mental health [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, most previous studies measured the neighborhood environment from an objective rather than a subjective perspective. Due to differences in people's perceptions of the objective environment, it may be more accurate to explore the mental health effects of neighborhood environments by combining objective measures and subjective perceptual perspectives. In addition, the relationship between the geographical environment and mental health is complicated, and the pathways and mechanisms linking the two are largely black boxes in cognition. The effect of the geographical environment on mental health and whether the geographical environment impacts mental health through potential mediating factors need to be further explored.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eFactors associated with mental health of rural residents\u003c/h3\u003e\n\u003cp\u003eThe mental health outlook of rural populations is not optimistic [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Studies have generally found that the mental health of rural residents is significantly poorer than that of urban residents [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, there are significant differences in mental health not only between urban and rural areas but also within rural areas [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhile previous studies have confirmed the association between the geographical environment and mental health, most have been conducted in urban areas. Compared to urban areas, the living environment, services, and facilities in rural areas are relatively poor [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. For example, irrational road network planning significantly reduces the efficiency of rural transport services. Healthcare in rural areas has weaknesses in health awareness and medical resource allocation. Unlike the closed living environments in cities, rural areas in China are typical acquaintance-based societies, where communication between neighbors is more frequent and closer [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Due to the differences between urban and rural geographical environments, there may also be different effects on mental health. Studies have indicated that the stressors of rural older persons are primarily related to the built environment, whereas those of urban older persons relate more to the social environment of their neighborhoods [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The same environmental characteristics may have different effects on the mental health of urban and rural residents. In rural areas, closer neighborhoods are associated with better mental health, whereas in urban areas, this association is not significant [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Owing to the history and practices associated with green spaces (such as farming), the symbolic dimensions of green spaces in rural areas are, in some ways, completely different from those of urban green spaces, and the impact on residents' mental health may also be different [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Researchers have found that rural residents who live in a good neighborhood environment have better mental health, and those who are exposed to air pollution, noise pollution, and inadequate facilities have worse mental health [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHealth geography primarily focuses on the influence of the urban geographical environment on the mental health of urban residents, whereas the influence of the neighborhood environment on the mental health of rural residents has not been considered in sufficient depth. Rural residents, especially in suburban rural areas in the context of urban-rural integration, are experiencing rapid spatial and social transformations. Therefore, it is necessary to pay attention to the influence of the neighborhood environment on the mental health of suburban rural residents.\u003c/p\u003e\n\u003ch3\u003eConceptual framework and hypotheses\u003c/h3\u003e\n\u003cp\u003eThe suburban rural area is the transition zone of urban-rural integration development, and rural residents in suburban areas are affected by both urban and rural areas. From an administrative perspective, suburban rural areas are within urban jurisdictions. From a geospatial perspective, suburban rural areas refer to rural areas on the periphery of built-up and adjacent urban areas [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. As urban-rural integration continues to advance, the population structure of suburban rural areas becomes more diversified, and the geographical environment becomes more complicated.\u003c/p\u003e\u003cp\u003eThe neighborhood environment consists of a built environment and a social environment. The built environment shapes the social environment, and it is generally assumed that a positive built environment provides residents with places and opportunities for neighborhood interaction and community engagement [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. When residents are satisfied with their neighborhood environment, they are more connected to neighbors, and this close neighborhood relationship positively affects their mental health [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. However, other studies have suggested that neighborhood social relationships are unlikely to act as mediating variables between the built environment and mental health [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eResearch on the health effects of neighborhood environments involves the use of objective and subjective perceived geographical environmental indicators [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Objective neighborhood environments reflect the objective characteristics of neighborhoods and can provide a reference for policymaking and environmental interventions. Subjective neighborhood environments are influenced by individual preferences and environmental experiences, which can reflect the degree of matching between individual needs and the geographical environment and highlight a human-centered perspective of the environment. Objective and subjective neighborhood environments may affect mental health independently, and objective neighborhood environments may indirectly affect mental health through subjective perceptions of the neighborhood environment [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eBased on the above discussion, the theoretical research framework and hypothesized relationships are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHypothesis 1\u003c/strong\u003e\u003cp\u003eThe neighborhood environment, framed by built and social aspects, and objective and subjective aspects, is significantly associated with the mental health of suburban rural residents.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHypothesis 2\u003c/strong\u003e\u003cp\u003ePerceived neighborhood environments mediate the relationship between the objective neighborhood environment and the mental health of suburban rural residents.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eHypothesis 3\u003c/strong\u003e\u003cp\u003eThe neighborhood social environment mediates the relationship between the built environment and the mental health of suburban rural residents.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData Collection and the Sample\u003c/h2\u003e\u003cp\u003eThe study area was Zhengzhou, the capital of Henan Province, which has the largest agricultural population in China. Zhengzhou is located in the central plain of China and is a megacity. The development level of Zhengzhou is close to the overall development level of China, showing typical Chinese social, economic, and cultural characteristics. In recent years, urbanization in Zhengzhou has developed rapidly. In the decade from 2013to 2023, the urbanization rate increased from 43.8\u0026ndash;80%, and the built-up area of the central urban area increased from 382.66 square kilometers to 796.70 square kilometers. According to the 7th National Census, there were still 2,721,545 people living in rural areas of Zhengzhou by the end of 2020. The suburban rural areas of Zhengzhou are transitioning from traditional rural areas to modern cities. Suburban rural residents in Zhengzhou are affected and squeezed by both urban and rural areas, and their mental health problems pose severe challenges.\u003c/p\u003e\u003cp\u003eThe data used in this study were obtained from a questionnaire survey conducted in the rural suburbs of Zhengzhou from March to April, 2024. Multi-stage probability proportional sampling (PPS) was used. The survey first selected 10 towns around the built-up area and adjacent to the urban area of Zhengzhou central city. Then, 33 sample villages were selected from 10 suburban towns. A total of 816 valid samples were collected through random sampling of rural residents in each sample village. The sample structure was consistent with that of the Seventh National Census. The questionnaire included individual and family socioeconomic attributes, perceived neighborhood environment, and mental health assessments. For the full questionnaire content, please refer to Appendix 1. Each sample signed an informed consent form.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the socioeconomic characteristics of the sample. In the sample of suburban rural residents in Zhengzhou, 49.75% were female and the average age was 46 years. The population with a high school education or above accounted for 40.19, which is slightly lower than the national urban and rural average of 43.79%. Most respondents were married (87.01%). According to the stratification of household income, a monthly income between 2500 and 6000 yuan accounted for 41.42% of the population, and the proportion below 2500 yuan was the smallest. In terms of family structure, three generations of rural residents in the suburbs dominated, accounting for 60.66% of the total.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-economic characteristics of the sample.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eProportion (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e406\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e410\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e50.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u0026ndash;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e388\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMiddle school and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e488\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e59.80\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHigh school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUniversity and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.89\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e710\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMonthly household income (RMB)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e211\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.86\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2500\u0026ndash;6000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e338\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;6000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e267\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.72\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily intergenerational structure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne-generation family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo-generation family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThree-generation family\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e495\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e60.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFamilies of four generations and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eVariable Definition\u003c/h2\u003e\u003cp\u003eThis study focuses on two mental health outcomes: depression (negative dimension) and life satisfaction (positive dimension). Depression was assessed using the CESD-10, a ten-item self-report scale designed to identify depressive symptoms in the general population. All items are rated on a 4-point Likert scale based on the frequency of negative mental experiences, from \u0026ldquo;always\u0026rdquo; (score 1) to \u0026ldquo;never\u0026rdquo; (score 4). The scores of the 10 items are summed to produce the depression score. The scale has shown good internal consistency (Cronbach's α\u0026thinsp;=\u0026thinsp;0.816). Mental health is not just the absence of mental disorders. Therefore, in addition to depression, we used Diener\u0026rsquo;s Life Satisfaction Scale to measure mental health. This scale scores the degree of five positive psychological experiences from \u0026ldquo;strongly disagree\u0026rdquo; (score 1) to \u0026ldquo;strongly agree\u0026rdquo; (score 7). In this study, the Cronbach's α was 0.853. The scores of the five items are summed; higher scores indicate better mental health. These scales have been widely used in mental health research and demonstrated good reliability and validity [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe neighborhood environment may be described by both objective measurements and subjective perception data (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In the built environment of neighborhoods, the dual system of urban and rural areas has resulted in rural residents becoming more dependent on their neighborhoods for amenities. Transportation, education, and healthcare facilities, which are important components of life, are the most fundamental neighborhood facilities. The diversification of shopping facilities can provide more shopping choices in residents' daily lives, which, to a certain extent, enhances the quality of life of rural residents. The distance from the city center reflects the locational conditions of the residential neighborhood. Therefore, we chose the number of bus stops and schools, the density of health and shopping facilities within 1 square kilometer of the geometric center of the village, and the straight-line distance to the city center as objective built environment indicators of the neighborhood. We also included subjective perceived assessments of housing quality, accessibility of transportation, shopping convenience, sanitary conditions, and neighborhood greenery. In a neighborhood\u0026rsquo;s social environment, under the influence of urban expansion, the original social network formed by clan and family relationships in suburban rural areas is deconstructed and residents are forced to establish new social relations. During the processes of deconstruction and reconstruction, the mental health of rural residents may fluctuate accordingly. Therefore, we chose the number of friends in the neighborhood, neighborhood interactions, and the proportion of the population that was not originally from the area as objective social environment indicators. As subjective social environment indicators we chose subjective perception and evaluation of neighborhood relationships, neighborhood safety, and neighborhood services. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e lists the variables selected and assigned to the models.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eVariable measurement.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLatent variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObserved variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDescription\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMental health (MH)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eY1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePsychological state over the last month: \u0026nbsp;Total scores range from 10 to 40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLife satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eY2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOverall satisfaction with life: \u0026nbsp;Total scores range from 5 to 35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObjective built environment (OBE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of bus stops\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNumber of bus stops in a 1-km buffer zone of the neighborhood where respondents live\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of schools\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNumber of schools in a 1-km buffer zone of the neighborhood where respondents live\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth facility density\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHealth facility density in a 1-km buffer zone of the neighborhood where respondents live\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShopping facility density\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eShopping facility density in a 1-km buffer zone of the neighborhood where respondents live\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDistance to city center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eA5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe straight-line distance from the neighborhood to the city center\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubjective built environment (SBE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHousing quality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eB1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe housing quality is very satisfactory: 1 (strongly disagree) to 5 (strongly agree)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTransportation accessibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eB2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe neighborhood transportation is very convenient, it is easy to go anywhere: 1 (strongly disagree) to 5 (strongly agree)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eShopping convenience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eB3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe neighborhood shopping facilities are convenient: 1 (strongly disagree) to 5 (strongly agree)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSanitary conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eB4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe public space in the neighborhood is clean and tidy: 1 (strongly disagree) to 5 (strongly agree)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeighborhood greening\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eB5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe greening in the neighborhood is well designed: 1 (strongly disagree) to 5 (strongly agree)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObjective social environment (OSE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeighborhood friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eC1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNumber of friends living in the same neighborhood: 1 (\u0026le;\u0026thinsp;10), 2 ( 10\u0026ndash;25), 3 ( 26\u0026ndash;50), 4 ( 51\u0026ndash;70), 5(\u0026ge;\u0026thinsp;70)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeighborhood interactions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eC2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency of interactions with neighbors: 1 (infrequent) to 5 (frequent)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProportion of population not originally from the area\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eC3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe proportion of immigrants and natives in the daily life of the neighborhood: 1 (fewer migrants) to 5 (fewer locals)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSubjective social environment (SSE)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeighborhood relationships\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eD1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEvaluation of satisfaction with neighborhood relationships: 1 (unsatisfactory) to 5 (satisfactory)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeighborhood safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eD2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEvaluation of satisfaction with neighborhood safety: 1 (unsatisfactory) to 5 (satisfactory)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeighborhood services\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eD3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eEvaluation of satisfaction with neighborhood services: 1 (unsatisfactory) to 5 (satisfactory)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis study adjusted the study for covariates of suburban rural residents\u0026rsquo; sociodemographic and family structure characteristics. For individual-level covariates, this study included gender (binary variable: male vs. female), age (continuous variable), education (categorical variable), and marital status (binary variable: married vs. not married). These are common indicators in mental health research. For covariates of family characteristics, this study used monthly household income (continuous variable) and family intergenerational structure (categorical variable). Household income affects the material living conditions and also represents the family's ability to resist risks. Family intergenerational structure can reflect the needs of the family's neighborhood environment, and living with family members can increase family support.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThis study used structural equation modeling (SEM) to analyze the relationship between the neighborhood environment and the mental health of suburban rural residents. The neighborhood environment is a comprehensive multi-dimensional concept that includes both built and social environments, as well as subjective and objective neighborhood environments. Each dimension of the neighborhood environment is a latent variable constructed by a series of observable variables, and the relationship between these latent variables. Mental health is a multidimensional concept that must be characterized by observational variables. SEM primarily uses a covariance matrix of variables, including measurement and structure models. Measurement models fit the relationship between observed and latent variables to model constructs that cannot be directly measured. Structural models primarily deal with causality between different variables, allowing the dependent variable to act as both an outcome and an explanatory variable. SEM can also be used to estimate the regression effects between independent and dependent variables, facilitating the analysis of complex direct and indirect effects [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eAnalysis of structural equation model estimation and test results\u003c/h2\u003e\u003cp\u003eWe conducted goodness-of-fit measurements for the SEM (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). All indicators met the recommended standards, indicating that the model fit the data well.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the results of the measurement model analysis. The loadings of each measurement variable were between 0.643 and 0.916, indicating that each measurement item reflected well the score of the latent variable. The combined reliability (CR) of each latent variable was between 0.895 and 0.932, which was greater than the criterion of 0.7, indicating good internal consistency of each measured variable. The average variance extracted (AVE) of each latent variable was between 0.733 and 0.820, which was greater than the criterion of 0.5, indicating good convergent validity of each item. In summary, the measurement models of subjective and objective built and social environments were reasonable and could be included in structural equation models as latent variables.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIndicators of model fit.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/df\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRMSEA\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCFI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eNFI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIdealized goodness of ft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1–3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt; 0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt; 0.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026gt; 0.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026gt; 0.90\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGoodness of ft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.929\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.928\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.933\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eConstructs, measurement items, and reliability and validity tests.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLatent variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObserved variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFactor loadings\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eT-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAVE\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eY1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.714\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFixed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.895\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.733\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eY2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.892\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOBE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.689\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFixed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.932\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.816\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.905\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.061\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.916\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.117\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.910\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eA5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.683\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-4.318\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.732\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFixed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.820\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.671\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.643\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.145\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.848\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.782\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.462\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003efixed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.999\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eC3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e-0.667\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-4.655\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSSE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eD1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.662\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFixed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.899\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.801\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eD2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.795\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eD3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.704\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11.563\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePath analysis results: The direct path of the impact of the neighborhood environment on the mental health of suburban rural residents\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe neighborhood environment was differentially associated with the mental health of suburban rural residents (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The objective social environment had a significant positive effect on mental health, with a direct effect of 0.273. With increased neighborhood interactions and friends in the neighborhood, rural residents can build their social networks and neighborhood support, which can alleviate negative emotions in daily life and enhance the sense of neighborhood belonging, thus promoting mental health. Incoming migrant populations can break up existing social networks and cause uncertainty, which is not conducive to harmonious social relationships and has a negative impact on mental health. The subjective social environment had a positive direct effect on mental health, with a direct effect of 0.323. The subjective social environment had a greater impact on mental health than did the objective social environment. This may be because the perceived assessment of neighborhood relations, neighborhood safety, and neighborhood services reflect the degree to which the neighborhood environment meets the needs of residents. Building a harmonious neighborhood context and enhancing residents' positive perceptions of the social environment can promote their mental health. Neighborhood facilities, such as bus stops, schools, and health and shopping facilities, can significantly improve the neighborhood built environment, whereas the distance from the city center is significantly negatively correlated with the built environment. However, the relationship between the objective neighborhood environment and mental health did not reach statistical significance. Similarly, subjective assessment of the built environment in the neighborhood a positive but nonsignificant effect on mental health. This may be because of the proximity of suburban rural areas to urban areas and the ease of access to townships and urban areas for relevant services and facilities. Moreover, the physical environment of the suburban rural areas changes rapidly in the context of rapid urbanization, and mental health tends to be the result of a long-term cumulative effect, short-term built environment experience is not enough to have a significant impact on mental health [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study confirmed that the mental health of suburban rural residents is affected by the neighborhood environment, and that improving the neighborhood environment can improve the mental health of residents. Thus, Hypothesis \u003cspan refid=\"FPar2\" class=\"InternalRef\"\u003e1\u003c/span\u003e was partially verified (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). However, different dimensions of the neighborhood environment had different effects on mental health. Compared with the objective neighborhood environment, the subjective perceived neighborhood environment had a greater impact on mental health. The perceived neighborhood environment assessment not only reflects the status of the neighborhood environment but also reveals the extent to which the neighborhood environment meets the needs and expectations of rural residents. The subjective and objective neighborhood social environments had a direct effect on the mental health of suburban rural residents, whereas the effect of the built environment was not significant.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePath analysis for SEM.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathways\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDirect effect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHypothesis test\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOBE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnsupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnsupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOSE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.273\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSSE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.323\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eIndirect effects: Mediation effects of the neighborhood environment on the mental health of suburban rural residents\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe neighborhood environment not only has a direct impact on mental health, but may also affect mental health through indirect pathways [\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e–\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. This study comprehensively examined the potential mediating effects of the different dimensions of the neighborhood environment (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The objective social environment positively affected the mental health of rural suburban residents through the subjective social environment, with an indirect effect of 0.519. This may be because the objective social environment can enhance residents’ sense of identity with their neighborhood, which further enhances the solidity of the neighborhood's social environment and improves residents' mental health. Thus, Hypothesis \u003cspan refid=\"FPar3\" class=\"InternalRef\"\u003e2\u003c/span\u003e was verified.\u003c/p\u003e\u003cp\u003eThis study further validated that the social environment mediates the effects of the built environment on mental health. The objective built environment affected mental health through the objective social environment, with an indirect effect of 0.070. The objective built environment has a significant negative impact on the objective social environment, which ultimately has a positive impact on mental health. Neighborhoods with a higher quality objective built environment tend to be more affected by urbanization, which has a greater impact on traditional social neighborhoods. The subjective built environment positively affected mental health through the subjective and objective social environments, with indirect effects of 0.568 and 1.133, respectively. Convenient neighborhood facilities and services can enhance residents' social interactions and neighborhood relations, improve their evaluation of neighborhood social environments, and promote mental health. In the chain mediation process, both the objective and subjective built environments affected the objective social environment, the subjective social environment, and, ultimately, mental health. This finding is consistent with previous studies that emphasized the mediating role of the social environment in the relationship between the built environment and mental health [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Thus, Hypothesis \u003cspan refid=\"FPar4\" class=\"InternalRef\"\u003e3\u003c/span\u003e was supported.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMediation effects of structural equation model.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePathways\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIndirect effect\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHypothesis test\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOBE→SBE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnsupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOSE→SSE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.519\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOBE→OSE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOBE→OSE→SSE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.316\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOBE→SSE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.271\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eUnsupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBE→OSE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.568\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBE→OSE→SSE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.814\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBE→SSE→MH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSupported\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion and conclusions","content":"\u003cp\u003eWith the continuous advancement of urban-rural integration, China has made remarkable progress in coordinating urban and rural development and promoting new urbanization. However, problems remain prominent, such as difficulties in integrating urban and rural factors, the irrational allocation of public resources, and the wide gap between urban and rural development [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. These problems can easily lead to anxiety, depression, injustice, and other negative emotions, which can cause significant damage to the mental health of rural residents. The suburban rural areas of large cities, where many factors of the urban and rural economy, society, and culture interact and interpenetrate, are intermediate zones that differ from both the city and the general countryside and regions and where a variety of social contradictions are concentrated and prominent. Suburban rural residents, who are affected by both rural habits and contemporary urban lifestyles, are experiencing rapid disintegration and reconstruction of the traditional physical and social environment and are facing an increasing risk severe mental health problem. Therefore, this study considered residents of Zhengzhou City to explore the relationship between the multi-dimensional neighborhood environment and mental health of suburban rural residents.\u003c/p\u003e\u003cp\u003eWe found that for suburban rural residents, improving the neighborhood environment can promote mental health. Both the objective and subjective neighborhood social environments can directly promote mental health, which is consistent with existing environmental health studies [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. China's traditional rural society relies primarily on family and kinship to construct social networks and identities. However, with urbanization, the traditional neighborhood relationships in suburban rural areas have been destroyed and replaced by a weak relationship network composed of neighbors in modern society. Building stable social relations and strengthening neighborhood cohesion and the social network of rural residents in the suburbs can enhance their sense of neighborhood belonging and identity, and thus promote their mental health. In contrast to previous studies of urban environmental health, the direct effect of the built environment on the mental health of suburban rural residents was not significant. This may be because, in the rapid process of urbanization in China, some suburban areas have been continuously incorporated into the scope of urban built-up areas through urban expansion, and urban space continues to expand, while rural space continues to be squeezed [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Although suburban rural areas still have a rural identity, they are profoundly influenced by cities. The gradual modernization of the traditional rural physical landscape has brought about rapid changes in the built environment, and people's experiences of it have not been deep or sustained enough to have a direct impact on their mental health.\u003c/p\u003e\u003cp\u003eOur research also found that the neighborhood environment not only directly affected the mental health of rural residents in the suburbs but also indirectly affected mental health through mediation. First, the subjective social environment played a significant mediating role between the objective social environment and mental health. That is, the objective social environment affected residents' subjective assessments of the social environment and their mental health. The objective neighborhood environment includes many friends in the neighborhood, close neighborhood interactions, and a smaller incoming migrant population, which can promote the formation of a stable neighborhood social structure. This stable social structure can increase residents’ perception of neighborhood relations as well as their evaluation of neighborhood safety and management, enhancing their belonging to and identification with their neighborhood, which further improves their mental health. Second, although the built environment did not directly affect mental health, it did so indirectly through the social environment. The objective built environment is negatively correlated with the social environment because improvement of the built environment in suburban rural areas accelerates the disintegration of the traditional social environment. However, the social environment was significantly positively correlated with mental health, offsetting some of the negative effects of the built environment and ultimately realizing the objective contribution of the built environment to mental health. Improvements in the subjective built environment can promote the social environment and improve the mental health of suburban rural residents. To some extent, the subjective built environment reflects residents' satisfaction with neighborhood facilities [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Improvement of the subjective built environment can increase neighborhood interactions and promote social relations, thus improving mental health.\u003c/p\u003e\u003cp\u003eIn the context of rapid urbanization in China, this study focused on the suburban rural areas of large cities to explore the influence of multi-dimensional neighborhood environments on the mental health of suburban rural residents. The findings have important implications for the development of policy interventions that promote rural residents’ mental health. In contrast to the single-dimensional neighborhood environment that has been considered in previous studies, this study focused on the subjective and objective neighborhood built and social environments, respectively, and analyzed the complex pathways through which different dimensions of the neighborhood environment affect mental health. This study also increases the understanding of the mental health status of rural residents in the suburbs and contributes to understanding the special geographical environment of suburban rural areas and the unique life changes of their residents in the context of urban-rural integration. Urbanization not only affects urban areas but also profoundly affects rural areas, especially suburban rural areas [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Neighborhood environments in suburban rural areas continue to disintegrate and restructure. In this rapid, dynamic change, residents are faced with constant adjustment and adaptation to the new environment, which affects their mental health [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Improving the built and social environments of neighborhoods can effectively enhance the mental health of rural and suburban residents. The social environment can not only directly affect mental health but can also mediate between the built environment and mental health. In addition to providing an objectively beneficial neighborhood environment, it is necessary to combine this with the psychological needs of rural residents in the suburbs and provide them with differentiated and targeted neighborhood environments based on their subjective perception and evaluation of the neighborhood environment to improve their mental health.\u003c/p\u003e\u003cp\u003eOur study had several limitations. First, this study used cross-sectional data analysis and therefore cannot determine causal paths. For example, residents with better mental health may choose to live in communities with better neighborhood environments. Future research should also consider the impact of residential self-selection on environmental health effects. Second, this study focused on rural residents in the suburbs; whether the findings of this study are applicable to all rural residents requires further verification. Despite these limitations, this study enriches environmental health research and increases understanding of the relationship between the neighborhood environment and the mental health of suburban rural residents. Future studies should conduct longitudinal investigations to explore the causal mechanisms between the environment and health, further expanding the scope of research to analyze the relationship between mental health and the neighborhood environment of rural residents in different spatial locations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eMH \u0026nbsp; \u0026nbsp;Mental health\u003c/p\u003e\n\u003cp\u003eOBE \u0026nbsp; Objective built environment\u003c/p\u003e\n\u003cp\u003eSBE \u0026nbsp; \u0026nbsp;Subjective built environment\u003c/p\u003e\n\u003cp\u003eOSE \u0026nbsp; \u0026nbsp;Objective social environment\u003c/p\u003e\n\u003cp\u003eSSE \u0026nbsp; \u0026nbsp;Subjective social environment\u003c/p\u003e\n\u003cp\u003eSEM \u0026nbsp; structural equation modeling\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki. This study does not involve clinical trials and individual privacy. The survey was approved by the Academic Committee of Henan University. Written informed consent was obtained from all participants before data collection. All methods of this study were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by\u0026nbsp;National Natural Science Foundation of China\u0026nbsp;(grant number:\u0026nbsp;42301282, 42401298, 42201265).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe conceptualization of this study was driven by SLL. Data collection was performed by SLL and SJ. Subsequently, data analyses were completed by SLL and XJB. The manuscript was written by SLL. Additionally, critical revisions for important intellectual content were carried out by SLL. Ultimately, all authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank those who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter publication, anonymized data underlying the results and analysis can be made available to researchers upon reasonable request to the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. 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Public Health. 2004; 94(10): 1682-1686.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"suburban rural, neighborhood environment, mental health, Zhengzhou","lastPublishedDoi":"10.21203/rs.3.rs-6835365/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6835365/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eEnvironmental health research focuses primarily on the influence of the urban geographical environment on the mental health of urban residents, whereas few studies have considered the effect of the neighborhood on rural residents' mental health. In particular, suburban rural areas of large cities face serious challenges in terms of neighborhood environments and mental health in the context of rapid urbanization.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eData were collected in 2024 from 816 respondents living in 33 suburban villages of Zhengzhou China. This study used the structural equation model to explore the pathways of multi-dimensional neighborhood environments on the mental health of suburban rural residents.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe results show that the social environment is closely related to the mental health of suburban rural residents, and that the objective social environment not only directly affects the mental health, but also affects the mental health through the subjective social environment. The built environment does not directly affect mental health but can indirectly affect mental health through the social environment. From the perspective of neighborhood effect, the mental health of suburban rural residents is more affected by subjective environment than objective environment, and social environment than built environment.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eConsidering the psychological needs of suburban rural residents to improve the neighborhood environment can improve their mental health and promote high-quality urban-rural integration.\u003c/p\u003e","manuscriptTitle":"How does the neighborhood environment affect the mental health of suburban rural residents in China?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-10 07:03:36","doi":"10.21203/rs.3.rs-6835365/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-07-31T05:50:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-21T16:03:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"73662453607801509862670041975779517547","date":"2025-07-10T07:04:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"141732407674787547029373259728350490115","date":"2025-07-08T14:06:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271587813130541722710274727876953002482","date":"2025-07-08T10:09:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-08T07:01:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-08T06:50:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-23T03:43:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-21T03:17:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-06-21T03:14:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4d2343a0-b299-45df-995d-4988ecae192a","owner":[],"postedDate":"July 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-10T07:03:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-10 07:03:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6835365","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6835365","identity":"rs-6835365","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}