Because segregation may shield blacks from discrimination as well as increase their exposure to concentrated poverty, its net impact on the mental well-being of black Americans is unclear. We investigated the intersection between segregation, neighborhood poverty, race, and psychological well-being.
Using data from the nationally representative 2008–2013 National Health Interview Survey merged with U.S. Census data, we examined the association between black–white metropolitan segregation (D-index and P-index) and psychological distress (a binary indicator based on the Kessler 6 score ≥ 13) for blacks and whites. Furthermore, we assessed whether neighborhood poverty explains and/or modifies the association. Logistic regression models were estimated separately for blacks and whites as well as for each segregation index.
Higher D- and P-indices were associated with higher odds of psychological distress for blacks. Neighborhood poverty explained some, but not all, of the association. In models that allowed for the impact of metropolitan segregation to vary by neighborhood poverty, higher segregation was found to be detrimental for blacks who resided in high poverty neighborhoods but not for those living in low poverty neighborhoods. We found no evidence that segregation impacts the mental health of whites—either detrimentally or beneficially—regardless of neighborhood poverty level.
The impact of segregation differs by neighborhood poverty and race. The psychological harm of structural racism, resulting in segregation and concentrated poverty, is not additive but multiplicative, reflecting a “triple jeopardy” for blacks, whereby their mental health is detrimentally impacted by the compounded effects of both neighborhood distress and racial segregation.
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US Department of Health and Human Services (1999) Mental health: A report of the Surgeon General (DHHS Pub. No. SMA 96-3098). Rockville, MD: US Department of Health and Human Services. Substance Abuse and Mental Health Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health
Forman-Hoffman VL, Muhuri PK, Novak SP, Pemberton MR, Ault KL, Mannix D (2014) Psychological distress and mortality among adults in the US household population. CBHSQ Data Rev 27:824–830
Kessler RC, Walters EE, Forthofer MS (1998) The social consequences of psychiatric disorders, III: probability of marital stability. Am J Psychiatry 155(8):1092–1096
Goetzel RZ, Long SR, Ozminkowski RJ, Hawkins K, Wang S, Lynch W (2004) Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting US employers. J Occup Environ Med 46(4):398–412
Uher R, McGuffin P (2008) The moderation by the serotonin transporter gene of environmental adversity in the aetiology of mental illness: review and methodological analysis. Mol Psychiatry 13(2):131
Vick B, Jones K, Mitra S (2012) Poverty and severe psychiatric disorder in the U.S.: evidence from the Medical Expenditure Panel Survey. J Ment Health Policy Econ 15(2):83–96
Compton MT, Shim RS (2015) The social determinants of mental health. Focus 13(4):419–425
Ludwig J, Duncan GJ, Gennetian LA et al (2012) Neighborhood effects on the long-term well-being of low-income adults. Science 337(6101):1505–1510
Costello EJ, Compton SN, Keeler G, Angold A (2003) Relationships between poverty and psychopathology: a natural experiment. Jama 290(15):2023–2029
Barnes DM, Bates LM (2017) Do racial patterns in psychological distress shed light on the Black–White depression paradox? A systematic review. Soc Psychiatry Psychiatr Epidemiol 52(8):913–928
Williams DR, Gonzalez HM, Neighbors H et al (2007) Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and non-Hispanic whites: results from the National Survey of American Life. Arch Gen Psychiatry 64(3):305–315
Ennis NE, Hobfoll SE, Schröder KE (2000) Money doesn’t talk, it swears: how economic stress and resistance resources impact inner-city women’s depressive mood. Am J Community Psychol 28(2):149–173
Hudson DL, Neighbors HW, Geronimus AT, Jackson JS (2012) The relationship between socioeconomic position and depression among a US nationally representative sample of African Americans. Soc Psychiatry Psychiatr Epidemiol 47(3):373–381
Keyes CL (2009) The Black–White paradox in health: flourishing in the face of social inequality and discrimination. J Personal 77(6):1677–1706
Muntaner C, Eaton WW, Miech R, O’Campo P (2004) Socioeconomic position and major mental disorders. Epidemiol Rev 26:53–62
Cutrona CE, Russell DW, Hessling RM, Brown PA, Murry V (2000) Direct and moderating effects of community context on the psychological well-being of African American women. J Personal Soc Psychol 79(6):1088
Cutrona CE, Wallace G, Wesner KA (2006) Neighborhood characteristics and depression: an examination of stress processes. Curr Direct Psychol Sci 15(4):188–192
Grant KE, McCormick A, Poindexter L et al (2005) Exposure to violence and parenting as mediators between poverty and psychological symptoms in urban African American adolescents. J Adoles 28(4):507–521
Williams R, Williams-Morris D (2000) R. Racism and mental health: the African American experience. Ethn Health 5(3–4):243–268
Riley AR (2018) Neighborhood disadvantage, residential segregation, and beyond—lessons for studying structural racism and health. J Racial Ethn Health Dispar 5(2):357–365
Forman TA (2003) The social psychological costs of racial segmentation in the workplace: a study of African Americans’ well-being. J Health Soc Behav 1:332–352
Carliner H, Delker E, Fink DS, Keyes KM, Hasin DS (2016) Racial discrimination, socioeconomic position, and illicit drug use among US Blacks. Soc Psychiatry Psychiatr Epidemiol 51(4):551–560
Dailey AB, Kasl SV, Holford TR, Lewis TT, Jones BA (2010) Neighborhood-and individual-level socioeconomic variation in perceptions of racial discrimination. Ethn Health 15(2):145–163
Williams DR, Mohammed SA, Leavell J, Collins C (2010) Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci 1186(1):69–101
Clark R, Anderson NB, Clark VR, Williams DR (1999) Racism as a stressor for African Americans: a biopsychosocial model. Am Psychol 54(10):805
Dolezsar CM, McGrath JJ, Herzig AJ, Miller SB (2014) Perceived racial discrimination and hypertension: a comprehensive systematic review. Health Psychol 33(1):20
Pascoe EA, Smart Richman L (2009) Perceived discrimination and health: a meta-analytic review. Psychol Bull 135(4):531
Black LL, Johnson R, VanHoose L (2015) The relationship between perceived racism/discrimination and health among black American women: a review of the literature from 2003 to 2013. J Racial Ethn Health Dispar 2(1):11–20
Massey DS, Denton NA (1993) American apartheid: segregation and the making of the underclass. Harvard University Press, Harvard
Do DP, Frank R, Iceland J (2017) Black-white metropolitan segregation and self-rated health: investigating the role of neighborhood poverty. Soc Sci Med 187:85–92
Kramer MR, Hogue CR (2009) Is segregation bad for your health? Epidemiol Rev 31(1):178–194
Herbst CM, Lucio J (2016) Happy in the hood? The impact of residential segregation on self-reported happiness. J Reg Sci 56(3):494–521
Bécares L, Nazroo J, Jackson J (2014) Ethnic density and depressive symptoms among African Americans: threshold and differential effects across social and demographic subgroups. Am J Public Health 104(12):2334–2341
Pettigrew TF, Tropp LR (2006) A meta-analytic test of intergroup contact theory. J Personal Soc Psychol 90(5):751
Hudson DL, Neighbors HW, Geronimus AT, Jackson JS (2016) Racial discrimination, John Henryism, and depression among African Americans. J Black Psychol 42(3):221–243
Bécares L, Nazroo J, Stafford M (2009) The buffering effects of ethnic density on experienced racism and health. Health Place 15(3):700–708
Blewett LA, Rivera Drew JA, Griffin R, King ML, Williams KCW (2016) IPUMS health surveys: national health interview survey, version 6.2. University of Minnesota, Minneapolis. https://doi.org/10.18128/D18070.V18126.18122
Kessler RC, Neighbors HW (1986) A new perspective on the relationships among race, social class, and psychological distress. J Health Soc Behav 1:107–115
Kessler RC, Andrews G, Colpe LJ et al (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 32(6):959–976
Massey DS, Denton NA (1988) The dimensions of residential segregation. Soc Forces 67(2):281–315
Kravitz-Wirtz N (2016) A discrete-time analysis of the effects of more prolonged exposure to neighborhood poverty on the risk of smoking initiation by age 25. Soc Sci Med 148:79–92
Blewett LA, Drew JAR, Griffin R, King ML, Williams KCW (2016) PUMS health surveys: National Health Interview Survey, Version 6.2.. In: Minnesota Uo, ed. Minneapolis
Snowden LR (2003) Bias in mental health assessment and intervention: theory and evidence. Am J Public Health 93(2):239–243
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On behalf of all authors, the corresponding author states that there is no conflict of interest.
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Do, D.P., Locklar, L.R.B. & Florsheim, P. Triple jeopardy: the joint impact of racial segregation and neighborhood poverty on the mental health of black Americans. Soc Psychiatry Psychiatr Epidemiol 54, 533–541 (2019). https://doi.org/10.1007/s00127-019-01654-5
- Racial segregation
- Neighborhood poverty
- Mental health