An Examination of Community-Based ACEs, Neighborhood Safety, Support, and Amenities on the Mental Health Symptom Severity of Older Youth

Background and Purpose: Stressors within neighborhoods, like community violence and discrimination, along with adverse childhood experiences (ACEs) contribute to mental health (MH) challenges. The rise in youth MH challenges in the United States, intensified by the COVID-19 pandemic, underscores the need to explore socio-environmental factors contributing to the MH crisis. While neighborhood support and safety are vital for youth, limited research examines if amenities like parks, libraries, sidewalks and recreation centers offer supplementary support in reducing MH severity. We address this gap by asking: 1) Are specific types of neighborhood amenities significantly associated with depression and anxiety severity among older youth aged 14 to 17 from families below the federal poverty level (FPL)? and 2) Are there differences in the relationships between neighborhood amenity types and MH severity among these youths by race/ethnicity?

Methods: This study utilized data from the 2021 National Survey of Children’s Health, comprising parent-reported data on youth demographics, community-based ACEs, neighborhood perceptions of safety and support, amenities, and MH symptom severity (n=3,258). Bivariate analyses explored relationships between key study variables. Ordinal regression models explored how community-based ACEs, neighborhood perceptions of safety and support, and four types of neighborhood amenities predicted depression and anxiety severity (no severity, mild severity, moderate/severe severity). Racial/ethnic categories were disaggregated in the regression models to enhance understanding of specific groups’ relationships between neighborhood factors and MH severity. Analyses were conducted using Stata v18.

Results: Nearly 29% of the total sample lived below 199% FPL, with about 22% of those families reporting on youth aged 14 to 17. Racial/ethnic disparities by income revealed higher proportions of Black and Hispanic families living below 199% FPL (13.26% and 22.22% respectively) compared to their proportion in the total sample (6.47% and 13.59% respectively). MH severity and community-based ACEs were also higher among families living below 199% FPL. Experiencing one or more community-based ACEs significantly predicted an increase in anxiety and depression severity across all racial/ethnic categories (p < .001). Further, differences in MH severity with each amenity as a predictor was observed across racial/ethnic categories. Based on parent report, Black youth residing in neighborhoods with libraries or sidewalks experienced higher anxiety severity (B = .90, p <. 05; B = 1.45, p < .01, respectively), and Black youth residing in neighborhoods with parks experienced lower anxiety (B = -.91 p<. 05). Conversely, Hispanic youth residing in neighborhoods with parks experienced higher depression severity (B = 1.11 p <. 01). Finally, youth from multiracial and other non-Hispanic ethnic backgrounds residing in neighborhoods with sidewalks experienced lower anxiety and depression severity (B = -.78 p < .05; B = -.91, p < .01, respectively).

Conclusions and Implications: Disaggregating by race/ethnicity acknowledges the influence of structural racism and oppression on the availability of amenities and experiences youth may have while navigating neighborhood spaces. Our study suggests implications for neighborhood-based qualitative research from the perspective of youth to cultivate community spaces that reduce MH severity.