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

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.