Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 3, pp 467–475

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

  • Kara E. Rudolph
  • Elizabeth A. Stuart
  • Thomas A. Glass
  • Kathleen R. Merikangas
Original Paper

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.

Keywords

Adolescent Mental health Psychiatric epidemiology Neighborhood Propensity score Survey 

Supplementary material

127_2013_725_MOESM1_ESM.pdf (116 kb)
Supplementary material 1 (PDF 115 kb)
127_2013_725_MOESM2_ESM.pdf (165 kb)
Supplementary material 2 (PDF 239 kb)

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kara E. Rudolph
    • 1
    • 2
  • Elizabeth A. Stuart
    • 2
    • 3
  • Thomas A. Glass
    • 1
  • Kathleen R. Merikangas
    • 4
  1. 1.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Genetic Epidemiology Research BranchNational Institute of Mental HealthBethesdaUSA

Personalised recommendations