Dataset Information

Associations between neighborhood-level violence and individual mental disorders: Results from the World Mental Health surveys in five Latin American cities.

ABSTRACT: Rapidly urbanizing areas of Latin America experience elevated but unevenly distributed levels of violence. Extensive research suggests that individual exposure to violence is associated with higher odds of both internalizing (anxiety and mood) and externalizing (substance and intermittent explosive) mental disorders. Less research, however, has focused on how neighborhood-level violence, as an indicator of broader neighborhood contexts, might relate to the mental health of residents, independently of an individual's personal exposure. We used multilevel analyses to examine associations of neighborhood-level violence with individual-level past-year mental disorders, controlling for individual-level violence exposure. We used data from 7,251 adults nested in 83 neighborhoods within five large Latin American cities as part of the WHO World Mental Health Surveys. Accounting for individual-level violence exposure, living in neighborhoods with more violence was associated with significantly elevated odds of individual-level internalizing disorders, but not externalizing disorders. Caution should be exercised when making causal inferences regarding the effects of neighborhood-level violence in the absence of experimental interventions. Nevertheless, neighborhood context, including violence, should be considered in the study of mental disorders. These findings are particularly relevant for rapidly urbanizing areas with high levels of violence, such as Latin America.

SUBMITTER: Benjet C

PROVIDER: S-EPMC6946059 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Associations between neighborhood-level violence and individual mental disorders: Results from the World Mental Health surveys in five Latin American cities.

Benjet C C Sampson L L Yu S S Kessler R C RC Zaslavsky A A Evans-Lacko S S Martins S S SS Andrade L H LH Aguilar-Gaxiola S S Cía A A Medina-Mora M E ME Stagnaro J C JC de Galvez M Y Torres MYT Viana M C MC Galea S S

Psychiatry research 20191011

Rapidly urbanizing areas of Latin America experience elevated but unevenly distributed levels of violence. Extensive research suggests that individual exposure to violence is associated with higher odds of both internalizing (anxiety and mood) and externalizing (substance and intermittent explosive) mental disorders. Less research, however, has focused on how neighborhood-level violence, as an indicator of broader neighborhood contexts, might relate to the mental health of residents, independent ...[more]

PMID: 31630039

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Project description:ObjectivesThe rapid growth of urban areas in China in the past few decades has introduced profound changes in family structure and income distribution that could plausibly affect mental health. Although multilevel studies of the influence of area-level socioeconomic factors on mental health have become more common in other parts of the world, a study of this sort has not been carried out in Chinese cities. Our objectives were to examine the associations of two key neighbourhood-level variables-median income and percentage of married individuals living in the neighbourhood-with mental disorders net of individual-level income and marital status in three Chinese cities.SettingHousehold interviews in Beijing, Shanghai and Shenzhen, PRC, as part of the cross-sectional World Mental Health Surveys.Participants4072 men and women aged 18-88 years.Primary and secondary outcome measuresLifetime and past-year internalising and externalising mental disorders.ResultsEach one-point increase in neighbourhood-level percentage of married residents was associated with a 1% lower odds of lifetime (p=0.024) and 2% lower odds of past-year (p=0.008) individual-level externalising disorder, net of individual-level marital status. When split into tertiles, individuals living in neighbourhoods in the top tertile of percentage of married residents had 54% lower odds of a past-year externalising disorder (OR=0.46, 95% CI: 0.24 to 0.87) compared with those in the bottom tertile. Neighbourhood-level marital status was not statistically associated with either lifetime or past-year internalising disorders. Neighbourhood-level income was not statistically associated with odds of either internalising or externalising disorders.ConclusionsThe proportion of married residents in respondents' neighbourhoods was significantly inversely associated with having externalising mental disorders in this sample of Chinese cities. Possible mechanisms for this finding are discussed and related to social causation, social selection and social control theories. Future work should examine these relationships longitudinally.

Project description:ObjectiveUsing data compiled by the SALURBAL project (Urban Health in Latin America; 'Salud Urbana en América Latina') we quantified variability in low birth weight (LBW) across cities in Latin America, and evaluated the associations of socio-economic characteristics at various levels (maternal, sub-city and city) with the prevalence of LBW.MethodsThe sample included 8 countries, 360 cities, 1321 administrative areas within cities (sub-city units) and birth registers of more than 4.5 million births for the year 2014. We linked maternal education from birth registers to data on socioeconomic characteristics of sub-cities and cities using the closest available national population census in each country. We applied linear and Poisson random-intercept multilevel models for aggregated data.ResultsThe median prevalence of city LBW by country ranged from a high of 13% in Guatemala to a low of 5% in Peru (median across all cities was 7.8%). Most of the LBW variability across sub-cities was between countries, but there were also significant proportions between cities within a country, and within cities. Low maternal education was associated with higher prevalence of LBW (Prevalence rate ratios (PRR) for less than primary vs. completed secondary or more 1.12 95% CI 1.10, 1.13) in the fully adjusted model. In contrast, higher sub-city education and a better city social environment index were independently associated with higher LBW prevalence after adjustment for maternal education and age, city population size and city gross domestic product (PRR 1.04 95% CI 1.03, 1.04 per SD higher sub-city education and PRR 1.02 95% CI 1.00, 1.04 per SD higher SEI). Larger city size was associated with a higher prevalence of LBW (PRR 1.06; 95% CI 1.01, 1.12).ConclusionOur findings highlight the presence of heterogeneity in the distribution of LBW and the importance of maternal education, local and broader social environments in shaping LBW in urban settings of Latin America. Implementing context-sensitive interventions guided to improve women's education is recommended to tackle LBW in the region.

Dataset Information

Associations between neighborhood-level violence and individual mental disorders: Results from the World Mental Health surveys in five Latin American cities.

Publications

Associations between neighborhood-level violence and individual mental disorders: Results from the World Mental Health surveys in five Latin American cities.

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