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T.D. Hill and D. Maimon with the most disadvantaged neighborhoods having the greatest burden of psychological distress, and. (c) neighborhood context ...
Chapter 23

Neighborhood Context and Mental Health Terrence D. Hill and David Maimon

Abbreviations AHEAD APOE CCH DRD2 HLM 5-HTT

Study of Assets and Health Dynamics Among the Oldest Old Apolipoprotein E Community Crime, and Health Dopamine receptor D2 Hierarchical linear models 5-Hydroxytryptamine transporter

Although studies of the social causes of mental health tend to emphasize social characteristics measured at the level of the individual (e.g., personal socioeconomic standing), research also suggests that mental health may vary according to social characteristics measured at the level of the neighborhood. More than 70 years ago, Faris and Dunham (1939) examined the spatial distribution of mental disorders in Chicago neighborhoods. Their analysis of data collected from over 34,000 psychiatric patients showed that “…high insanity rates appear to cluster in the deteriorated regions in and surrounding the center of the city…” (Faris & Dunham, 1939, p. 35). Using the urban ecological approach developed by Park (1915) and Burgess (1925), Faris and Dunham explained that the conditions of life in socially disorganized neighborhoods could favor the development of mental disorders by promoting a sense of extreme social isolation and by exposing residents to environments that are conducive to substance abuse. The pioneering work of Faris and Dunham (1939) and numerous subsequent studies show us that (a) neighborhoods are socially patterned, such that the most disadvantaged groups in society tend to live in disadvantaged neighborhoods, (b) mental health varies systematically across neighborhoods,

T.D. Hill (*) Department of Sociology, Florida State University, 526 Bellamy Building, P.O. Box 3062270, Tallahassee, FL 32306, USA e-mail: [email protected] D. Maimon Department of Criminology and Criminal Justice, University of Maryland, College Park, MD, USA

C.S. Aneshensel et al. (eds.), Handbook of the Sociology of Mental Health, Second Edition, Handbooks of Sociology and Social Research, DOI 10.1007/978-94-007-4276-5_23, © Springer Science+Business Media Dordrecht 2013

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with the most disadvantaged neighborhoods having the greatest burden of psychological distress, and (c) neighborhood context matters for mental health, even when researchers account for the fact that socially disadvantaged individuals tend to live in disadvantaged neighborhoods. Taken together, these patterns are of sociological interest because they emphasize the social origins of mental health. Neighborhoods are socially structured conditions that are external to individuals. These contextual effects cannot be explained by the dominant psychiatric model that locates the causes of psychological distress within individuals. In this chapter, we provide a critical overview of research concerning the association between neighborhood context and mental health. Along the way, we consider (a) the measurement and analysis of neighborhood context, (b) the nature and extent of the association between neighborhood context and mental health, (c) explanations for why neighborhood context might contribute to mental health, and (d) whether certain groups of people are more or less vulnerable to the psychological consequences of neighborhood context. Because relevant work has reemerged and matured over the past two decades, we emphasize studies conducted during this period. Although we intend for this research collection to be representative of the field, we do not consider it to be exhaustive. We conclude by highlighting several important avenues for future research.

The Measurement and Analysis of Neighborhood Context Neighborhoods are distinct geographical areas within cities and towns where groups of people live and interact with one another. Neighborhoods are defined by particular boundaries and conditions. Boundaries are established informally by history and landmarks, the judgments and movements of residents and nonresidents, and formally by administrative classifications like ZIP codes and census tracts. Conditions refer to unique physical, social, cultural, economic, and political environments. In practice, neighborhood context is measured with objective and subjective indicators. Objective indicators include measures of neighborhood structure, neighborhood social organization, and neighborhood disorder. These indicators are objective in the sense that they are assessed independently of residents’ personal attributes (e.g., census characteristics). Subjective indicators measure how residents perceive or experience the residential environment. These indicators are subjective in the sense that they draw from information collected from individual residents (e.g., resident reports of noise in the neighborhood). In this section, we describe common indicators of neighborhood context and established methods of analysis.

Objective Indicators of Neighborhood Context Neighborhood Structure Neighborhood structure refers to the demographic attributes of neighborhoods and is primarily indicated by neighborhood-level socioeconomic disadvantage, racial and ethnic composition, and residential instability. Demographic attributes of neighborhoods are calculated by aggregating the attributes of individual residents within neighborhoods. Having said this, neighborhood-level characteristics (e.g., the neighborhood unemployment rate) are conceptually distinct from individual-level characteristics (e.g., the employment status of a particular resident). For example, a particular

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resident can be unemployed in a neighborhood with a low unemployment rate. It is easy to imagine how personal employment status might be related to mental health. Explanations for the psychological consequences of living in a neighborhood with high or low unemployment are less evident. Neighborhood socioeconomic disadvantage is defined as the concentration of lower socioeconomic status individuals within neighborhoods (Krieger et al., 2003). Disadvantaged neighborhoods are poor communities with restricted access to public resources and municipal services and limited opportunities for status attainment (Robert, 1999). Common indicators of neighborhood socioeconomic disadvantage include the percentage of residents with less than a high school degree, the unemployment rate, median household income, and the percentage of residents living below the poverty line. Racial and ethnic composition refers to the concentration of race and ethnic minority groups within neighborhoods (Acevedo-Garcia & Lochner, 2003). The concentration of race and ethnic minorities is associated with distinct sociocultural environments and neighborhood socioeconomic disadvantage (Acevedo-Garcia & Lochner, 2003; Kwate, 2008; Massey, 2004). Racial and ethnic composition is typically indicated by the percentage of residents classified as black, Hispanic, minority, and immigrant. Residential instability is defined as the rate of turnover or change in the neighborhood population (Ross, Reynolds, & Geis, 2000). When a neighborhood is characterized by high residential instability, residents have fewer opportunities to develop and maintain social ties with other residents and, as a consequence, community organization and informal social control are undermined (Sampson, Raudenbush, & Earls, 1997; Shaw & McKay, 1942). Common indicators of residential instability include the percentage of residents living in apartment buildings, the percentage of owner-occupied dwellings, the percentage of current residents who were raised in the neighborhood, and the percentage of residents living less than 5 years in the neighborhood.

Neighborhood Social Organization Neighborhood social organization refers to the density of social ties and the level of collective efficacy. The density of social ties is defined by the number of social relationships and the frequency of social interaction in the neighborhood (Mair, Diez Roux, & Morenoff, 2010; Sampson & Groves, 1989). Neighborhood social ties can be indicated by the average number of friends and relatives that residents have living in the neighborhood and how often neighbors talk to and visit each other. Collective efficacy refers to the degree of neighborhood cohesion and the willingness of residents to exercise informal social control (Sampson et al., 1997). Dense social ties, local organizations, and voluntary associations promote neighborhood cohesion, and informal social control is most likely performed under these conditions. Neighborhood cohesion is indicated by the degree to which residents get along with each other, trust and help each other, and share common values. Informal social control is indicated by the willingness of residents to intervene under various conditions of crisis, incivility, and crime (e.g., keeping the local fire station open, children showing disrespect to adults, and someone being beaten or threatened). We would like to emphasize that measures of neighborhood social organization characterize neighborhoods, not individual residents. Indicators of neighborhood social organization are typically calculated in three steps. First, individual residents are asked about their social ties or perceptions of collective efficacy. Second, these responses are indexed or averaged for each resident. Finally, the average scores (for each resident) are aggregated or averaged across residents living in the same neighborhood or census tract. Through this method of “ecometric” assessment, individual-level measures are aggregated to the neighborhood-level (Raudenbush, 2003).

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Neighborhood Disorder Neighborhood disorder refers to a range of objective social and physical conditions that indicate the breakdown of social control in the community (Raudenbush, 2003; Ross & Mirowsky, 1999). Signs of social disorder include people hanging around on the streets, open alcohol consumption and drug use, prostitution, and other criminal activity. Indicators of physical disorder include the presence of abandoned buildings, vandalism, graffiti, garbage, and ambient noise. These objective conditions are measured independently of neighborhood residents through, for example, systematic social observations. Systematic social observations involve researchers traveling through neighborhoods, filming and recording social activities and physical features.

Subjective Indicators of Neighborhood Context Neighborhood Experience The neighborhood experience is defined by the perceptions and personal encounters of residents within neighborhoods (Aneshensel & Sucoff, 1996; Ross & Mirowsky, 1999). Measurements of the neighborhood experience are direct assessments of the human experience. Common indicators emphasize personal experiences within the neighborhood (e.g., personal victimization and relationships with neighbors) and subjective assessments or ratings of the neighborhood environment (e.g., perceptions of neighborhood disorder and collective efficacy). Because objective indicators of collective efficacy and neighborhood disorder are conceptually distinct from individual perceptions and experiences, it is possible to estimate associations between objective and subjective indicators. For example, are residents of neighborhoods with higher crime rates (an objective indicator of social disorder) more likely to report that crime is a problem in the neighborhood (a subjective perception of the objective condition) than residents of neighborhoods with less crime?

Analyzing Indicators of Neighborhood Context There are four primary methodological approaches to analyzing objective and subjective indicators of neighborhood context, including ecological models, individual-level models, contextual models, and multilevel models. Ecological models use spatial analytic and regression techniques to estimate associations between indicators measured exclusively at the level of the neighborhood (e.g., Do neighborhoods with higher poverty rates have higher rates of major depression?). Individual-level models use regression techniques to estimate associations between indicators measured exclusively at the level of the individual (e.g., Do individuals who perceive higher levels of neighborhood disorder also tend to report higher levels of anxiety?). Contextual models use conventional regression techniques to estimate associations between neighborhood characteristics measured at the neighborhood- and individual-level and mental health outcomes measured at the individual-level (e.g., Do individuals who live in neighborhoods characterized by residential instability tend to report higher levels of psychological distress?). Methodologically, contextual designs link neighborhood-level data (e.g., census estimates) to individual-level data derived from a single sampling unit (e.g., a national sample of United States residents). Like contextual models, multilevel models estimate associations between neighborhood characteristics measured at the neighborhood- and individual-level and mental health outcomes measured at the

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individual-level. Unlike contextual designs, multilevel models require at least two formal sampling units (e.g., a sample of individuals nested within a sample of neighborhoods) and special software packages (e.g., HLM). Multilevel models are also unique because they distinguish variation in mental health that occurs between and within neighborhoods. If mental health varies significantly between neighborhoods, multilevel models assess the degree to which this variation is due to characteristics of neighborhoods and individuals, respectively. Compared with contextual models, multilevel models allow for more accurate estimates of standard errors and cross-level interactions between neighborhood-level and individual-level characteristics (Raudenbush & Bryk, 2002). To be fair, all approaches have unique methodological strengths and limitations; however, such a discussion is beyond the scope of this chapter.

Neighborhood Context and Mental Health Status Studies show that neighborhood context is widely associated with mental health status. In this section, we focus on the most commonly studied indicators of mental health, including depression, anxiety, and psychological distress. We also reference recent developments in the study of neighborhood context and cognitive functioning. For each of these mental health outcomes, we summarize the overall patterns of previous research and highlight an especially influential study.

Depression Most studies of neighborhood context and mental health focus on depressive symptoms. Research in this area demonstrates that residents of disadvantaged neighborhoods tend to exhibit higher levels of depression than residents of more advantaged neighborhoods. This basic pattern is consistent across indicators of neighborhood structure (Galea et al., 2007; Kim, 2010; Ross, 2000; Wight, Ko, & Aneshensel, 2011; but see Aneshensel et al., 2007; Lee, 2009; Matheson et al., 2006; Silver, Mulvey, & Swanson, 2002 for some null findings), neighborhood social organization (Mair, Diez Roux, Osypuk, et al., 2010; but see Mair, Diez Roux, & Morenoff, 2010 for some null findings), neighborhood disorder (Downey & Van Willigen, 2005; Echeverría, Diez-Roux, Shea, Borrell, & Jackson, 2008; Mair, Diez Roux, Osypuk, et al., 2010; but see Mair, Diez Roux, & Morenoff, 2010 for some null findings), and neighborhood experience (Aneshensel & Sucoff, 1996; Bierman, 2009; Clark et al., 2007; Downey & Van Willigen, 2005; Echeverría et al., 2008; Kim, 2010; Latkin & Curry, 2003; Ross, 2000; Ross & Mirowsky, 2009; Schieman & Meersman, 2004; Stafford, McMunn, & De Vogli, 2011; but see Gary, Stark, & LaVeist, 2007 for some null findings). Ross (2000) provides an excellent study of neighborhood structure and depression. Her analysis of data from the Community, Crime, and Health (CCH) survey shows that adults who live in disadvantaged neighborhoods (indicated by the percentage of households below the federal poverty line and female-headed households with children) tend to exhibit higher levels of depression than residents of other neighborhoods. This association persisted with comprehensive adjustments for age, gender, race/ethnicity, education, employment status, household income, marital status, the presence of children, household crowding, and urban residence. Almost any association between neighborhood context and mental health could simply reflect the fact that disadvantaged individuals often live in disadvantaged neighborhoods (i.e., the composition of the neighborhood). These findings clearly suggest that neighborhood context matters for mental health over and above a range of individual attributes.

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Anxiety Consistent with studies of depression, research suggests that residents of disadvantaged neighborhoods tend to exhibit higher levels of anxiety. This pattern holds across two indicators of neighborhood context, including neighborhood structure (Ross et al., 2000; but see Lee, 2009 for some null findings) and neighborhood experience (Aneshensel & Sucoff, 1996; Clark et al., 2007; Ross & Mirowsky, 2009; Schieman & Meersman, 2004; but see Gary et al., 2007 for some null findings). Aneshensel and Sucoff (1996) sparked a great deal of contemporary research in the area of neighborhood context and mental health. Using data collected from adolescents in Los Angeles County, Aneshensel and Sucoff demonstrate that youths who perceive high levels of “ambient hazards” (signs of neighborhood disorder indicated by appraisals of, e.g., violence, crime, and the physical appearance of the neighborhood) tend to report higher levels of anxiety than youths who perceive fewer problems in the environment. These patterns held with controls for age, gender, race/ethnicity, family structure, living arrangements, perceptions of neighborhood social cohesion, neighborhood stability, and the combination of neighborhood socioeconomic status and race/ethnic composition. This analysis is especially influential because it is among the first to consider the psychological consequences of the “subjective neighborhood.”

Psychological Distress Given the patterns for depression and anxiety, it should come as no surprise that residents of disadvantaged neighborhoods also tend to exhibit higher levels of overall psychological distress. This general trend is consistent across three indicators of neighborhood context, including neighborhood structure (Ross et al., 2000; but see Stockdale et al., 2007 for some null findings), neighborhood disorder (Cutrona, Russell, Hessling, Brown, & Murry, 2000), and neighborhood experience (Hill, Burdette, & Hale, 2009; Stockdale et al., 2007; but see Steptoe & Feldman, 2001 for some null findings). Ross et al. (2000) present an intricate analysis of the psychological consequences of neighborhood stability. Their analysis of CCH data shows that higher levels of residential stability (indicated by the percentage of people who lived in the respondent’s census tract over a defined 5-year period) tend to favor lower levels of psychological distress in lower-poverty neighborhoods and higher levels of distress in higher-poverty neighborhoods. These results persisted with adjustments for age, gender, race/ethnicity, education, employment status, household income, home ownership, marital status, the number of children, household crowding, urban residence, and personal social ties with neighbors. The truly distinctive feature of this study is the interaction between unique dimensions of neighborhood structure (i.e., the effect of residential stability across levels of neighborhood socioeconomic disadvantage).

Cognitive Functioning Cognitive functioning is captured by basic indicators of mental status, including, for example, orientation, attention, memory, language, and reasoning. Because cognitive functioning is a recent extension of research on neighborhood context and mental health, very few relevant studies have been conducted. Nevertheless, research shows that residents of disadvantaged neighborhoods tend to exhibit poorer cognitive functioning and faster rates of cognitive decline. To this point, studies have focused exclusively on the effects of neighborhood structure (McCulloch & Joshi, 2001; Sampson, Sharkey, &

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Raudenbush, 2008; Sheffield & Peek, 2009; but see Aneshensel, Ko, Chodosh, & Wight, 2011; Wight et al., 2006 for some null findings). Wight et al. (2006) provide a comprehensive analysis of the link between neighborhood structure and cognitive health. Using data from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), these researchers find that individuals who live in neighborhoods characterized by low levels of education (indicated by the percentage of residents aged 25 and older without a high school degree) tend to exhibit lower levels of cognitive status (indicated by measures of memory, knowledge, language, and orientation). Interestingly, this study also indicates that the cognitive consequences of living in low-education areas can be offset by higher levels of personal education. These patterns held with an impressive array of adjustments for age, gender, race/ethnicity, marital status, household income, household wealth, a host of mental and physical health indicators, and the median household income of the neighborhood. This analysis is unique because it considers the interaction between neighborhood- and individual-level characteristics (i.e., the effect of neighborhood socioeconomic disadvantage across levels of individual socioeconomic status).

Mediators of Neighborhood Context Several significant publications have considered why neighborhood context might be associated with mental health status (e.g., Aneshensel, 2010; Aneshensel & Sucoff, 1996; Cutrona, Wallace, & Wesner, 2006; Fitzpatrick & LaGory, 2010; Massey, 2004; Mirowsky & Ross, 2003; Ross, 2000; Ross & Mirowsky, 2009; Wandersman & Nation, 1998). Drawing on this body of work and relevant empirical evidence, we develop a theoretical model (Fig. 23.1) that links neighborhood-level factors and mental health through the direct experience of neighborhood conditions and several classes of secondary mechanisms.

Neighborhood Structure Socioeconomic Disadvantage Race and Ethnic Composition Residential Instability

Socioeconomic Status Employment Education Income Biological Factors Epigenetic Modifications Allostatic Load

Social Organization Collective Efficacy Social Ties

Neighborhood Experience Perceived Collective Efficacy Personal Victimization Perceived Social Ties Perceived Disorder

Psychological Dispositions Sense of Control Self-Esteem Mistrust

Neighborhood Disorder Structural Dilapidation Industrial Activity Amenity Scarcity Toxic Conditions Criminal Activity Ambient Noise Open Incivility

Fig. 23.1 Mediators linking neighborhood context and mental health

Social Resources Social Support Social Ties Health Behaviors Sleep Deprivation Substance Use

Mental Health Cognitive Decline Depression Anxiety

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Neighborhood-Level Processes Our theoretical model begins with neighborhood-level processes. According to Fig. 23.1, neighborhood structural disadvantage is related to neighborhood social organization and neighborhood disorder. In their classic formulation, Shaw and McKay (1942) argue that neighborhood-level socioeconomic disadvantage, ethnic heterogeneity, and residential instability are key structural factors that contribute to social disorganization. They explain that disadvantaged communities often lack the material, social, and institutional resources needed to build consensus or solidarity. Sampson et al. (1997) define social disorganization as the inability of neighborhood residents to realize common values and to develop and maintain informal social controls. Wilson (1987, 1996) also notes that social disorganization can undermine the ability of communities to sustain important social institutions (e.g., schools, churches, businesses, and community organizations). Neighborhoods with high levels of socioeconomic disadvantage, black residential segregation, and residential instability contribute to physical and social disorder in various ways (Massey & Denton, 1989, 1993; Sampson et al., 1997). Neighborhood socioeconomic disadvantage is directly associated with structural dilapidation and amenity scarcity. Massey & Denton (1989, 1993) describe an indirect process by which extreme residential segregation and neighborhood poverty could contribute to social disorder and physical decay by isolating residents from mainstream society. Neighborhood structural disadvantage could also lead to social disorder by limiting the willingness of residents to exercise informal social control. For example, research shows that the effects of residential instability and concentrated disadvantage (a mixture of socioeconomic disadvantage and race composition) on violent crime are largely explained by lower levels of collective efficacy (Sampson et al.).

The Neighborhood Experience The second stage of our theoretical model (Fig. 23.1) suggests that the experience of neighborhood conditions is the primary link between neighborhood-level processes and mental health status. Over eight decades ago, Thomas and Thomas (1928) noted that when situations are defined as real, they are real in their consequences. We argue, by extension, that residents experience the neighborhood as more or less stressful as neighborhood conditions are defined as more or less noxious or threatening. To be clear, our perspective suggests that, with few exceptions, features of the neighborhood environment must be directly perceived or experienced to be relevant to mental health status. This assertion rests on the following assumptions: (a) stress is the primary explanation for the association between neighborhood context and mental health (Cutrona et al., 2006; Mirowsky & Ross, 2003), and (b) perception is a fundamental condition of any stress-related response (McEwen & Lasley, 2002). Research suggests that disadvantaged neighborhoods undermine mental health by exposing residents to conditions that they define as stressful (Aneshensel & Sucoff, 1996; Ross, 2000; Wandersman & Nation, 1998). Residence in neighborhoods characterized by socioeconomic disadvantage, the concentration of racial and ethnic minorities, residential instability, weak social ties, low collective efficacy, and visible signs of disorder clearly increases the probability of perceiving or experiencing disadvantage and danger in the environment (Aneshensel & Sucoff, 1996; Raudenbush, 2003; Ross et al., 2000; Schieman, 2009; Schieman & Pearlin, 2006). The important question is whether these perceptions and experiences link neighborhood-level processes and mental health status. Consistent with our model, Ross (2000) finds that the positive association between neighborhood disadvantage (indicated by the percentage of households below the federal poverty line and female-headed households with children) and depression is entirely mediated or explained by increased perceptions of neighborhood disorder.

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Secondary Mechanisms If the neighborhood experience is the primary link between neighborhood-level processes and mental health, what might account for the psychological consequences of the neighborhood experience? The third stage of our theoretical model (Fig. 23.1) suggests that the association between the neighborhood experience and mental health status is mediated or explained by several classes of secondary mechanisms, including socioeconomic status, biological factors, psychological dispositions, social resources, and health behaviors. With few exceptions, neighborhood-level processes are only indirectly associated with these secondary mechanisms through the neighborhood experience.

Socioeconomic Status The arrow leading from neighborhood structure to socioeconomic status suggests that neighborhoodlevel socioeconomic disadvantage could undermine mental health by limiting opportunities for individuallevel socioeconomic status. Research suggests that poorer neighborhoods are characterized by restricted access to community resources and opportunities, including quality schools and employment opportunities (Connell & Halpern-Felsher, 1997; Jencks & Mayer, 1990). Because poorer neighborhoods are defined by the concentration of poorer residents, tax revenue and consumer bases are often limited. Under these unique economic conditions, funding for schools is restricted and businesses are less viable. Studies provide indirect support for these explanations, showing that residence in a disadvantaged neighborhood is associated with poorer educational outcomes (Connell & Halpern-Felsher, 1997; Halpern-Felsher et al., 1997; Jencks & Mayer, 1990). Unfortunately, because people of low socioeconomic status are often selected into disadvantaged neighborhoods, it is extremely difficult to directly test whether neighborhood structure contributes to mental health through socioeconomic mechanisms. Any attenuation of the association between neighborhood structure and mental health could reflect selection processes, mediation processes, or some combination. Neighborhood-level factors could also undermine socioeconomic status through processes related to the neighborhood experience. Perceptions of low collective efficacy in the neighborhood could increase the probability of absenteeism by reducing the perceived costs associated with skipping school. When residents attend school, perceptions of disorder in the environment could undermine learning through biological, psychological, and behavioral mechanisms. For example, research shows that chronic stress can impair memory function, the sense of control, and sleep quality (McEwen & Lasley, 2002; Mirowsky & Ross, 2003).

Biological Factors The neighborhood experience could also undermine mental health through biological mechanisms, including physiological and cellular functioning. Residents of disadvantaged neighborhood environments are likely to experience allostatic load or chronic activation of the physiological stress response and overexposure to stress hormones (Hill, Ross, & Angel, 2005; Massey, 2004; McEwen, 1998; Ross & Mirowsky, 2001), which is sufficient to disrupt or even damage the hypothalamus, hippocampus, and amygdala—regions of the brain that play important roles in the development of anxiety, depression, and cognitive dysfunction (Massey, 2004; McEwen & Lasley, 2002; Mirowsky & Ross, 2003). Although studies show that neighborhood-level disadvantage is associated with increased allostatic load (Merkin et al., 2009; Stimpson, Ju, Raji, & Eschbach, 2007), there is, to the best of our knowledge, no direct evidence linking the neighborhood experience to physiological functioning, only indirect assessments of perceived disorder and perceived stress (Gary et al., 2007).

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Neighborhood context might also influence mental health through cellular functioning. Physiological functioning is closely tied to conditions in the environment. Although we tend to emphasize the human stress response when describing this relationship, it is important to consider that environmental conditions can also alter the function (not the sequence) of DNA through epigenetic processes. Studies have identified several key environmental conditions (e.g., stressors, toxic exposures, and poor nutrition) that produce epigenetic modifications to the DNA and affect gene expression (Meaney, 2010; Rutter, Moffitt, & Caspi, 2006). If, as research suggests, disadvantaged neighborhoods support relevant environmental signals, experiences in the neighborhood could conceivably enhance the liability toward a range of mental health conditions through epigenetic processes (Rutter et al., 2006).

Psychological Dispositions The association between the neighborhood experience and mental health could be explained by various psychological dispositions, including mistrust, self-esteem, and the sense of control. When residents experience neighborhood disorder (e.g., criminal activity) as a way of life, they learn that people in the environment can be threatening and dangerous (Mirowsky & Ross, 2003; Ross & Jang, 2000). Under these conditions, residents are likely to develop negative dispositions toward humanity (e.g., generalized mistrust and misanthropy) in the interest of survival. Mirowsky and Ross define mistrust as “…the cognitive habit of interpreting the intentions and behavior of others as unsupportive, self-seeking, and dishonest” (p. 234). Studies show that perceptions of neighborhood disorder can contribute to general feelings of mistrust (Ross & Jang, 2000; Ross & Mirowsky, 2009; Ross, Mirowsky, & Pribesh, 2001). These patterns are important because research also suggests that mistrust is associated with higher levels of psychological distress (Mirowsky & Ross, 2003). Mirowsky and Ross (2003) offer the following explanation for the link between mistrust and mental health: “Mistrust represents a profound form of alienation that has gone beyond a perceived separation from others to a suspicion of them… The suspicion of others indicates a heightened sense of threat, and the lack of confidence in others is a form of demoralization” (p. 236). Consistent with these processes, (Ross & Mirowsky, 2009) find that the positive association between perceived disorder and distress is partially mediated or explained by higher levels of mistrust. Because places are imbued with social significance and social value, the self-concept can be intimately tied to the places we inhabit (Fitzpatrick & LaGory, 2010). What is the symbolic value of living in a disadvantaged neighborhood? Mirowsky and Ross (2003) argue that perceptions of neighborhood disorder suggest to residents that “…the people who live around them are not concerned with public order, that the local agents of social control are either unable or unwilling to cope with local problems, and that those in power have probably abandoned the neighborhood” (p. 151). If residents feel this way about their neighborhoods, their self-esteem or self-worth is likely to suffer as a consequence of negative social comparisons and reflected appraisals. Although empirical support for these processes is limited, there is at least some evidence to suggest that perceptions of neighborhood disorder can undermine self-esteem in childhood (Turley, 2003), adolescence (Bámaca, Umaña-Taylor, Shin, & Alfaro, 2005; Behnke, Plunkett, Sands, & Bámaca-Colbert, 2011), and adulthood (Haney, 2007). Furthermore, Behnke et al., (2011) find that the association between perceived neighborhood disorder and depression is at least partially mediated or explained by lower levels of self-esteem in Latino adolescent boys living in Los Angeles. Stable conditions of neighborhood disadvantage and disorder can be overwhelming. When residents are repeatedly exposed to dilapidation, crime, and low levels of social control, they come to view the neighborhood environment as unpredictable and chaotic (Mirowsky & Ross, 2003; Ross & Mirowsky, 2009). If residents perceive that these conditions are inescapable and that they are incapable of changing or improving their living conditions, they are likely to develop a general sense of powerlessness. In support of this perspective, studies show that neighborhood disadvantage, perceived

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disorder, and lower levels of perceived neighborhood cohesion can undermine control beliefs, including self-efficacy, self-control, and the sense of control (Bierman, 2009; Boardman & Robert, 2000; Downey & Van Willigen, 2005; Geis & Ross, 1998; Ross & Mirowsky, 2009; Ross et al., 2001; Ross et al., 2000; Stafford et al., 2011; Teasdale & Silver, 2009). Our review of the literature revealed two formal mediation tests involving the sense of control. Ross & Mirowsky (2009) report that the positive association between perceived neighborhood disorder and psychological distress is partially mediated or explained by the sense of control. Stafford et al. (2011) find that the sense of control partially mediates the inverse association between perceived neighborhood cohesion and depression.

Social Resources Neighborhood context could also contribute to mental health by shaping social resources, including social ties and social support (Cutrona et al., 2006). Residence in a disadvantaged neighborhood may undermine the formation and maintenance of social ties in various ways. Residential instability (i.e., people frequently moving in and out of the neighborhood) would clearly limit opportunities for social interaction. For example, Ross et al. (2000) show that residential stability is positively associated with social ties in the neighborhood. Ross et al. (2000) also find that neighborhood poverty reduces social ties with neighbors. They argue that perceived neighborhood disorder is one possible mechanism of neighborhood stability and neighborhood socioeconomic status. If perceptions of disorder contribute to negative dispositions toward humanity (e.g., mistrust and misanthropy), it is reasonable to expect that residents of disadvantaged neighborhoods might go out of their way to avoid social interaction (Ross & Mirowsky, 2009). Consistent with this perspective, studies show that perceptions of disorder tend to limit social ties with neighbors (Geis & Ross, 1998; Kim, 2010). There is also some evidence to suggest that residents who perceive their neighborhoods to be less cohesive also tend to rate their friendships more negatively (Stafford et al., 2011). Restricted opportunities for social interaction would obviously constrain network size and, by extension, limit the availability or receipt of social support. Even under the conditions of extensive social networks, negative dispositions toward humanity (e.g., mistrust) could undermine perceptions of the availability of social support (Ross & Mirowsky, 2009). Research shows that neighborhood socioeconomic disadvantage (Schieman, 2005) and perceived neighborhood disorder (Kim, 2010) are associated with lower levels of social support. There is also some evidence to suggest that the inverse association between neighborhood socioeconomic disadvantage and social support can be offset by residential stability (Schieman, 2005). We were able to find two mediation tests involving social resources. Kim and Ross (2009) show that social ties and social support partially mediate the positive association between perceived neighborhood disorder and depression. Stafford et al. (2011) find that the inverse association between perceived neighborhood cohesion and depression is partially mediated by friendship quality.

Health Behaviors Finally, the neighborhood experience could undermine mental health by promoting risky healthrelated behaviors, including, for example, poor sleep quality and substance use. Because sleep is an adaptive behavior, neighborhoods that are characterized by noise, dilapidation, and crime might directly undermine the ability of residents to initiate and/or maintain sleep (Hill et al., 2009). Studies show that perceptions of neighborhood disorder are associated with sleep problems (e.g., trouble falling asleep and difficulty staying asleep) and poorer overall sleep quality (Hill et al., 2009; Steptoe, O’Donnell, Marmot, & Wardle, 2008). There is even some evidence to suggest that the association

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between perceived neighborhood disorder and psychological distress is at least partially mediated or explained by sleep quality (Hill et al., 2009). Disadvantaged neighborhood environments may also encourage the use and abuse of alcohol and illicit drugs. Residents of disadvantaged neighborhoods have more opportunities to purchase alcohol and drugs. For example, research suggests that alcohol outlets are more prevalent in disadvantaged communities (Hill & Angel, 2005; Nielsen, Hill, French, & Hernandez, 2010). Disadvantaged neighborhoods may provide a normative context in which heavy drinking and illicit substance use are not sanctioned as strongly as within other neighborhoods (Boardman, Finch, Ellison, Williams, & Jackson, 2001; Fitzpatrick & LaGory, 2010; Hill & Angel, 2005). It is hypothesized that residents may use substances to cope with the stress associated with the experience of neighborhood disorder (Boardman et al., 2001; Hill & Angel, 2005). Indeed, studies show that neighborhood disadvantage and disorder are associated with higher levels of alcohol consumption and drug use (Boardman et al., 2001; Hill & Angel, 2005; Stimpson et al., 2007).

Moderators of Neighborhood Context Bronfenbrenner (1979) was among the first to suggest that similar living environments could influence individuals more or less depending upon personal characteristics and life conditions. Following this important work and more recent discussions (Aneshensel, 2010), Fig. 23.2 presents several potential moderators of the association between neighborhood context and mental health. In this section, we consider subgroup variations that have been emphasized in the literature, including those by socioeconomic status, race/ethnicity, and social resources. We also explore more recent attempts to frame psychological dispositions and health behaviors as moderators.

Neighborhood Structure Socioeconomic Disadvantage Race and Ethnic Composition Residential Instability

Mental Health Cognitive Decline Depression Anxiety

Social Organization Collective Efficacy Social Ties Neighborhood Disorder Structural Dilapidation Industrial Activity Amenity Scarcity ToxicConditions Criminal Activity Ambient Noise Open Incivility Neighborhood Experience Personal Victimization Perceived Disorder

Individual Characteristics Socioeconomic Status Household Disrepair Race/Ethnicity Gender Age Perceived Collective Efficacy Social Ties/Support Marital Status Children Religiosity Sense of Control Self-Esteem Mistrust Substance Use Sleep Quality Allostatic Load

Fig. 23.2 Moderators of the link between neighborhood context and mental health

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Socioeconomic Status Studies consistently show that individual-level socioeconomic status is protective against the mental health consequences of living in a disadvantaged neighborhood. Research indicates that personal wealth may attenuate the effects of neighborhood socioeconomic disadvantage on depression (Wight et al., 2011) and cognitive functioning (Aneshensel et al., 2011). Other studies show that education can buffer the effects of black residential segregation (Aneshensel et al., 2011) and neighborhood socioeconomic disadvantage (Wight et al., 2006) on cognitive functioning. There is also some evidence to suggest that industrial waste production in the neighborhood is less distressing for residents with higher levels of personal income (Downey & Van Willigen, 2005). These moderation patterns have been attributed to “compound disadvantage” processes (Aneshensel et al., 2011; Wight et al., 2011). The idea is that disadvantaged individuals (e.g., people of low socioeconomic status) may be especially vulnerable to the psychological consequences of stressful neighborhood conditions. Downey and Van Willigen (2005) speculate that disadvantaged individuals may be more susceptible because they tend to have fewer stress-buffering resources (e.g., a sense of personal control).

Race and Ethnicity Subgroup variations by race and ethnicity are somewhat mixed. Studies show that neighborhood industrial waste production and perceptions of disorder may be especially depressing among Hispanics (Downey & Van Willigen, 2005; Echeverría et al., 2008). Research also suggests that non-Hispanic whites may benefit more from neighborhood cohesion in terms of anxiety and depression than non-Hispanic blacks (Gary et al., 2007). Although Asian subgroup data is scarce, there is some evidence to suggest that the association between perceived neighborhood disorder and depression is more pronounced among Chinese Americans than non-Hispanic whites and blacks (Echeverría et al., 2008). Some research reports no black-white variations in the effects of perceived disorder on depression (Echeverría et al., 2008; Gary et al., 2007) and anxiety (Gary et al., 2007). Other studies of depression show no race or ethnic variations in the effects of perceived disorder (Ross, 2000) and neighborhood cohesion (Echeverría et al., 2008). Why might the association between neighborhood context and mental health status vary according to race and ethnicity? Viable answers to this question are uncertain because relevant moderation tests are often performed in an exploratory fashion, with little to no theoretical background. “Compound disadvantage” could help to explain the susceptibility patterns of certain groups (e.g., blacks and Hispanics), but this perspective cannot be applied to other groups (e.g., Chinese Americans). It is also unclear why subgroup variations by race and ethnicity are apparently less common than those by socioeconomic status.

Social Resources Research concerning the buffering role of social resources is less consistent than variations by socioeconomic status and race and ethnicity. Some work on depression finds that neighborhood social ties and general social support are protective against perceived neighborhood disorder (Kim & Ross, 2009; Schieman & Meersman, 2004), while others show no variations according to levels of general social integration and social support (Latkin & Curry, 2003). Bierman (2009) considers whether the effect

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of perceived neighborhood disorder on changes in depression varies according to marital status among older adults. His analysis indicates that perceived neighborhood disorder contributes to new symptoms of depression among nonmarried individuals; among married individuals, perceived neighborhood disorder is unrelated to changes in depression. Although some anxiety research suggests that the effect of perceived neighborhood disorder is attenuated by neighborhood social ties (Ross & Jang, 2000), social support (Schieman & Meersman, 2004) and perceived neighborhood cohesion (Aneshensel & Sucoff, 1996) are not effective in this way. There is also some evidence to suggest that the effect of neighborhood disorder (indicated by the aggregation of individual ratings of community dilapidation and deviance) on psychological distress is less pronounced for individuals with higher levels of relationship quality (indicated by a mix of perceived social support and network burden) (Cutrona et al., 2000). Explanations for the stress-buffering role of social resources are well established in the mental health literature. Social ties are important as sources of social support, which may help to reduce the psychological consequences of stressful neighborhood conditions by encouraging positive psychological dispositions (e.g., self-esteem) and stress appraisals (e.g., from knowing that one has help, that one is not alone) (Kim & Ross, 2009; Ross & Jang, 2000). Through these general mechanisms, social support (e.g., knowing that people are available to listen to problems) could attenuate the impact of social and physical disorder in the environment, but research clearly suggests that neighborhood conditions can be sufficient to overcome personal social resources.

Psychological Dispositions To the best of our knowledge, very few studies have tested whether the association between neighborhood context and mental health might vary according to psychological dispositions. Nevertheless, research by Cutrona et al., (2000) suggests that the effect of high neighborhood disorder (aggregate ratings) on psychological distress can be buffered by a positive outlook (indicated by the combination of the sense of control and optimism). Schieman and Meersman (2004) also find that, among older men, the positive association between neighborhood disorder and anger is attenuated by a greater sense of mastery; however, this moderation pattern did not extend to depression or anxiety in older men or women. Unfortunately, there are no established explanations for these patterns. Disadvantaged neighborhoods should be less threatening to people who feel in control of their own lives and to those who are generally optimistic about the future. For example, when individuals have a strong sense of control, they believe that life is manageable and controllable (Mirowsky & Ross, 2003). Under these conditions, life events are less uncertain and discouraging, and symptoms of anxiety (e.g., fear and worry) and depression (e.g., sadness and hopelessness) are less likely.

Health Behaviors Like psychological dispositions, there is very little evidence to suggest the relevance of health behaviors as viable moderators. One study by Hill et al. (2009) indicates that the positive association between perceived neighborhood disorder and psychological distress is attenuated among residents with higher levels of sleep quality. They explain that sleep is fundamental for physiological restoration. Under the conditions of restful sleep, the brain downregulates the sympathetic nervous system and activates the parasympathetic nervous system. Because sleep deprivation tends to prolong the sympathetic stress response, the body is especially vulnerable to the effects of stressors in the environment.

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Avenues for Future Research In this chapter, we explored the association between neighborhood context and mental health. We defined neighborhood context, described associations with several indicators of mental health status, and developed the theoretical and empirical bases for several potential mediation and moderation processes. Where do we go from here? In this final section, we highlight several promising avenues for future research.

Neighborhood Assessments Objective assessments of the neighborhood environment (e.g., census measures) are often thought to represent the model of measurement excellence; however, they can result in significant “exposure misclassification.” For example, a recent study by Basta et al., (2010) show that residents’ drawings of neighborhoods and activity paths are often inconsistent with census tract boundaries. This research raises an important methodological issue. If residents perceive their neighborhoods in one way and census definitions operationalize neighborhoods in a different way, what are we measuring? Basta et al. (2010) conclude that “…classifying subjects as exposed based solely on the prevalence of the exposure in the geographic area of their residence may misrepresent the exposure that is etiologically meaningful” (p. 1943). Subjective assessments of the neighborhood are generally devalued because preexisting mental health conditions are likely to favor negative ratings of the neighborhood. To avoid the possibility of “same-source bias,” many studies are restricted to objective or independent assessments of the neighborhood. When studies are limited to independent assessments, there is no direct sense of the human experience within neighborhoods. This raises an important theoretical issue. If stress serves as the primary link between neighborhood context and mental health, the subjective neighborhood experience must be directly measured to establish that residents actually define neighborhood conditions as noxious or threatening. It is also important to think more critically about how to use and explain objective and subjective assessments in the same study. This is especially important when data sources include objective and subjective assessments of the same concept. For example, is it theoretically meaningful to incorporate individual-level measures of collective efficacy in a model that includes the same measures aggregated to the neighborhood-level? Collective efficacy measured at the neighborhood-level could favor mental health by increasing awareness (i.e., subjective perceptions) among individual residents that neighbors get along, trust and help each other, share common values, and are willing to intervene in the interests of the community. The effect of neighborhood-level collective efficacy on mental health might also vary according to individual-level perceptions of collective efficacy. How comforting is high neighborhood-level collective efficacy to individuals who perceive low levels of collective efficacy?

Mental Health Outcomes Although this chapter has focused on research in the areas of depression, anxiety, psychological distress, and cognitive functioning, we acknowledge that neighborhood context is related to other important indicators of mental health, including, for example, happiness (Usher, 2007), anger (Ross & Mirowsky, 2009; Schieman & Meersman, 2004; Schieman, Pearlin, & Meersman, 2006), schizophrenia

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(Goldsmith, Holzer, & Manderscheid, 1998; Silver et al., 2002), broader classifications of internalizing and externalizing disorders (McLeod & Edwards, 1995; Wheaton & Clarke, 2003), and any mental disorder (Goldsmith et al., 1998; Stockdale et al., 2007). Because most studies focus on depression, it is important for future work to explore a broader range of mental health outcomes. Research along these lines would directly test whether the effects of neighborhood context are truly nonspecific. Aneshensel and Sucoff (1996) explain that “…understanding the mental health consequences of social organization is a more complex task than describing the social etiology of a specific psychiatric disorder” (p. 306).

Mediation Processes Studies often speculate as to why neighborhood context might be associated with mental health; however, empirical support for these explanations is sorely lacking. For example, we noted limited evidence for biological and behavioral mechanisms. It is vital for future research to employ formal mediation tests to confirm these patterns and to examine new and understudied mechanisms. If the neighborhood experience is a crucial mechanism of neighborhood-level processes, the next step is to explain the psychological consequences of these experiences. While it is important to establish individual mechanisms, future work should focus more on developing and testing elaborate theoretical models with multiple mediators and complex causal chains (Ross & Mirowsky, 2009). We should also devote more attention to developing and testing patterns of mediated moderation. Tests of mediated moderation seek to identify mechanisms to explain subgroup variations (Bierman, 2009; Ross et al., 2000). If subgroup variations exist, why do they?

Moderation Processes Under which conditions might neighborhood context be more or less relevant to mental health? Empirical evidence of subgroup variations is often either limited or mixed. Clearly, additional research is needed to confirm previous patterns (e.g., for social resource moderators) and to consider new and understudied subgroup variations (e.g., for biological, behavioral, and psychological moderators). In the interest of interpretation, it is extremely important for studies to develop theoretical explanations for these variations a priori (e.g., for race and ethnic subgroup analyses). Whitfield et al., (2008) argue that “Science is advanced by evaluating theories in different groups to see if they remain valid and applicable” (p. P307). With this in mind, it is also important to consider the possibility of moderated mediation. Tests of moderated mediation consider the validity of causal processes within theoretically relevant subgroups. Are mediation processes invariant across groups, or do certain causal processes fit certain groups more or less?

Selection Effects Does neighborhood context matter for mental health, or could we simply attribute these “effects” to the composition of the neighborhood? Because disadvantaged people are often selected into disadvantaged neighborhoods, it is often unclear whether the apparent mental health consequences of neighborhood context are true or simply a reflection of individual-level disadvantage. Contemporary research attempts to isolate context by controlling for composition at the individual-level. For example, adjustments for background demographic characteristics often attenuate (and sometimes eliminate) the effects of neighborhood structure on mental health. However, if the effect of neighborhood context on mental

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a Social Position Socioeconomic Status

Neighborhood Context Neighborhood Experience Neighborhood Structure Neighborhood Disorder Social Organization

Mental Health Cognitive Decline Depression Anxiety

b Neighborhood Context Neighborhood Experience Neighborhood Structure Neighborhood Disorder Social Organization

Mental Health Cognitive Decline Depression Anxiety

Psychological Dispositions Socioeconomic Status Deviant Behavior Biological Factors Social Resources Health Behaviors Physical Health Mortality Risk

Fig. 23.3 Neighborhood context as a mechanism of social position (a) and mental health as a lynchpin mechanism (b)

health remains statistically significant at conventional levels when elements of composition have been taken into account, the contextual effect is assumed to be plausible. Although recent studies do a good job of accounting for individual-level socioeconomic status, researchers rarely (if ever) account for other important elements of neighborhood composition that are related to personality and genetics. If personalities are patterned ways of thinking, feeling, and behaving, certain personality types might be more likely to move into or remain in a disadvantaged neighborhood. For example, dangerous neighborhoods could seem less noxious to residents with personalities that favor risk-taking (e.g., psychoticism). The concern is that psychoticism is known to predict poorer mental health (Compton, Carter, Kryda, Goulding, & Kaslow, 2008). It is also possible for an association between neighborhood context and mental health to be produced by a gene-environment correlation (i.e., genetic influences on environmental exposures). If families with risky genetic profiles are concentrated in disadvantaged neighborhoods, and if parents and children share a genetic liability toward a risky personality type, mental health condition, or both, any association between neighborhood context and mental health could reflect some unknown heritability process (Caspi, Taylor, Moffitt, & Plomin, 2000).

Model Extensions The studies referenced in this chapter tend to emphasize a fundamental relationship between neighborhood context (the focal predictor) and mental health (the focal outcome). We would like to encourage researchers to expand their focus beyond these parameters. The connection between neighborhood context and mental health could be essential to understanding numerous outcomes and health-related processes. Figures 23.3 and 23.4 illustrate several viable paths by which to extend the relevance of future work. Does neighborhood context link socioeconomic status and mental health (Fig. 23.3a)? It is well established that low socioeconomic status favors residence in disadvantaged neighborhoods. The broader issue is whether neighborhood-related exposures help to explain why people of low

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Stressful Conditions Relationship Stressors Household Disrepair Poor Physical Health Economic Hardship Work Stressors

Genetic Liability 5-HTT DRD2 APOE

Mental Health Cognitive Decline Depression Anxiety

a Mental Health Cognitive Decline Depression Anxiety

b

Mental Health Cognitive Decline Depression Anxiety

c

Neighborhood Context Neighborhood Experience Neighborhood Structure Neighborhood Disorder Social Organization

Psychological Dispositions Socioeconomic Status Deviant Behavior Biological Factors Social Resources Health Behaviors Physical Health Mortality Risk

Fig. 23.4 Neighborhood context as a moderator of stressful conditions (a), genetic liability (b), and mental health (c)

socioeconomic status tend to exhibit poorer mental health (Evans & Kantrowitz, 2002; Williams & Collins, 1995). Admittedly, this process will be difficult to establish because, as discussed earlier, neighborhood context may also constrain status attainment. Could mental health link neighborhood context with other outcomes (Fig. 23.3b)? Because mental health is relevant to so many health-related characteristics, it could serve as a lynchpin mechanism. For example, research suggests that mental health may help to mediate or explain the effects of neighborhood context on alcohol consumption (Hill & Angel, 2005), drug use (Boardman et al., 2001), diet, exercise, body mass (Burdette & Hill, 2008), and self-rated physical health (Hill et al., 2005). Given that mental health status is associated with chronic physical health conditions (Needham & Hill, 2010) and mortality risk (Rogers, Hummer, & Nam, 2000), future work should also emphasize these important outcomes. Does neighborhood context moderate the association between stressful life conditions and mental health (Fig. 23.4a)? In other words, could stressful life conditions undermine mental health more or less depending on the neighborhood context? Living in a disadvantaged neighborhood could make already difficult life conditions worse. For example, research suggests that acute negative life events are more depressing in economically disadvantaged neighborhoods (Cutrona et al., 2005) and that lead exposure is especially detrimental to cognitive functioning under the conditions social and physical disorder (Glass et al., 2009). It is also possible for neighborhoods to enhance positive mental health processes. Indeed, there is some evidence to suggest that social integration is only protective against depression in economically advantaged neighborhoods (Elliot, 2000). Could neighborhood context moderate the genetic liability toward poor mental health (Fig. 23.4b)? Several susceptibility genes have been implicated in the development of mental health conditions, including, for example, DRD2, 5-HTT, and APOE (Tsuang, Bar, Stone, & Faraone, 2004). The question

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is whether an individual’s genetic predisposition toward a mental health condition could be expressed differently across neighborhood environments (Rutter et al., 2006; van Os, Hanssen, Bak, Bijl & Vollebergh, 2003). Research by van Os et al. (2003) offers some indirect evidence of this process. They find that the association between family history of psychosis (an indicator of genetic risk) and lifetime prevalence of psychotic disorder is more pronounced with increasing levels of urbanicity (indicated by residential density). The authors conclude that “Social environments with a high level of deprivation and a low level of social capital may constitute the environments that interact with genetic liability to increase the risk for psychotic illness” (van Os et al., 2003, p. 481). Finally, could neighborhood context serve as a moderator of the effect of mental health on other outcomes (Fig. 23.4c)? If neighborhoods shape exposures to stressful conditions and access to stressbuffering resources, neighborhood context could either amplify or protect against the adverse consequences of poor mental health status. For example, Maimon and Kuhl (2008) show that the positive association between depression and the number of suicide attempts in adolescence is attenuated with increasing levels of community-level religiosity. The authors conclude that “religious neighborhoods are more integrative in nature and offer more support through religious organizations and local social networks” (Maimon & Kuhl, 2008, p. 935).

Conclusion Our overview and critical examination of relevant studies conducted over the past two decades suggests that neighborhood context matters for mental health over and above the characteristics of individual residents. This general pattern is remarkably consistent across studies of various indicators of mental health. Even more impressive is the reliability of findings across disciplines, including sociology, psychology, public health, and gerontology. Having said this, additional research is needed to establish (a) associations with new or understudied mental health outcomes, (b) complex mediation and moderation processes, and (c) theoretical and empirical links to subjective assessments of neighborhood experiences. It is also important for future studies to (d) consider selection linked to personality and genetic characteristics and to (e) extend the relevance of neighborhood-mental health research to new outcomes and health-related processes. Research along these lines will no doubt contribute to a more thorough understanding of neighborhood context as an important social cause of mental health. Acknowledgments We would like to thank Carol S. Aneshensel, Alex Bierman, Catherine E. Ross, and Sunshine Rote for valuable comments on previous drafts. Kari Ann Levine and Stephen McGuinn also provided critical research assistance.

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