The Impact of Neighborhood Factors and Sleep on Positive Mental Health in Children and Adolescents

Background: Positive mental health in children and adolescents is foundational to healthy development and lifelong well-being. While mental health challenges in youth have been widely studied, less is known about the promotive factors that contribute to positive mental health, especially within the context of neighborhood environments and sleep health. This study investigates how neighborhood characteristics—such as perceived safety, social cohesion, and environmental conditions—interact with sleep duration and quality to influence positive mental health outcomes among U.S. children and adolescents.

Methods: This study used cross-sectional data from the 2020–2021 National Survey of Children’s Health (NSCH), a nationally representative dataset, including responses from over 70,000 caregivers of children aged 6–17. Positive mental health was operationalized based on caregiver reports of flourishing behaviors, such as curiosity, emotional regulation, and resilience. Multivariate logistic regression models were used to examine associations between neighborhood factors and positive mental health, adjusting for sociodemographic variables. Generalized Structural Equation Model (GSEM) was applied to verify the intermediacy effect of adequate sleep within the neighborhood factor and flourishing relationship.

Results: Results indicated that children and adolescents living in neighborhoods perceived as supportive, safe, and rich in amenities had significantly higher odds of flourishing. Specifically, perceived neighborhood support was associated with greater odds of adequate sleep (B = 0.26, SE = 0.02, p < .001, OR = 1.29, 95% CI [1.25, 1.34]), which in turn predicted flourishing (B = 0.26, SE = 0.02, p < .001, OR = 1.30, 95% CI [1.25, 1.35]). The direct effect of neighborhood support on flourishing remained strong (B = 0.70, SE = 0.02, p < .001, OR = 2.01, 95% CI [1.94, 2.08]), indicating partial mediation through sleep.

Similarly, children living in neighborhoods perceived as “definitely safe” were more likely to report adequate sleep (B = 0.30, SE = 0.05, p < .001, OR = 1.35, 95% CI [1.23, 1.49]) and flourishing (B = 0.98, SE = 0.05, p < .001, OR = 2.66, 95% CI [2.43, 2.79]). Perceptions of “somewhat safe” neighborhoods were also positively associated with sleep (B = 0.11, SE = 0.05, p = .031, OR = 1.12, 95% CI [1.01, 1.23]) and flourishing (B = 0.40, SE = 0.05, p < .001, OR = 1.49, 95% CI [1.36, 1.65]).

Children living in neighborhoods with four amenities had significantly higher odds of flourishing (B = 0.15, SE = 0.03, p < .001, OR = 1.16, 95% CI [1.10, 1.23]). Sleep adequacy remained a robust independent predictor of flourishing across all models (B range = 0.26–0.28, OR range = 1.30–1.32, p < .001).

Conclusions and Implications: Findings underscore the importance of both ecological and individual-level determinants of youth mental well-being. Social work interventions should prioritize neighborhood revitalization, community safety initiatives, and sleep education as part of integrated mental health promotion strategies. This study supports the need for cross-sector collaboration to foster environments that enable youth to flourish.