The Contribution of Neighborhood Socioeconomic Disadvantage to Depressive Symptoms Over the Course of Adult Life

A 32-Year Prospective Cohort Study

Marko Elovainio; Jussi Vahtera; Jaana Pentti; Christian Hakulinen; Laura Pulkki-Råback; Jari Lipsanen; Marianna Virtanen; Liisa Keltikangas-Järvinen; Mika Kivimäki; Mika Kähönen; Jorma Viikari; Terho Lehtimäki; Olli Raitakari

Disclosures

Am J Epidemiol. 2020;189(7):679-689. 

In This Article

Abstract and Introduction

Abstract

The association between socioeconomic disadvantage and increased risk of depressive symptoms in adulthood is well established. We tested 1) the contribution of early exposure to neighborhood socioeconomic disadvantage to later depressive symptoms throughout life, 2) the persistence of the potential association between early exposure and depressive symptoms, and 3) the contributions of other known risk factors to the association. Data were collected from the Young Finns Study, a prospective, population-based 32-year follow-up study that included participants aged 3–18 years at baseline in 1980. Participants were followed up with repeated measurements of depressive symptoms between 1992 and 2012 (n = 2,788) and linked to national grid data on neighborhood disadvantage via residential addresses. We examined the associations in mixed models separately for the 5-, 10-, 15-, and 20-year follow-ups. Living in a disadvantaged neighborhood during childhood and adolescence was associated with a higher level of depressive symptoms in adulthood during all follow-up periods (β = 0.07, P = 0.001) than living in a nondisadvantaged area. Individual adulthood socioeconomic status mediated the associations. These findings suggest that living in a socioeconomically disadvantaged area during childhood and adolescence has a long-lasting negative association with mental health irrespective of family-related risks, partially due to socioeconomic adversity later in life.

Introduction

Although the etiology of depression and depressive symptoms is multifactorial,[1] adverse environmental exposures in early life are known to play a role.[1–4] It is unclear whether early-life experiences predict depression because they are linked to accumulation of risks over a lifetime. Alternatively, childhood and adolescence may be critical periods in life that have irreversible effects on mental health. One psychosocial risk factor that may have long-term effects on mental health outcomes is growing up in a disadvantaged residential neighborhood characterized by poverty, lack of employment opportunities, a high percentage of renters, and reduced economic prospects,[5] which, in turn, is related to marginalization[6,7] and low neighborhood integration.[7]

Although many[7–22] but not all[23] previous studies have shown an association between neighborhood socioeconomic factors and depression, a recent meta-analysis did not reveal consistent support for such an association.[24] In that meta-analysis, Richardson et al.[24] found an association between neighborhood socioeconomic disadvantage and later depression only in studies with short (<5 years) follow-up times, not in those with longer ones. Most of the studies included in the meta-analysis comprised older adults, and only 1 study was based on participants aged <16 years at baseline.[24]

Additionally, there are multiple other family-related psychosocial risk factors in childhood that potentially affect the development of depressive symptoms, including low parental socioeconomic status (SES), parental mental health problems,[16–20] parental alcohol use or antisocial behaviour,[20,25] unhealthy parental diet,[14,26,27] a low-quality emotional environment (the degree of acceptance and nurturance),[28] and stressful life events.[14,29] Studies suggest that these family-related psychosocial risk factors confer increased risk of mental or physical health problems,[16–22,25–28] particularly when multiple risk factors accumulate.[14,30,31]

Depressive symptoms and major depressive disorder have a high risk of recurrence. Recurring episodes have been shown to predict a progressively increasing risk of subsequent episodes, particularly with onset in adolescence.[32–35] Furthermore, although the initial onset of a depressive episode may be preceded by stressful life events, later recurrent episodes may be less closely related to such distal stressors due to an individual's heightened sensitivity to environmental stressors of daily life.[36,37] Thus, factors that increase the risk of early depressive episodes may dramatically increase the risk of developing depression later in life.[38,39] Few studies using prospective data have examined the associations of childhood and adolescent neighborhood disadvantage with the development of later mental health problems.[14,15] Similarly, very few studies have considered the associations of other family-level risk factors with the development of depressive symptoms[12,13] in addition to individual SES. Understanding how childhood and adolescent risk factors predict change in risk factors over a lifetime is thus of growing scientific and public health relevance, potentially facilitating focused and timely prevention.

We used data from the Young Finns Study, a prospective cohort study, to examine the associations of long-term neighborhood disadvantage during childhood and adolescence with the development of depressive symptoms in adulthood, using multiple follow-up times ranging from 5 years to 20 years. We also considered the associations of accumulated psychosocial adversities in childhood from multiple domains. We also tested the potentially mediating effect of adulthood socioeconomic adversity using causal mediation models.[40]

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