Kaiser Permanente study finds higher rates with every level of declining neighborhood privilege
A Kaiser Permanente study of nearly 35,000 Northern California teens found higher rates of depression and suicidality among those living in less economically and racially privileged neighborhoods. The study was published August 18 in JAMA Network Open.
It found adolescents from the least privileged neighborhoods had a 37% greater risk of reporting depression and a 59% greater risk of reporting suicidality during a medical visit, compared with the adolescents living in the most privileged neighborhoods.
“These findings suggest that young people in some neighborhoods are in greater distress,” said senior author Ai Kubo, MPH, PhD, an epidemiologist and research scientist at the Kaiser Permanente Division of Research. “While our study doesn’t show exactly how those factors are connected, it’s important to understand the risk factors so we can do more prevention on the individual as well as the policy level.”
The analysis used data from mental health screenings during routine medical visits between 2017 and 2021 for patients aged 12 to 16. The authors used an established measure of neighborhood privilege called the Index of Concentration at the Extremes that quantifies the relative concentration of white, high-income residents to Black, low-income residents in a neighborhood.
The findings are consistent with other studies showing greater distress among Black and Latino teens, particularly since the COVID-19 pandemic. The study adds to the evidence that neighborhood privilege stemming from a history of structural racism is relevant to mental health, the authors said.
“We found a clear dose-response relationship between this measure of structural racism and teen mental health outcomes,” said lead author Julia Acker, MS, a PhD student at the University of California, Berkeley. The greater the economic deprivation and racial segregation in a neighborhood, the greater chance that a teen would report depression or suicidality during a medical visit, the study found.
The specific reasons for the association require more research, Acker said. “There are likely many aspects of neighborhood environments that could be contributing, and they probably interact with each other in complex ways,” she said. “Because children from marginalized racial and ethnic groups are still under-represented in mental health research, we don’t know a lot about the unique contributors to their mental health risk. Our study also highlights that we need to be extending research beyond the clinical setting and thinking about neighborhood conditions and inequities.”
A strength of the study was that the data came from routine well visit screenings rather than patients being seen specifically for depression symptoms. And while the study sample was widely diverse, Kubo noted, it also included people with health insurance. “I think what we found is probably an underestimate, and the problem is bigger than what we are reporting,” she said.
The group of 34,252 adolescents included in the study was 51.3% male, 35% white, 27% Hispanic, 21% Asian or Pacific Islander, and 8% Black.
This study was part of Kubo’s ongoing research into disparities in adolescent health. She and Acker teamed up for a previous study that found a relationship between neighborhood privilege and early puberty in Black and Latino girls.
The study was funded by the National Institutes of Health.
Additional co-authors were Sara Aghaee, MPH, of the Division of Research, and Mahasin Mujahid, PhD, and Julianna Deardorff, PhD, of the UC Berkeley School of Public Health.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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