Geospatial Indices of Neighborhood Environment and Preadolescent Behavioral Health Screening in Primary Care

To evaluate whether children living in more disadvantaged neighborhoods are less likely to be screened for behavioral health concerns and more likely to screen positive for symptoms at a well-child visit, and to examine whether the Child Opportunity Index (COI) and Area Deprivation Index (ADI) produce similar findings.

We analyzed electronic health record data from 48 200 9-year-old well-child visits. Behavioral health risk was measured using the Pediatric Symptom Checklist-17. Patient addresses were geocoded to derive COI and ADI scores.

Children living in more disadvantaged neighborhoods had significantly lower odds of behavioral health screening (ORs 0.62-0.88) and significantly greater odds of screening positive on the Pediatric Symptom Checklist-17 total, externalizing, and attention scales (ORs 1.23-1.78). Neighborhood disadvantage was not associated with internalizing risk in this sample. COI and ADI were highly correlated (r = -0.91) and yielded nearly identical results.

Our findings underscore the importance of addressing structural barriers to behavioral health screening in childhood and support the use of geospatial measures to inform equitable screening implementation and mental health intervention efforts in pediatric primary care.