TY - JOUR
T1 - Neighborhood disadvantage in context
T2 - The influence of Urbanicity on the association between neighborhood disadvantage and adolescent emotional disorders
AU - Rudolph, Kara E.
AU - Stuart, Elizabeth A.
AU - Glass, Thomas A.
AU - Merikangas, Kathleen R.
N1 - Funding Information:
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.
PY - 2014/3
Y1 - 2014/3
N2 - 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.
AB - 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.
KW - Adolescent
KW - Mental health
KW - Neighborhood
KW - Propensity score
KW - Psychiatric epidemiology
KW - Survey
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U2 - 10.1007/s00127-013-0725-8
DO - 10.1007/s00127-013-0725-8
M3 - Article
C2 - 23754682
AN - SCOPUS:84896718883
SN - 0933-7954
VL - 49
SP - 467
EP - 475
JO - Social psychiatry and psychiatric epidemiology
JF - Social psychiatry and psychiatric epidemiology
IS - 3
ER -