title: Familial and neighborhood effects on psychiatric disorders in childhood and adolescence.
abstract: BACKGROUND
  More knowledge is needed on potential associations between individual-, family-, and neighborhood-level factors and psychiatric disorders in children and adolescents.
  
  
  OBJECTIVE
  To 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  26,514 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).
  
  
  CONCLUSIONS
  These findings call for policies to promote mental health that consider potential influences from children's family and neighborhood environments.conclusion
  
  
  BACKGROUND
  Not applicable.
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: jan.sundquist@med.lu.se.
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden. Electronic address: xinjun.li@med.lu.se.
authors.forename: Xinjun
authors.initials: X
authors.lastname: Li
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden. Electronic address: henrik.ohlsson@med.lu.se.
authors.forename: Henrik
authors.initials: H
authors.lastname: Ohlsson
authors.affiliation: Child and Adolescent Psychiatry, Department of Clinical Sciences in Lund, Lund University, Lund, Sweden. Electronic address: maria.rastam@med.lu.se.
authors.forename: Maria
authors.initials: M
authors.lastname: Råstam
authors.affiliation: Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: winkleby@stanford.edu.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Winkleby
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: kristina.sundquist@med.lu.se.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
authors.affiliation: Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA; Department of Psychiatry, Virginia Commonwealth University, Richmond VA, USA; Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: kendler@vcu.edu.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Kendler
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: kccrump@stanford.edu.
authors.forename: Casey
authors.initials: C
authors.lastname: Crump
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000453:epidemiology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019955:Conduct Disorder / Q000453:epidemiology*; D005190:Family; D005500:Follow-Up Studies; D006801:Humans; D007206:Individuality; D016015:Logistic Models; D019964:Mood Disorders / Q000453:epidemiology*; D012042:Registries; D012931:Social Environment; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology
keywords: Cohort study; Internalizing and externalizing psychiatric disorders; Neighborhood SES