The path to mental health: Associations between walkability and depression prevalence in west Virginia

Despite increasing awareness of walkable neighborhoods’ health benefits, the relationship between walkability and mental health remains unclear. This study examined the relationship between walkability and depression in West Virginia which has the highest rate of depression according to 2023 CDC report. Increasing neighborhood walkability was hypothesized to result in a reduction in mental health encounters. Using the most recent census tract boundaries in West Virginia (N = 546), National Walkability Index (NWI) scores were aggregated from 2019 block group data to tract-level averages. Depression prevalence was obtained from CDC PLACES, and population data were sourced from the U.S. Census Bureau. Multiple imputations were applied to address missing data as the result of mismatches between the 2019 NWI and 2024 tract boundaries, and regression analyses were conducted using both imputed and complete-case datasets. In the imputed model, no significant association was found between walkability and depression (β = 0.03, p = 0.631). However, the complete-case model revealed a small but statistically significant positive relationship between walkability and depression (β = 0.04, p = 0.046). Population showed a consistent inverse association with depression in both models. Contrary to prior assumptions, higher walkability was associated with increased depression in the complete-case analysis. These findings highlight the complex relationship between the built environment and mental health and suggest that walkability alone may not be protective against depression. Future studies should incorporate additional contextual and sociodemographic factors while examining such a relationship.