RATIONALE: Two gaps in the literature arise on the relationship between social cohesion and depressive disorders. Firstly, there is a lack of studies comparing countries with diverse communal bonds and population-level differences in depression. Secondly, most work on explanatory mechanisms has overwhelmingly focussed on social network and social support pathways. OBJECTIVES: We compared the prospective association between perceived neighbourhood social cohesion and depressive symptoms among older adults in England, the Czech Republic, Poland and Russia; and examined whether psychological and health behavioural pathways mediated this association. METHODS: Harmonized data on 26,081 adults from the English Longitudinal Study of Ageing (ELSA), and the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) studies were analysed. Prospective associations between perceived neighbourhood social cohesion at baseline and depressive symptoms at follow-up were assessed using multivariable negative binomial regression. The psychological (through control of life, and control at home) and health behavioural (through smoking and drinking) pathways were tested using path analysis. RESULTS: Low cohesion predicted a higher number of depressive symptoms at follow-up among English (b = 0.106, p = 0.001), Czech (b=0.203, p < 0.001), Polish (0.115, p < 0.001) and Russian adults (b = 0.087, p < 0.001). Indirect effects via psychological mechanisms were strong and explained 64% (Poland), 82% (Russia), 84% (England) and 95% (Czech Republic) of the total indirect effects from low cohesion to elevated symptoms in these populations. Indirect effects via health behaviours were much weaker by comparison. CONCLUSIONS: Prospective associations between low social cohesion and increased depressive symptoms were largely congruent among older adults from England and three Central and Eastern European countries. These associations operated via a psychological, but not a health behavioural, pathway among ageing adults living in diverse parts of Europe.

Centre for Environmental Health Monitoring National Institute of Public Health Šrobárova 48 10042 Prague Czech Republic

Faculty of Physical Education and Sport Charles University José Martího 31 Prague 6 162 52 Czech Republic

Institute of Public Health Faculty of Health Sciences Jagiellonian University Medical College Grzegórzecka 20 31 531 Krakow Poland

Novosibirsk State Medical University Borisa Bogatkova 175 1 630089 Novosibirsk Russia

Research Department of Epidemiology and Public Health University College London 1 19 Torrington Place London WC1E 7HB United Kingdom

Research Institute of Internal and Preventive Medicine Branch of the Institute of Cytology and Genetics SB RAS Prospekt Lavrentyeva 10 630090 Novosibirsk Russia

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