Having more resilience factors only gets you so far in the context of neighborhood disadvantage: understanding differential predictors of internalizing symptoms and body mass index in youth with spina bifida

Abstract

Objective: The primary aim of this study was to determine if neighborhood disadvantage predicted internalizing symptoms and body mass index (BMI) in youth with spina bifida (SB), while accounting for several sociodemographic factors. We also explored whether resilience factors helped explain associations between neighborhood disadvantage and internalizing symptoms or neighborhood disadvantage and BMI.

Methods: Participants (n = 69, Mage=14.13, Range: 8-20, 51% biological female, 25% Hispanic/Latinx White, 28% Other/Multiracial, 48% non-Hispanic/Latinx White) were drawn from a retrospective chart review of clinical data, including self-reported resilience factors and internalizing symptoms, collected as part of the standard of care in a multidisciplinary pediatric SB clinic. Neighborhood disadvantage scores were extracted from participant addresses. Using structural equation modeling, we examined whether neighborhood disadvantage predicted BMI and internalizing symptoms. We explored whether these paths were mediated by resilience factors.

Results: Higher neighborhood disadvantage predicted higher BMI and lower internalizing symptoms. Higher neighborhood disadvantage predicted higher resilience factors, which predicted lower internalizing symptoms. Higher resilience factors did not predict BMI.

Conclusions: Neighborhood disadvantage may require youth with SB to navigate their way to additional resilience factors to maintain better psychosocial outcomes. However, having more resilience factors may not help offset the physical health costs of disadvantaged neighborhoods.

Keywords: anxiety; depression; diversity; equity; inclusion; obesity and weight management; resilience/strengths-based; spina bifida.