Housing Conditions, Neighbourhood Satisfaction and Suicide Mortality in Belgium: A Population-Based Cohort Study

Background Housing and neighbourhood conditions are increasingly recognised as structural determinants of mental health, yet their role in suicide mortality remains poorly quantified. We examined how housing quality and neighbourhood satisfaction are associated with suicide risk in the Belgian working-age population, and whether these associations vary across life stages or according to concordance between housing and neighbourhood conditions. Methods We used linked data from the 2001 Belgian Census, the National Register and cause-of-death records to construct a population-based cohort of all adults aged 25–69 years (N = 2.8 million) followed for suicide mortality between 2002 and 2006. Housing and neighbourhood quality scores were derived using principal component analysis from detailed census items on dwelling characteristics, installations and satisfaction with the immediate environment and local services. We estimated sex-specific Cox proportional hazards models for suicide, adjusting for demographic and socioeconomic characteristics, subjective health, residential duration and municipal deprivation. We tested interactions with age group and neighbourhood satisfaction and conducted robustness checks excluding imputed data, restricting to respondents in good self-rated health, and applying Fine-Gray competing-risks models. Results Compared with living in the lowest quartile of housing quality, residence in the highest quartile was associated with a 13% lower suicide hazard among men and a 21% lower hazard among women, net of individual and contextual covariates. Neighbourhood satisfaction showed only weak overall associations with suicide risk. However, among individuals living in good-quality housing, higher neighbourhood satisfaction was associated with lower suicide hazards, whereas among those in poor-quality housing, neighbourhood satisfaction did not attenuate the elevated suicide risk. We found no clear evidence that associations between housing quality and suicide differed across adult life stages. Robustness analyses yielded similar patterns. Conclusions In early-2000s Belgium, poor housing conditions were strongly associated with higher suicide mortality, independently of conventional sociodemographic risk factors. Neighbourhood advantages appeared protective only when basic housing adequacy was ensured, and did not compensate for poor housing. Suicide prevention and mental health policy should therefore consider housing quality as a key determinant, alongside efforts to improve neighbourhood environments. Trial registration not applicable