Date of Award

Fall 2021

Document Type

Open Access Dissertation



First Advisor

Bret Kloos


The relationship between environmental factors and individual health outcomes has historically been a major area of interest for multiple scientific disciplines. However, the specific environmental factors relevant for describing this relationship and effective measuring methods are unclear. One approach that may assist in addressing these issues is by analyzing this relationship using a comprehensive theoretical framework. This study used a social-ecological model first proposed by Moos and colleagues (Insel & Moos, 1974: Moos & Moos, 1976) to investigate connections between environmental factors and mental health recovery outcomes of psychiatric distress, management of mental health symptoms, and recovery-oriented behavior. A series of hierarchical regression models were used to determine the relative strength of association to mental health outcomes for four variables: Objective Structural Factors (O-S), Subjective Structural Factors (S-S), Objective Psychosocial Factors (O-P), and Subjective Psychosocial Factors (S-P).Environmental factors were assessed using resident perceptions from a sample of persons with serious mental illness and a combination of researcher observations and geocoded GIS data. The results of these models supported hypotheses consistent with a social-ecological model; that psychosocial environmental factors more “proximal” to residents significantly influence individual health outcomes unaccounted for by more “distal” structural environmental factors. Furthermore, the results illustrate that psychosocial environmental factors and subjective measurements of these factors explain a significant amount of variance in individual mental health outcomes even when accounting for variance explained by other variables. Finally, this study revealed that environmental factors have a modest impact on individual mental health factors. Findings from this study have implications for community integration and independent living for persons with serious mental illness, advocacy efforts for residents, and policy decisions for community leaders to promote and maintain positive mental health outcomes within environments.