Familial and neighborhood effects on psychiatric disorders in childhood and adolescence

•We followed 542,195 children for 11 years and 4.8% developed a psychiatric disorder.•High neighborhood deprivation was associated with a 2-fold risk of conduct disorder.•High neighborhood deprivation was not associated with ADHD.•Psychiatric disorders were even more influenced by familial than neighborhood effects.•Familial effects were stronger for externalizing than internalizing disorders.

BackgroundMore knowledge is needed on potential associations between individual-, family-, and neighborhood-level factors and psychiatric disorders in children and adolescents.AimsTo examine associations between, individual-, family-, and neighborhood-level factors and incident internalizing (anxiety and mood) disorders and externalizing (ADHD and conduct) disorders in children and adolescents, and to estimate the relative contributions of family and neighborhood to individual variation in these disorders.MethodWe performed a three-level logistic regression on all 542,195 children born in Sweden in 1992–1996, nested in 427,954 families, which in turn were nested in 8475 neighborhoods. The children were followed from 2000 to 2010 for incident internalizing and externalizing psychiatric disorders, assessed from medical records.Results26,514 children (4.8%) were diagnosed with internalizing or externalizing psychiatric disorders. Approximately 29% of the total individual variance in internalizing disorders could be attributed to the family level, which includes both genetic and family environmental effects, and 5% to the neighborhood level. The corresponding figures for externalizing disorders were 43.5% and 5.5%, respectively. After adjustment for individual-level sociodemographic factors, high neighborhood deprivation was associated with increased risks of externalizing and internalizing psychiatric disorders (odds ratio [OR] = 1.37, 95% credible interval [CI] = 1.25–1.50 and OR = 1.34, 95% CI = 1.25–1.45, respectively), including conduct disorder (OR = 2.01, 95% CI = 1.58–2.55), anxiety disorders (OR = 1.40, 95% CI = 1.29–1.52), and mood disorders (OR = 1.21, 95% CI, 1.09–1.35). The strongest association between neighborhood deprivation and ADHD was observed in moderately deprived neighborhoods (OR = 1.31, 95% CI = 1.19–1.44).ConclusionsThese findings call for policies to promote mental health that consider potential influences from children's family and neighborhood environments.conclusionTrial registrationNot applicable.