摘要：Objectives. Although schools and neighborhoods influence health, little is known about their relative importance, or the influence of one context after the influence of the other has been taken into account. We simultaneously examined the influence of each setting on depression among adolescents. Methods. Analyzing data from wave 1 (1994–1995) of the National Longitudinal Study of Adolescent Health, we used cross-classified multilevel modeling to examine between-level variation and individual-, school-, and neighborhood-level predictors of adolescent depressive symptoms. Also, we compared the results of our cross-classified multilevel models (CCMMs) with those of a multilevel model wherein either school or neighborhood was excluded. Results. In CCMMs, the school-level random effect was significant and more than 3 times the neighborhood-level random effect, even after individual-level characteristics had been taken into account. Individual-level indicators (e.g., race/ethnicity, socioeconomic status) were associated with depressive symptoms, but there was no association with either school- or neighborhood-level fixed effects. The between-level variance in depressive symptoms was driven largely by schools as opposed to neighborhoods. Conclusions. Schools appear to be more salient than neighborhoods in explaining variation in depressive symptoms. Future work incorporating cross-classified multilevel modeling is needed to understand the relative effects of schools and neighborhoods. Depression is one of the most serious public health problems among adolescents in the United States. Large epidemiological studies estimate that 12% of young people meet lifetime diagnostic criteria for major depression or dysthymia 1 and that 29% of high school students report having felt sad or hopeless nearly every day during the preceding 2 weeks. 2 Given that adolescent-onset depression is associated with many short- and long-term consequences, including suicidal thoughts and behaviors 3,4 ; cigarette, alcohol, and drug use 5–7 ; and recurrent episodes of depression in adulthood, 8,9 there is an urgent need to understand the etiology of depression in adolescence. Interest in the social determinants of depression—or how features of the broader social context in which adolescents are embedded affect their risk for depression—has increased in the past decade. Neighborhood social environments have been primarily examined to date. 10–14 Research in this area suggests that a neighborhood’s racial/ethnic and socioeconomic composition and culture (e.g., levels of social cohesion, norms related to relationships between neighbors) are associated with individual mental health outcomes, even after individual-level factors have been taken into account. Although schools are gaining more interest from public health researchers, 15,16 research on the role of schools in depression is lacking outside of a small number of studies. These studies, which have primarily focused on school connectedness and school socioeconomic status (SES), have shown that higher levels of each of these elements are associated with lower levels of depressive symptoms among students. 17–25 In addition, most school-related studies have focused on individual-level rather than multilevel associations. 26–32 Not only are schools understudied on their own, but their role in relation to neighborhoods is also poorly understood. 33 Studies involving cross-classified multilevel modeling techniques, which explicitly allow researchers to disentangle the unique effects on health of multiple nonnested contexts (e.g., school and neighborhood environments), 34,35 are rare. This is especially true for mental health outcomes. As a result, it remains unclear whether each context is important independent of the other and, if so, whether schools or neighborhoods are equally important determinants of adolescent depression or one context is more salient than the other. A case could be made for the importance of both schools and neighborhoods. Schools are likely to be important determinants of depression because they serve more than 95% of the nation’s young people for approximately 6 hours per day (or upward of 40% of students’ waking time during the school year) and at least 11 continuous years of their lives. 36 Schools are also well-defined social institutions providing access to a range of supportive relationships that promote mental health. 30,37,38 Neighborhoods, by contrast, may be important because they are the setting where unstructured social activity occurs outside of school and during the summer. 39,40 Neighborhoods may also have a more direct influence on parents’ capacity to raise their children through shaping of community norms, supervision and monitoring, collective efficacy, and reductions in the burdens and stressors associated with caregiving. 41,42 Studies that examine the salience of schools relative to neighborhoods (and vice versa) are needed, given that schools and neighborhoods have increasingly become nonnested contexts in the United States. Indeed, a growing number of young people are attending schools outside of their neighborhoods as a result of the popularity of school choice (e.g., charter schools, federal vouchers to attend private school) and the desire to close low-performing schools. 43,44 Thus, in the case of many young people, schools and neighborhoods are no longer hierarchically nested; for example, adolescents may attend non-neighborhood-based schools that have demographic features different from those of their neighborhood of residence. Our objective was to address these gaps in the literature by providing an understanding of the relative importance of neighborhoods and schools in levels of youth depressive symptoms. Specifically, we set out to determine the unique proportion of variance in depressive symptoms attributable to schools and neighborhoods (i.e., the random effects of each context) and examine the association between youth depression and sociodemographic characteristics (e.g., SES, race/ethnicity) at the individual, school, and neighborhood levels (i.e., fixed effects).
