Neighborhood Context and Adolescent Anxiety and Depression: The Mediating Effect of Adolescent Well-Being

Background and Purpose Neighborhood factors that impact adolescent mental health are of great concern to social workers. Neighborhood collective efficacy (NCE), defined as social cohesion, trust, and informal social control, has been associated with positive adolescent outcomes. Conversely, a lack of neighborhood collective efficacy has been linked with negative adolescent outcomes including increased aggression, anxiety, and depression. However, studies have not examined the potential mediating, protective effect of adolescents’ individual strengths and resilience (i.e., well-being) on the relationship between NCE and negative outcomes.  This study aims to examine whether adolescent well-being mediates the relationship between NCE and two adverse outcomes, depression and anxiety.

Methods   The present study used data from adolescents (N = 3,444) approximately age 15, participating in the sixth wave (2014-2017) of data collection for the Fragile Families and Child Well-being Study (FFCWS). The FFCWS originally recruited nearly 5,000 pregnant women giving birth in hospitals between 1998-2000, focusing on families of unwed parents with few resources and high rates of financial instability. Depression was measured using an abbreviated 5-item version of the Center for Epidemiologic Studies Depression Scale (CES-D Scale). Anxiety was assessed using a 6-item subscale of the Brief Symptom Inventory 18 (BSI-18).  NCE was assessed by combining responses to items that measure neighborhood informal social control, social cohesion, and trust. Items assessing engagement, perseverance, optimism, connectedness, and happiness (EPOCH) were combined into a single measure representing adolescent well-being. We estimated separate ordinary least squares (OLS) models to regress depression and anxiety scores on NCE and adolescent well-being while controlling for the effects of age, gender, race, and poverty level. Each model was estimated using jackknife replicate weights to account for survey design effects with analysis of the mediation effects of adolescent well-being assessed using a Sobel-Goodman test with bootstrapped standard errors.

Results. Results indicate that NCE significantly increased both anxiety and depression, but that both of these effects were mediated by well-being  For anxiety, the total effect for NCE (β=.19, p < .05) decomposed into a significant direct (β=.15, p < .04) and indirect (mediated) effect (β=.04, p < .01). For depression, the total effect for NCE (β=.89, p < .001) decomposed into a significant direct (β=.49, p < .05) and indirect effect (β=.40, p < .001). Thus, well-being accounted for 21% of the total effect of NCE on anxiety and 45% of the total effect of NCE on depression, in both cases having a protective influence.

Conclusions and Implications. This study suggests that promoting well-being can insulate adolescents from the negative psychological effects of neighborhood context. Community level interventions that target adolescents, specifically aimed at increasing youth engagement in and connectedness to their schools, neighborhoods, and other social outlets are recommended. At the individual level, solution-focused therapy calls for an emphasis on clients’ inherent strengths and resiliency in problem solving rather than the history of the problem itself. Social workers, often trained in strength’s based, solution-focused modalities, should continue utilizing these methods when working with adolescents, especially those living in economically distressed neighborhoods.