Neighborhood Disadvantage and Comorbid Mental Health Conditions in Adolescents and Young Adults With Eating Disorders

Anxiety and depression are highly prevalent among adolescents and young adults with eating disorders. A comorbid mental health condition is associated with worsened long-term eating disorder outcomes. While individual risk factors for comorbid anxiety or depression and eating disorders have been elucidated, the impact of external factors, such as neighborhood disadvantage, remains understudied. The purpose of this study was to examine the associations between levels of neighborhood disadvantage and comorbid anxiety and depression.

This was a retrospective study utilizing data available from Epic Cosmos, an electronic health record data platform. Individuals aged 9-25 years with an eating disorder diagnosis and a healthcare encounter within the last year were included. The exposure variable of neighborhood disadvantage was measured by the Area Deprivation Index percentile ranks. Outcomes included ICD-10 diagnoses of anxiety or depression. Logistic regression models were used to assess associations between area deprivation and mental health conditions.

Inclusion criteria were met in 100,924 individuals. The median age was 17 years, and the majority were female, White, and non-Hispanic. Anxiety was present in 71.2% of the cohort and depression was present in 52.5%. Higher levels of neighborhood disadvantage were associated with increased odds of anxiety and depression. Disparities based on sociodemographic characteristics were also observed.

More neighborhood disadvantage is associated with increased odds of anxiety and depression among adolescents and young adults with eating disorders. These findings highlight the importance of understanding neighborhood context in eating disorder presentations.