Cross-sectional analysis of neighbourhood profiles and mental health conditions in the USA: insights from the All of Us Research Program.

BACKGROUND

Neighbourhood characteristics are critical determinants of mental health; however, few studies have applied a multidimensional approach to examine neighbourhood profiles and their association with leading mental health outcomes. In this cross-sectional study, we leveraged data from the All of Us Research Program to identify neighbourhood profiles and examine associations with depression, anxiety and post-traumatic stress disorder (PTSD) in the USA.

METHODS

First, profiles were derived using latent profile analysis of self-reported neighbourhood characteristics, including accessibility/resources, safety, social cohesion, physical disorder and social disorder. Next, logistic regression models tested associations between neighbourhood profiles and self-reported diagnoses of PTSD, depression and anxiety, adjusting for age, education, income, housing status, health insurance, geographic region and neighbourhood socioeconomic disadvantage.

RESULTS

Among the 153 712 participants (76% non-Hispanic white; 67% female), a diagnosis of PTSD was self-reported by 12%, depression by 37% and anxiety by 28%. Five neighbourhood profiles were identified: high-access/moderate-risk, high-access/high-risk, high-access/low-safety, low-access/protective and high-access/protective. Significant ethnoracial and socioeconomic inequities emerged: the majority of non-Hispanic white participants lived in low-access/protective neighbourhoods, while ethnoracially minoritised and socioeconomically disadvantaged individuals disproportionately lived in high-access/high-risk neighbourhoods. Compared with the high-access/protective profile, all other profiles were associated with an increased likelihood of mental health diagnoses (psadj <0.001). The high-access/high-risk profile was associated with the highest likelihood of reporting PTSD (OR=1.87), depression (OR=1.52) and anxiety (OR=1.46).

CONCLUSIONS

Using a profiling approach, results reveal that more accessible neighbourhoods with low physical/social disorder and high safety and cohesion are associated with a lower likelihood of a mental health diagnosis. More accessible neighbourhoods may confer both benefits (eg, resources) and risks (eg, higher crime exposure). Evaluating the mechanisms by which multiple neighbourhood exposures influence PTSD, depression and anxiety may better inform interventions aimed at reducing the prevalence of these conditions and narrowing mental health inequities.