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Structural Context and Lived Experience as Complementary Indicators of Youth Mental Health Risk
Kimberly J Mitchell1, Deirdre Colburn1, Victoria Banyard2
1University of New Hampshire, 10 West Edge Drive, Suite 106, Durham, NH, USA.
American Journal of Preventive Medicine
|July 31, 2026
Summary
Youths' lived experiences of adversity are stronger predictors of mental health risk than county-level social determinants of health (SDoH). Tailoring prevention to individual experiences, not just geography, is crucial for identifying at-risk youth.
Area of Science:
- Public Health
- Adolescent Health
- Mental Health Research
Background:
- Social and structural determinants of health (SDoH) significantly influence youth mental health and suicide risk.
- County-level SDoH indicators are commonly used for prevention but may not fully capture individual lived experiences of adversity.
Purpose of the Study:
- To examine how county-level SDoH profiles and self-reported SDoH relate to mental health and suicide risk in adolescents and young adults.
- To determine which factors, geographic or individual, better differentiate youth vulnerability.
Main Methods:
- Utilized data from Project Lift Up (N=4,800, ages 13-22) with residential ZIP code data.
- Compared county-level SDoH indicators (County Health Rankings) with self-reported SDoH (financial instability, food insecurity, discrimination, etc.).
- Employed multivariate regression models to assess associations with depression/anxiety, suicidal ideation, and suicide attempts.
Main Results:
- Seven county-level SDoH profiles showed modest associations with self-reported SDoH and mental health outcomes.
- Self-reported SDoH were more strongly associated with mental health outcomes than county-level context.
- Food insecurity, discrimination, adversity, and community disorder significantly predicted higher depression/anxiety and suicide attempt risk.
Conclusions:
- Youths' lived experiences of adversity are more critical for identifying individual vulnerability than county-level SDoH alone.
- Prevention strategies should integrate geographic targeting with screening for social adversity to effectively identify at-risk youth.
- Relying solely on county-level data may overlook high-risk individuals in seemingly advantaged areas.
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