Associations between neighborhood disorder and mental health service utilization in the All of Us study

Neighborhood environment is critically important in shaping mental health outcomes. Among those with a history of diagnoses of anxiety, depression, and post-traumatic stress disorder (PTSD) the likelihood of ongoing visits and current medication/treatment can be influenced by social and physical neighborhood-related risk factors. Despite growing evidence, only a few large-scale studies have examined these associations. Using data from the All of Us Research Program funded by the National Institute of Health (NIH), we examined the association between neighborhood disorders on mental health service utilization among adults in the United States.

The present study analyzed the All of Us Controlled Tier Dataset V7, which included self-reported survey data collected between May 31, 2017, and June 30, 2022. The 39,438 participants responded to the "Basics" (demographics), "Social Determinants of Health" (SDOH), and "Personal and Family Health History" (PFHH) surveys, all completed within 365 days of enrollment. The Neighborhood Disorder Scale was used to assess social and physical disorder in neighborhoods. Self-reported history of anxiety, depression, or PTSD were collected via questionnaire on additional measures of ongoing provider care and current treatment or medication use. Data were analyzed via chi-square tests, Wilcoxon rank sum tests, and t-tests, while univariable and multivariable binary logistic regression models estimated the association between neighborhood disorder and mental health care engagement.

Greater neighborhood disorder was linked to higher odds of ongoing mental health care (OR 1.18; 95% CI 1.12-1.24) and current medication or treatment (OR 1.13; 95% CI 1.07-1.18). Mental health care engagement declined with increasing age, with participants above 75 years being significantly less likely to receive care (OR 0.14; 95% CI 0.12-0.16) and treatment (OR 0.19; 95% CI 0.16-0.21) when compared to those 18-44 years of age. Cisgender men had lower odds of care (OR 0.57; 95% CI 0.54-0.61) and treatment (OR 0.54; 95% CI 0.51-0.57) compared to cisgender women, while non-cisgender participants showed significantly higher odds of both. Non-Hispanic White participants were more likely to receive care (OR 2.08; 95% CI 1.91-2.27) and treatment (OR 2.21; 95% CI 2.03-2.42) when compared with Hispanic/Latino participants.

Findings underscore the importance of neighborhood conditions in receiving mental health care. These results emphasize the need for targeted public health interventions addressing structural determinants of mental health care utilization.

The online version contains supplementary material available at 10.1186/s12982-026-02103-w.