A MULTILEVEL ANALYSIS OF THE RELATION OF SOCIOECONOMIC
STATUS TO ADOLESCENT DEPRESSIVE SYMPTOMS: DOES SCHOOL
CONTEXT MATTER?

ELIZABETH GOODMAN, MD, BIN HUANG, PHD, TERRANCE J.WADE, PHD, AND ROBERT S.
KAHN, MD
Objective To determine whether the socioeconomic context of the school
environment is associated with adolescent
depressive symptoms independent of individual household income.

Study design Data were drawn from a 1995 nationally representative study of
7th to 12th grade students. Multivariable
linear regression at the school and individual levels assessed the relation
between income and depressive symptoms.
Multilevel modeling techniques were then used to understand how these
factors are jointly associated with adolescent depressive symptoms.

Participants Adolescents (n = 13,235) in grades 7 through 12 from 132
schools whose parent provided income
information.

Results Linear regression analyses indicated that lower household income,
average
school income, and increasing school-level income inequality were
significantly
(P < .001) associated with depressive symptoms. Further examination of
these relations
through multilevel modeling indicated that both household income (P < .01)
and average
school income (P < .05) were significantly related to depressive symptoms
after adjusting
for covariates, with evidence for an interaction between the two. The
impact of lower
household income on depressive symptoms was approximately 2-fold greater
for students
attending a poor versus a rich school.

Conclusions School context is associated with adolescents' depressive
symptoms,
even after adjusting for individual-level factors. The school environment
may partially
buffer the adverse influence of lower household income on adolescent
depressive symptoms.
(J Pediatr 2003;143:451-6)

From Schneider Institute for Health
Policy, Heller School for Social Policy
and Management, Brandeis University,
Waltham, Massachusetts; the
Center for Epidemiology and Biostatistics,

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