Neighborhood socioeconomic structure and major depression in urban environments: The interaction of neighborhood stability and percent middle income

Recent research suggests that neighborhood stability may be beneficial to health in affluent neighborhoods but detrimental in impoverished neighborhoods. However, little is known about health effects of proportion of middle income households in neighborhoods, which is of particular significance in cities experiencing substantial economic disinvestment and loss of middle income residents.

This study examined whether neighborhood percent middle income modified the effect of residential stability on major depression in a predominantly low income, multiethnic city. Data are from the Healthy Environments Partnership, a community based participatory research effort in Detroit, Michigan. Individual data from a stratified proportional sample survey of 919 persons living in 69 block group neighborhoods were linked with 2000 U.S. Census data. Major depression was measured by CIDI (unadjusted prevalence=0.18). Findings from multilevel logistic regression (HLM) indicate that the effect of residential stability on depression varies by neighborhood percent middle income ($40,000 plus). In very stable neighborhoods, probability of major depression is three times higher when there are relatively few (20%) compared to half middle income households. However, in very unstable neighborhoods, depression is substantially higher in half middle income compared to predominantly low income neighborhoods. In a crossover effect, residents of very unstable middle income neighborhoods experience high rates of depression comparable to those in stable lowest income neighborhoods (predicted probability 0.47 and 0.43 respectively for highest risk groups). We discuss implications for future research on neighborhood structural change, and suggest policies and interventions to preserve and regenerate urban neighborhoods to reduce the risk of depression.