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

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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.

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Acknowledgments

The authors wish to express their gratitude to NCS-A participants and study team who made this work possible. The authors also wish to thank Kathy Georgiades for helpful comments on a previous version of the manuscript and Vanya Aggarwal for help with Census data abstraction. Results from this paper were presented as a poster at the 45th Annual Society for Epidemiologic Research Meeting, Minneapolis, Minnesota, June 29, 2012. The Intramural Research Program of the National Institute of Mental Health at the National Institutes of Health supported this work. The National Comorbidity Survey Replication Adolescent Supplement (NCS-A) and the larger program of related National Comorbidity Surveys are supported by the National Institute of Mental Health [U01-MH60220] and the National Institute of Drug Abuse [R01 DA016558] at the National Institutes of Mental Health. The NCS-A was carried out in conjunction with the World Health Organization World Mental Health Survey Initiative. The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or US Government.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Human participant protection

The survey was administered by the professional staff of the Institute for Social Research at the University of Michigan. The recruitment and consent procedures were approved by the Human Subjects Committees of Harvard Medical School and the University of Michigan.

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Authors and Affiliations

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6541, Baltimore, MD, 21205, USA

    Kara E. Rudolph & Thomas A. Glass

  2. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Kara E. Rudolph & Elizabeth A. Stuart

  3. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Elizabeth A. Stuart

  4. Genetic Epidemiology Research Branch, National Institute of Mental Health, Bethesda, MD, USA

    Kathleen R. Merikangas

Authors
  1. Kara E. Rudolph
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  2. Elizabeth A. Stuart
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  4. Kathleen R. Merikangas
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Corresponding author

Correspondence to Kara E. Rudolph.

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Rudolph, K.E., Stuart, E.A., Glass, T.A. et al. Neighborhood disadvantage in context: the influence of urbanicity on the association between neighborhood disadvantage and adolescent emotional disorders. Soc Psychiatry Psychiatr Epidemiol 49, 467–475 (2014). https://doi.org/10.1007/s00127-013-0725-8

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