Carol S. Aneshensel

The neighborhood context of adolescent mental health.

Mental health disorders in adolescence are pervasive, often carry into adulthood, and appear to be inversely associated with social status. We examine how structural aspects of neighborhood context, specifically, socioeconomic stratification and racial/ethnic segregation, affect adolescent emotional well-being by shaping subjective perceptions of their neighborhoods. Using a community-based sample of 877 adolescents in Los Angeles County, we find that youth in low socioeconomic status (SES) neighborhoods perceive greater ambient hazards such as crime, violence, drug use, and graffiti than those in high SES neighborhoods. The perception of the neighborhood as dangerous, in turn, influences the mental health of adolescents: the more threatening the neighborhood, the more common the symptoms of depression, anxiety, oppositional defiant disorder, and conduct disorder. Social stability and, to a lesser extent, social cohesion, also emerge as contributors to adolescent disorder. This investigation demonstrates that research into the mental health of young people should consider the socioeconomic and demographic environments in which they live.

Social Structure, Stress, and Mental Health: Competing Conceptual and Analytic Models:

A sociological model for the mental health consequences of social organization is distinguished from a sociomedical model for the social etiology of particular disorders. Both models use stress to explain associations between social placement and disorder. These models are not interchangeable, despite apparent similarities, but researchers frequently apply the sociomedical model to sociological questions. Discrepancies between models are illustrated with survey data collected from a community sample of adults. We demonstrate that gender differences in the impact of stress are disorder-specific and do not indicate general differences between women and men in susceptibility to stress.

Community and dating violence among adolescents: Perpetration and victimization

PURPOSE Adolescents are both the perpetrators and victims of violence in the United States. To reduce violence, it is important to identify those most at risk within particular contexts. METHODS A social learning framework was used to investigate involvement in violence in a survey of 719 high school students. Four outcomes (community violence perpetration, community violence victimization, dating violence perpetration, and dating violence victimization) were examined as a function of demographic characteristics, exposure to violence, and several potential mediating variables. RESULTS Exposure to weapons and violent injury in the community was the sole consistent predictor across the four outcomes. Gender generally was an important correlate of violence; there were substantial gender differences in the correlates of dating violence perpetration and victimization, but relatively few gender differences in the correlates of community violence involvement. Other demographic characteristics typically were of limited importance, and were largely accounted for by exposure to violence or other mediators. Personal norms about the circumstances under which the use of violence is perceived as justified were important for three of the four outcome: community violence perpetration, and dating violence perpetration and victimization. CONCLUSIONS Being exposed to violence in one context appears to have crossover effects to victimization and perpetration in another context. Furthermore, victimization and perpetration often co-occur.

Body image, perceived pubertal timing, and adolescent mental health

PURPOSE To examine the impact of gender, racial-ethnic group, and perceived pubertal timing on body image and adolescent mental health. METHOD A three-stage, area probability sample was selected which included 877 teens (13-18 years) with diverse social and demographic characteristics. Interviews in English or Spanish were conducted in person. The content emphasized emotional distress and problematic behavior, exposure to social stressors, coping resources and behaviors, and socioeconomic and demographic characteristics of the adolescent and his or her family. RESULTS Girls were more depressed and had lower self-esteem than boys, but not after controlling for body image. Hispanics were more depressed and had lower self-esteem than other racial-ethnic groups, a difference that remained when controlling for body image. African-Americans had the most positive body image, a finding that could not be attributed to higher self-esteem or fewer depressive symptoms. The impact of perceived pubertal timing on body image varied considerably by gender and across racial-ethnic group. CONCLUSIONS Negative feelings about their bodies contribute to the higher prevalence of depressive symptomatology and lower self-esteem among girls. African-Americans appear to take pride in their bodies in a manner that sets them apart from other teenagers, suggesting they hold a different ideal. Relative to teenagers of other racial-ethnic backgrounds, Hispanics may be at elevated risk for mental health problems.

Depression and Physical Illness: A Multiwave, Nonrecursive Causal Model

Causal influence has frequently been assumed, but rarely demonstrated, in studies documenting a positive association between physical illness and psychological distress. The present study assesses a latent variable causal model of subjectively experienced physical illness and depression in order to disentangle reciprocal patterns of influence. The data consist of interviews from a community sample of adults (N = 744) interviewed four times over one year. For the total sample, the exogenous variables of socioeconomic status, age, and sex are shown to affect both constructs of physical illness and depression. Illness has a large, contemporaneous effect of increasing depressive symptomatology over previous levels, and depression is found to have a smaller, 4-month lagged effect of increasing levels of physical illness. Multiple group analyses reveal some differences by age and sex, but demonstrate an overall consistency in the reciprocal relationship between depression and physical illness.

The forms and mechanisms of stress proliferation: the case of AIDS caregivers

Processes of stress proliferation are explored in a sample of informal caregivers to people with AIDS. Proliferation refers to the tendency for stressors to beget stressors. Two forms of proliferation are explored, each based on the distinction between primary and secondary stressors. Among AIDS caregivers, primary stressors are the hardships rooted in the caregiving role. Secondary stressors result from primary stressors, but arise in roles and activities outside of caregiving. One form of proliferation is the expansion of primary stressors, reflected in an increase in role overload and a growing sense of being a captive of the caregiver role. Expansion is largely driven by the course of AIDS and the elevation of demands it places on the caregiver. The second form of proliferation is the surfacing of secondary stressors in social and leisure life and in the occupational realm. This form arises from the strains imposed by the emerging caregiver role on the other roles and activities of the caregiver. It is proposed that the systematic assessment of proliferated stressors can help illuminate the dynamic connections between stress and health.

Neighborhood and family contexts of adolescent sexual activity

Although numerous studies have examined the sociodemographic and psychosocial factors associated with first sex there is little research on the contribution of social context. The impact of neighborhood and family structure on adolescents risk of first sex was investigated in a community-based sample of 879 ethnically diverse youth 12-17 years of age (mean age 14.5 years) from Los Angeles California. 48.7% of respondents were Hispanic; 57.9% lived with both biological parents. Commonly reported neighborhood hazards included gangs (59.8%) and drug use or dealing (43.4%). Males who lived in underclass Black or working class Hispanic neighborhoods had significantly higher rates of first sex than those from middle or upper-middle class White neighborhoods. Those reporting more ambient hazards in their neighborhoods had the highest levels of first sex suggesting that neighborhood structural effects are mediated by adolescents perceptions of the level of threat and social disintegration. Males and females living in single-parent or step-parent families had significantly higher rates of first sex than their counterparts living with both biological parents. Parental socio-emotional support and control captured distinct dimensions of the family contexts and were particularly important dimensions for males risk of first sex. These findings suggest that adolescents experience of their neighborhoods and their family situations are key determinants of their propensity to become sexually active. Both families and neighborhoods provide a milieu of opportunities and norms that shape social behavior.

Stress, role captivity, and the cessation of caregiving.

Difficulties experienced when caring for an impaired elderly relative, including decisions to place this person in institutional care, are examined as a function of caregiver stress. Three annual interviews were conducted with 555 caregivers to parents or spouses with Alzheimers Disease. All patients were initially cared for at home, but 192 were subsequently placed in institutional care and 146 died. Background-contextual factors and disease characteristics have only limited associations with institutionalization. Two secondary stressors--consequences of caregiving that do not directly involve care-related tasks--exert the most proximal impact upon placement: role captivity and economic strain. Role captivity is stable over time when in-home care continues, but institutionalization alleviates this sentiment. The odds of patient death increase substantially following institutionalization, even when health status is controlled. These results illustrate that in-home care may be beneficial for care-recipients, but increase role-related stress for the care provider.

Gender and ethnic differences in the timing of first sexual intercourse.

CONTEXT Whether the effect of gender on the risk of first intercourse in influenced by adolescents ethnicity has received limited attention in research on age at first sex. Such information could provide a more complete understanding of adolescent sexual behavior. METHODS Life-table analysis using data from a population-based, ethnically diverse sample of 87/Los Angeles County youths was employed to estimate the median age at first sex for each gender-and-ethnicity group. Multivariate analysis using proportional hazards techniques was conducted to determine the relative risk of sexual activity among teenagers in each group. RESULTS Overall, the teenagers in the sample had a median age at first sex of 16.9 years. Black males had the lowest observed median (15.0), and Asian American males the highest (18.1); white and Hispanic males, and white and black females, reported similar ages (about 16.5 years). Hispanic and Asian American females had rates of first sex about half that of white females, although these protective effects were explained by differences in family structure. Even after controlling for background characteristics, black males had rates of first sex that were about 3-5 times the rates of the other gender-and-ethnicity groups. In addition, Asian American males were less likely than Hispanic males to be sexually experienced, and Hispanic males had almost twice the rates of sexual activity of Hispanic females. CONCLUSIONS Socioeconomic conditions account for ethnic differences among females in the age at first sex, and cultural influences may contribute to the difference between Hispanic males and females; explanations for black males, however, remain elusive.

Measuring Depression in the Community: A Comparison of Telephone and Personal Interviews

Interview method effects in response to the Center for Epidemiologic Studies-Depression Scale (CES-D) are compared among a community sample (N = 546) of adults randomly assigned to either telephone or in-person interviews. The interviews were conducted in Los Angeles during 1980. No significant differences were observed between the two interview methods in nonresponse to symptom items, preference for specific response categories, reliability, mean level of depression, or proportion classified as depressed. Furthermore, no significant interactions were found between sociodemographic characteristics and the method of interview.