African Americans, Caribbean Blacks, Depression, and Neighborhood Disadvantage

Purpose and Objective: Residing in a disadvantaged neighborhood is associated with adverse social and health-related consequences including violence and crime victimization (Sampson, Raudenbush, & Earls, 1997), physical illness (Kawachi & Berkman, 2003), and mental illness (Goldsmith, Holzer, & Mandersheid, 1998; Ross, 2000; Stiffman, Hadley-Ives, Elze, & Johnson, 1999). African Americans are overrepresented in disadvantaged neighborhoods, and Black Americans' greater exposure to disadvantaged neighborhood conditions is thought to be one pathway by which being African American is linked to social, physical, and health-related adversity (Kawachi & Berkman, 2003). The objective of this study was to investigate whether neighborhood disadvantage served as a risk factor for depression in the Black population of the United States.

Methodology: The National Survey of American Life (NSAL) sample of African Americans and Caribbean Blacks were stratified into lower, middle, and higher socioeconomic status (SES) subsamples equaling a study sample of 5,181. The NSAL was part of the National Institutes of Mental Health Collaborative Psychiatric epidemiology Surveys initiative that included three nationally representative surveys: the NSAL, the National Comorbidity Survey Replication (NCS-R), and the National Latino and Asian American Study (NLAAS). The NSAL included a household probability sample of 3,570 African Americans, 1,621 blacks of Caribbean descent (hereafter referred to as Caribbean blacks), and 891 non-Hispanic whites aged 18 years and older. Associations between SES, neighborhood disorder, and depression were calculated by stratifying the overall sample on SES. Logistic regression equations were estimated within SES strata to characterize depression as a function of neighborhood characteristics and individual demographic characteristics.

Results: The association between neighborhood disorder and past-year depression was significant for persons categorized as low SES (F = 7.55; p = 0.01) and middle SES individuals (F = 4.77, p = 0.03). After controlling for individual demographic characteristics, the association between neighborhood disorder and past-year depression was statistically significant for low SES individuals (at or below the federal poverty line) (OR=1.73 [CI: 1.08, 2.76]; p=0.023, and at the boundary of significance for middle SES individuals (between 100% and 300% of the poverty line) (OR=1.61 [CI: 1.00, 2.59]; p=0.052), but not for higher SES individuals (at or above 300% of the poverty line) in this nationally representative sample of Black Americans.

Conclusion: Results suggest that contextual (area-level) neighborhood risk interacts with socioeconomic risk for depression, and that housing and community development policies aimed at neighborhood improvement and poverty de-concentration may benefit the mental health of low-income African Americans and Caribbean Blacks especially.