Texas College of Osteopathic Medicine (S Oyegoke), University of North Texas Health Science Center, Fort Worth, Texas.
Division of Pharmaceutical Outcomes and Policy (PM Hughes), University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC; Division of Research (PM Hughes), UNC Health Sciences at MAHEC, Asheville, NC; Cecil G. Sheps Center for Health Services Research (PM Hughes), University of North Carolina, Chapel Hill, NC.
Acad Pediatr. 2024 Nov-Dec;24(8):1246-1255. doi: 10.1016/j.acap.2024.08.008. Epub 2024 Aug 17.
Mental health diagnoses among adolescents are increasing in prevalence. Existing literature considers associations between individual-level social determinants of health (SDOH) and adolescent mental health. Neighborhood-level SDOH can have a substantial impact on health. This paper examines associations between neighborhood-level SDOH and mental health diagnoses of anxiety, depression, and suicidal ideation among hospitalized adolescents.
We used 2018 and 2019 Texas Inpatient Discharge Public Use Data Files linked to the zip-code level Child Opportunity Index 2.0, a composite measure of subdomains which characterize neighborhood-level SDOH, to examine rates of mental health diagnoses and associations with patient characteristics across opportunity level quintiles.
The sample included 50,011 adolescents ages 10-19 admitted to the hospital with the mental health diagnoses anxiety, depression, and/or suicide. Most had a single diagnosis; anxiety (12.9%), depression (37.5%), or suicide (13.0%). Hospitalized adolescents 10-14 years old were a plurality (44.2%) of the sample. Most adolescents were White (64.2%) and non-Hispanic (67.4%) and lived in rural areas (29.6%). Adolescents from racial minority populations and those in rural communities with mental health diagnoses had lower opportunity-levels. Higher opportunity levels were associated with greater odds of having an anxiety or suicide diagnosis while a depression diagnosis was associated with a lower opportunity-level.
There are significant differences in adolescent mental health diagnoses associated with neighborhood opportunity-level. While all adolescents can benefit from mental health education, screening, and early interventions, additional resources tailored to neighborhood-level opportunity may prove a more meaningful way to improve population-level mental health outcomes.
青少年的心理健康诊断发病率呈上升趋势。现有文献认为个体层面的健康社会决定因素（SDOH）与青少年心理健康之间存在关联。邻里层面的 SDOH 对健康有重大影响。本文研究了邻里层面的 SDOH 与住院青少年焦虑、抑郁和自杀意念的心理健康诊断之间的关联。
我们使用了 2018 年和 2019 年德克萨斯州住院病人公共使用数据文件，并将其与邮政编码层面的儿童机会指数 2.0 进行了关联，后者是邻里层面 SDOH 子领域特征的综合衡量指标，以检查心理健康诊断的比率以及与机会水平五分位数内患者特征的关联。
样本包括 50011 名年龄在 10-19 岁之间因心理健康诊断而住院的青少年，包括焦虑症、抑郁症和/或自杀症。大多数人只有一个诊断；焦虑症（12.9%）、抑郁症（37.5%）或自杀症（13.0%）。10-14 岁的住院青少年占样本的多数（44.2%）。大多数青少年是白人（64.2%）和非西班牙裔（67.4%），并居住在农村地区（29.6%）。有心理健康诊断的少数族裔和农村社区的青少年机会水平较低。较高的机会水平与更大概率患有焦虑症或自杀症相关，而抑郁症诊断则与较低的机会水平相关。
与邻里机会水平相关的青少年心理健康诊断存在显著差异。虽然所有青少年都可以从心理健康教育、筛查和早期干预中受益，但针对邻里层面机会的额外资源可能是改善人口层面心理健康结果的更有意义的方法。
