The effect of urban-area unemployment on the mental health of citizens differs between Slovak and Dutch cities Martina Behanova a,b,c,n , Iveta Nagyova a,b,c , Zuzana Katreniakova a,b,c , Erik J.C. van Ameijden d , Jitse P. van Dijk a,e , Sijmen A. Reijneveld e a Graduate School Kosice Institute for Society and Health, Safarik University, Trieda SNP 1, 04011 Kosice, Slovak Republic b Department of Social Medicine, Medical Faculty, PJ Safarik University Kosice, Trieda SNP 1, 04011 Kosice, Slovak Republic c Slovak Public Health Association – SAVEZ, Trieda SNP 1, 04011 Kosice, Slovak Republic d Municipal Health Service, Jaarbeursplein 17, 3521 AN Utrecht, The Netherlands e Department of Health Sciences, University Medical Center Groningen, University of Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands article info Article history: Received 22 March 2013 Received in revised form 25 September 2013 Accepted 29 September 2013 Available online 9 October 2013 Keywords: Urban health Mental health Area deprivation Socioeconomic inequalities abstract Conclusive evidence on the association of mental health problems (MHP) with area unemployment is lacking in regard to Central European cities. We obtained data on residents aged 19–64 from Slovak and Dutch cities from the FP7 EURO-URHIS 2 project. Multilevel logistic regression showed that the association between MHP (GHQ-12-total score Z2) and area unemployment was strong in the Netherlands, but absent in Slovakia. Slovak citizens from the most favourable neighbourhoods had nearly double the risk of MHP than their Dutch counterparts. Individual-level socioeconomic characteristics did not explain area differences. The effect of urban-area unemployment seems to differ between Central European and Western European countries. & 2013 Elsevier Ltd. All rights reserved. 1. Introduction The urban context is known for a frequently higher prevalence of mental health disorders (Pinto-Meza et al., 2013; Galea et al., 2005; de Vries et al., 2003). This especially concerns deprived neighbourhoods (Mair et al., 2008; Matheson et al., 2006). This phenomenon is explained in two ways. First, there is a higher occurrence of stressors in deprived urban areas, such as crowding and noise (Guite et al., 2006), a densely built environment (Galea et al., 2005), more crime and violence in the area, a lack of green spaces (Sugiyama et al., 2008) and a lack of economic resources (Pattyn et al., 2011), which may function as triggers of mental health problems (MHP). Second, a selective migration of residents may occur to and within cities; i.e. people with poor (mental) health tend to move to poor urban neighbourhoods (Piro et al., 2007) or those with poor mental health are less able to move out of poor urban neighbourhoods than their neighbours with good mental health. Studies that examined the effect of neighbourhood socioeco- nomic position on mental health disorders are not consistent in their findings (Mair et al., 2008). Some studies concluded that living in socially and economically deprived neighbourhoods contributed to an increased risk of mental health disorders independent of individual characteristics (Galea et al., 2007; Matheson et al., 2006; Ross, 2000). Others reported that a higher prevalence of mental health disorders in socioeconomically disadvantaged neighbour- hoods is the result of a concentration of residents with low socio- economic status in deprived neighbourhoods (Pikhartova et al., 2009; Reijneveld and Schene, 1998; Propper et al., 2005). To our knowledge only three studies have estimated the prevalence of mental health problems in urban areas in the healthy adult population in Central European (CE) countries (Pikhartova et al., 2009; Nicholson et al., 2008; Bobak et al., 2006). From those, only one (Pikhartova et al., 2009) examined the association between depressive symptoms and socioeconomic area deprivation (in the Czech Republic). The other two (Nicholson et al., 2008; Bobak et al., 2006) provide evidence that the so-called East–West health gap is also present for mental health. They found a higher prevalence of depressive symptoms in the urban population in Poland and Russia compared with the Czech Republic. However, a direct comparison of a Central and a Western European (WE) country regarding mental health problems in Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/healthplace Health & Place 1353-8292/$ - see front matter & 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.healthplace.2013.09.013 n Corresponding author at: Department of Social Medicine, Medical Faculty, PJ Safarik University Kosice, Trieda SNP 1, 04011 Kosice, Slovak Republic. Tel.: þ421 55 234 3455. E-mail address: martina.behanova@upjs.sk (M. Behanova). Health & Place 24 (2013) 210–215