Social-spatial residence patterns and adolescent mental health: Investigating the influences of residential segregation, neighborhood social cohesion, and race on persistent, distressing psychotic-like experiences in the United States

Prior work suggests that living among people who share similar identities may be protective against psychosis, but the meaning of this association in the context of racialized residential segregation is not well understood. We investigated the effects of evenness and exposure residential segregation on persistent, distressing psychotic-like experiences (PLEs) in Black and White adolescents living in urban neighborhoods with high and low social cohesion in the United States. Data from the Adolescent Brain Cognitive Development Study were used (N = 5871), measuring evenness and exposure segregation in metropolitan statistical areas using the Dissimilarity Index (DI) and Exposure-Interaction Index (EII), respectively. Multi-level log binomial generalized estimating equations estimated the relative risk of PLEs by exposure to each domain of segregation. Evenness and exposure segregation were associated with risk of PLE (DI: aRR = 1.11, 95 % CI 1.06–1.17; EII: aRR = 0.82, 95 % CI 0.78–0.87). When both domains were present in the same model, the effect of evenness, but not exposure, was attenuated (DI: aRR = 0.98, 95 % CI 0.92–1.05; EII: aRR = 0.81, 95 % 0.75–0.88). These associations were not statistically significantly different for levels of race (p-values ranged 0.08–0.86) or neighborhood social cohesion (p-values ranged 0.16–0.56). Sensitivity analysis indicated the main effect was not altered by duration of exposure. Lower exposure to exposure domain segregation may be protective against risk of PLEs in young adolescents in urban areas. The association was similar in comparisons of Black-White racial groups and high-low neighborhood social cohesion groups.