The Impact of Environmental Risk Factors and Adolescent Depression: Focusing on the Buffering Effect of Family Strength

Background and purpose: Adolescent depression constitutes a major burden of disease for adolescents with deleterious effects persisting into adulthood. In the United States in 2019, approximately 36% of youth aged 12-17 years reported high levels of depressive symptoms, 15% suffered from major depression, and 8% of those suffering from major depression died by suicide. Previous empirical evidence has shown that neighborhood and school risk factors are associated with increased depression among adolescents; however, limited research has focused on moderating factors that potentially buffer these associations. Guided by the family resilience theory, this study examined the buffering effects of family strength on the associations between neighborhood and school risk factors on adolescent depression.

Methods: Using National Survey of Children's Health, this study incorporates multi-year data from 2016-2020. Among the total sample of 174,551 participants, this study concentrated on 81,809 adolescents (48% female) aged 11-17 years old. Controlling for gender, age, race, parental education, income, and family structure, this study examined the impact of neighborhood physical disorder, lack of neighborhood support, neighborhood violence/danger, lack of school engagement, lack of school safety, and racial discrimination on adolescents’ depression and the moderating effect of family strength. We used Python and the statsmodel library for data cleaning and logistic regression models. Missing data was handled with multivariate imputation by chained equations.

Results: After controlling for covariates, the logistic regression results presented that neighborhood danger/violence increased the odds of depression by 1.83 times (CI: 1.70-1.97); lack of neighborhood support increased the odds of depression by 1.09 times (CI: 1.03-1.16), lack of school engagement increased the odds of depression by 2.75 times (CI: 2.64-2.86), lack of school safety increased the odds of depression by 1.71 times (CI: 1.52-1.94), and racial discrimination increased the odds of depression by 1.55 times (CI: 1.39-1.73). In contrast, family strength decreased the odds of depression by 0.91 times (CI: 0.90-0.92). Lastly, the moderating effect of family strength presented that family strength alleviated the negative impact of neighborhood danger/violence (OR=1.03, CI: 1.00-1.06), lack of school engagement (OR=1.04, CI: 1.03 - 1.06) and racial discrimination on depression (OR=1.07, CI: 1.03 - 1.12).

Conclusions and Implications: Consistent with prior findings, neighborhood danger/violence, lack of neighborhood support, lack of school engagement, lack of school safety and racial discrimination increased adolescent depression. However, family strength effectively alleviated the risks from neighborhood violence/danger and lack of school engagement, ultimately reducing adolescent depression, along with limited effectiveness on racial discrimination. Social work as a discipline has long-recognized the importance of person-in-environment for mental health and since environments cannot be improved in a short-time period, adolescents may be exposed to various environmental risks. However, appropriate support and assistance from family may be an appropriate intervention to reduce adolescent depression. Although family strength is not a panacea against all types of environmental risk factors, social workers should consider providing family intervention to reduce adolescent depression. Compared to improving negative neighborhood or school environments, family interventions can be a cost-effective and immediate approach to treating adolescent depression.