Neighbourhood poverty and psychological distress in adolescents aged 11–15 in China: a multilevel study of 507 local communities

Background Neuropsychiatric conditions have become the leading cause of disability in adolescents aged 11–24 globally. Higher neighbourhood economic status was found to be associated with lower incidence of neuropsychiatric conditions in children and adolescents in developed countries, but there is a lack of evidence in China. This study aims to examine the associations between neighbourhood poverty and psychological distress among adolescents in China. Methods We applied multilevel logistic regression to data from the 2014 China Family Panel Studies. 281 villages and 226 cities were randomly selected, and 1790 adolescents aged 11–15 were surveyed from 2178 households selected randomly. Severe psychological distress was defined as a score of 16 or over out of 24 in the K6 psychological disorder scale. Neighbourhood economic status was measured in two ways: using the log of median household monthly income within the community; and the percentage of residents receiving governmental subsistence allowance. Neighbourhood poverty was defined as more than 15% of residents receiving governmental subsistence allowance. We controlled for family-level economic conditions by ranking the households within each community by income. We also controlled for family structure and individual demographics. Rural and urban neighbourhoods were analysed separately. Findings Of the surveyed adolescents, 2·3% (41 of 1790) were at high risk of severe distress (a score of >16 out of 24). The percentages were substantially higher in villages (2·6%, 29 of 1107) than in cities (1·8%, 12 of 683). Multilevel regression demonstrated diverse risk factors of psychological distress between adolescents in rural and urban areas. In villages, neighbourhood poverty was a significant and positive predictor of psychological distress in adolescents (adjusted odds ratio [AOR] 3·54, 95% CI 1·05–11·88, p=0·04), net of family-level and individual-level features. In cities, neighbourhood poverty had no significant effect on adolescents' mental health, but adolescents in families with higher income rankings within the community had a lower risk of psychological distress (0·81, 0·67–0·97, p=0·02). Median neighbourhood income and total household income were insignificant to adolescents' psychological distress in both rural and urban China. Interpretation Our findings highlight the serious issue of psychological distress in adolescents, and its influencing factors, in rural and urban China. The study focused on neighbourhood poverty. Further studies may consider other ecological characteristics. Funding No funding.