Power, Place and Mental Health: Pathways between Neighborhood Vulnerability and Depressive Symptoms
Battle, Shanice
2021
Abstract
Depression is the leading contributor to disability and the fourth leading cause of non-fatal disease burden worldwide. Over the past several decades, persistent race and gender differences in depression prevalence have been reported. Studies have shown women have twice the lifetime risk of first onset of depression compared to men, with differences in severity and chronicity between race and gender groups. In addition, structural factors such as those within the neighborhood context (poverty, unemployment, education, etc.) may contribute to depression outcomes. Race and gender appear to modify the influence of structural factors on depressive symptoms, making the etiology of this disorder of particular public health importance. Based on these observations, through this dissertation, we considered the role of neighborhood context and its contribution to the burden of depressive symptoms among race and gender groups. In the first study, we created a composite measure of exposure to neighborhood context, the Neighborhood Vulnerability Index (NVI). The NVI consists of 8 census tract indicators of social disadvantage and affluence using data from a nationally representative longitudinal population-based sample at five timepoints between 1986 and 2011; the findings highlighted stark inequities in which groups are exposed to neighborhood vulnerability. Furthermore, race by gender trajectories show the compounding effect of race and gender on neighborhood vulnerability, where Black women navigate the most vulnerable environments. The results highlight the persistent and reinforcing pattern of inequitable neighborhood conditions along racial and gender lines in the United States. Next, we examined the longitudinal association between neighborhood vulnerability and depressive symptoms and found a positive association with some heterogeneity between groups. Neighborhood vulnerability was most strongly associated with depressive symptoms for Black men, had the weakest association among Black women and a similar impact on white men and women. The impact of neighborhood vulnerability on depressive symptoms was consistent over the course of the 26 year follow up. Lastly, through the third aim of this dissertation we examined the roles of vigilance and discrimination, two types of race-related stress and coping, as mediators in the association between neighborhood vulnerability and depressive symptoms. We found evidence of strong mediation by vigilance and no evidence of mediation by discrimination. There were differences between race and gender groups, with an association more strongly mediated for Black Americans compared to whites and for men compared to women; however, many of the indirect effects were only marginally significant. Taken together, the results of this dissertation provide evidence of a significant contribution of neighborhood context to the development of depressive symptoms among U.S. adults. By taking an innovative approach that considers the structural and interpersonal aspects of neighborhood characteristics, we offer a more nuanced view of depression etiology among race and gender groups. The pattern of findings between groups suggests race and gender contribute to differences in vulnerability to the effect of neighborhood context and social stress on depressive symptoms. Consideration of neighborhood vulnerability in depression etiology and interventions may offer opportunities for improving the mental health of the U.S. adult population as they age.Deep Blue DOI
Subjects
Depression and neighborhoods Structural Factors
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