Neighborhood Disadvantage and Trajectories of Adolescent Internalizing and Externalizing Psychopathology

Background and Purpose. Many mental health problems emerge during adolescence, and neighborhood disadvantage is a risk factor that has been associated with depressive and anxiety symptoms during this developmental stage. Relatively little is known, though, about how neighborhood disadvantage is linked to the development of internalizing and externalizing behaviors across time, which would indicate when and in what manner neighborhood-related risk begins to emerge. Moreover, neighborhood disadvantage may be associated with distinct, group-based patterns of elevation or change in symptoms that may not be captured by examining linear developmental trajectories. Consequently, the study aimed to identify subgroups with distinct trajectories of internalizing and externalizing behaviors and examine how neighborhood disadvantage is associated with the group-based patterns of trajectories.

Methods. Data came from the Adolescent Brain and Cognitive Development (ABCD) study, a nation-wide 21-site study on biological, social, and environmental factors that influence adolescent brain and neurocognitive development. The study recruited 11,876 children from large metropolitan areas. The current analysis used Baseline (ages 9-11), Year 1 (10-12), and Year 2 follow-up (11-13) data of a subset (N = 7,888) of adolescents after limiting the sample to pre-COVID-19 collection dates and randomly selecting one child per family to address non-independence. Neighborhood disadvantage at baseline was measured with a factor score of five census tract level constructs (e.g., median family income, unemployment rate). Internalizing and externalizing behaviors were assessed by parent report using the Child Behavior Checklist (CBCL) at all timepoints. To identify latent subgroups with distinct trajectories of internalizing and externalizing problems from Baseline to Year 2, a growth mixture model (GMM) was used accounting for the nested structure of the sampling design by site. Multiple logistic regression was used to evaluate the association between neighborhood disadvantage and trajectory group membership controlling for age, sex, race/ethnicity, family income, and parental education level.

Results. Fit statistics suggested that a two-class solution best fit the data for internalizing behavior such that most participants demonstrated low initial levels of internalizing behavior which slightly decreased over time (91%; low-decreasing group), while a relatively small sample showed clinically elevated initial levels of internalizing behavior which increased over time (9%; high-increasing group). Similar results were found for externalizing behavior (92%; low-decreasing group, 8%; high-increasing group). Multiple logistic regression analyses suggested a higher proportion of participants living in disadvantaged neighborhoods in the “high-increasing” trajectory group for internalizing behavior (1.16:1 odds; 95% CI [1.02, 1.32]) but not for externalizing behavior (1.04:1 odds; 95% CI [.92, 1.19]), controlling for age, sex, race/ethnicity, family income, and parental education.

Conclusion and Implication. Neighborhood disadvantage is an important risk factor for clinically elevated levels of internalizing behavior by Age 9 that persist or increase throughout early adolescence, indicating that the association may begin earlier in childhood. Risk screening and interventions addressing internalizing symptoms in children who are living in disadvantaged neighborhoods may be warranted prior to Age 9. From a public health standpoint, community and policy-level programs targeted at enhancing the neighborhood context and reducing neighborhood-level risk exposures may improve adolescent mental health development.