Neighborhood disadvantage in context: the influence of urbanicity on the association between neighborhood disadvantage and adolescent emotional disorders

Abstract

Purpose: Inconsistent evidence of a relationship between neighborhood disadvantage and adolescent mental health may be, in part, attributable to heterogeneity based on urban or rural residence. Using the largest nationally representative survey of US adolescent mental health available, we estimated the association between neighborhood disadvantage and adolescent emotional disorders and the extent to which urbanicity modified this association.

Methods: The National Comorbidity Survey Replication Adolescent Supplement (NCS-A) sampled adolescents aged 13-17 years (N = 10,123). Households were geocoded to Census tracts. Using a propensity score approach that addresses bias from non-random selection of individuals into neighborhoods, logistic regression models were used to estimate the relative odds of having a DSM-IV emotional disorder (any past-year anxiety disorder, major depressive disorder or dysthymia) comparing similar adolescents living in disadvantaged versus non-disadvantaged neighborhoods in urban center, urban fringe, and non-urban areas.

Results: The association between neighborhood disadvantage and emotional disorder was more than twice as large for adolescents living in urban centers versus non-urban areas. In urban centers, living in a disadvantaged neighborhood was associated with 59% (95% confidence interval 25-103) increased adjusted odds of emotional disorder.

Conclusions: Urbanicity modifies the relationship between neighborhood disadvantage and emotional disorder in adolescents. This effect modification may explain why evidence of a relationship between neighborhood disadvantage and adolescent mental health has been inconsistent. Recognizing the joint influence of neighborhood socioeconomic context and urbanicity may improve specificity in identifying relevant neighborhood processes.

Fig. 1

Covariate balance pre- and post-subclassification. Plotted points represent the standardized mean differences (difference in means between the disadvantaged neighborhood group and non-disadvantaged neighborhood group standardized by the standard deviation in the disadvantaged group) for each covariate. Open dots represent standardized mean differences in the pre-propensity score subclassification data. Closed dots represent standardized mean differences in the post-propensity score subclassification data

Fig. 2

Log odds ratios and 95 % confidence intervals for the effect of neighborhood disadvantage within strata of urbanicity for emotional disorders