A cohort study examining factors associated with improvement in mental health symptoms among residents of a low-income neighborhood facing multiple axes of marginalization
- 1Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- 2Faculty of Medicine, University of British Columbia, Vancouver, Canada
- 3Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
Abstract
Background: Structurally marginalized populations living with poverty in the urban core of large cities are disproportionately affected by mental health problems. We undertook an analysis to determine what factors are associated with improvements in mental health symptoms over time among clients of a primary care clinic in the Downtown Eastside of Vancouver, Canada.
Methodology: Beginning in June 2021, we enrolled clients of a low-barrier integrated primary care clinic, and administered surveys every six months until December 2023. Symptoms for depression and anxiety were measured using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and Generalized Anxiety Disorder-7 (GAD-7) scales. We used logistic regression with Generalized Estimating Equations to examine associations between sociodemographic and structural factors, substance use and clinical factors and improvements in mental health symptoms.
Results: We included 455 participants, with complete GAD-7 and CESD-10 assessments at baseline. Of these, 67.2% identified as men, 30.9% as women, and 1.7% as other gender identities. The median age was 46 years (IQR: 38–54) and 23.6% were currently homeless and 61.4% had a past history of homelessness. At baseline, 69.0% had CESD-10 scores ≥10 and 44.8% had GAD-7 scores ≥10. Of participants with at least one visit with a CESD-10 or GAD-7 score ≥10, 43.3 of those with high CESD-10 scores and 54.5% of those with high GAD-7 scores had at least one visit where their score was subsequently <10. Depression score improvement was less likely among participants with food insecurity (adjusted odds ratio [aOR]=0.54; 95% CI 0.37-0.78), higher loneliness scores (aOR =0.77; 95% CI 0.65-0.92), and self-reported depression diagnosis (aOR=0.40; 95% CI 0.19-0.85), while higher odds were observed among Indigenous participants (aOR=1.36; 95% CI 1.02-1.82). Anxiety improvement was less likely among women (aOR=0.71; 95% CI 0.53-0.97), participants reporting recent injection drug use (aOR=0.61; 95% CI 0.43-0.84), or food insecurity (aOR=0.50; 95% CI 0.31-0.77) and those who ranked mental health as a top health priority (aOR=0.41; 95% CI 0.25-0.67).
Conclusion: A substantial proportion of clients demonstrated improvements in depression and anxiety symptoms over time. However, persistent barriers including food insecurity, substance use, and loneliness underscore the need for structural interventions.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28803-1.
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BibTeX
@article{sharma2026cohort,
title = {{A cohort study examining factors associated with improvement in mental health symptoms among residents of a low-income neighborhood facing multiple axes of marginalization}},
author = {Riya Sharma and Wendy Zhang and Jenny Li and Kate Salters and Paul Sereda and Cole Stanley and Ron Joe and Silvia Guillemi and Viviane Dias Lima and Gabriela Sincrain and Antonio Marante Changir and Rebecca Parry and Julio Montaner and Surita Parashar and Katie Timms and David M Moore},
journal = {BMC Public Health},
year = {2026},
month = aug,
doi = {10.1186/s12889-026-28803-1},
url = {https://doi.org/10.1186/s12889-026-28803-1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - A cohort study examining factors associated with improvement in mental health symptoms among residents of a low-income neighborhood facing multiple axes of marginalization
AU - Riya Sharma
AU - Wendy Zhang
AU - Jenny Li
AU - Kate Salters
AU - Paul Sereda
AU - Cole Stanley
AU - Ron Joe
AU - Silvia Guillemi
AU - Viviane Dias Lima
AU - Gabriela Sincrain
AU - Antonio Marante Changir
AU - Rebecca Parry
AU - Julio Montaner
AU - Surita Parashar
AU - Katie Timms
AU - David M Moore
PY - 2026
DA - 2026/08/12
JO - BMC Public Health
DO - 10.1186/s12889-026-28803-1
UR - https://doi.org/10.1186/s12889-026-28803-1
AB - Background: Structurally marginalized populations living with poverty in the urban core of large cities are disproportionately affected by mental health problems. We undertook an analysis to determine what factors are associated with improvements in mental health symptoms over time among clients of a primary care clinic in the Downtown Eastside of Vancouver, Canada. Methodology: Beginning in June 2021, we enrolled clients of a low-barrier integrated primary care clinic, and administered surveys every six months until December 2023. Symptoms for depression and anxiety were measured using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and Generalized Anxiety Disorder-7 (GAD-7) scales. We used logistic regression with Generalized Estimating Equations to examine associations between sociodemographic and structural factors, substance use and clinical factors and improvements in mental health symptoms. Results: We included 455 participants, with complete GAD-7 and CESD-10 assessments at baseline. Of these, 67.2% identified as men, 30.9% as women, and 1.7% as other gender identities. The median age was 46 years (IQR: 38–54) and 23.6% were currently homeless and 61.4% had a past history of homelessness. At baseline, 69.0% had CESD-10 scores ≥10 and 44.8% had GAD-7 scores ≥10. Of participants with at least one visit with a CESD-10 or GAD-7 score ≥10, 43.3 of those with high CESD-10 scores and 54.5% of those with high GAD-7 scores had at least one visit where their score was subsequently <10. Depression score improvement was less likely among participants with food insecurity (adjusted odds ratio [aOR]=0.54; 95% CI 0.37-0.78), higher loneliness scores (aOR =0.77; 95% CI 0.65-0.92), and self-reported depression diagnosis (aOR=0.40; 95% CI 0.19-0.85), while higher odds were observed among Indigenous participants (aOR=1.36; 95% CI 1.02-1.82). Anxiety improvement was less likely among women (aOR=0.71; 95% CI 0.53-0.97), participants reporting recent injection drug use (aOR=0.61; 95% CI 0.43-0.84), or food insecurity (aOR=0.50; 95% CI 0.31-0.77) and those who ranked mental health as a top health priority (aOR=0.41; 95% CI 0.25-0.67). Conclusion: A substantial proportion of clients demonstrated improvements in depression and anxiety symptoms over time. However, persistent barriers including food insecurity, substance use, and loneliness underscore the need for structural interventions. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28803-1.
SN - 1471-2458
ER -