The Relationship Between Experiencing Neighborhood Violence and Mental Health Outcomes Among High School Students in the United States, YRBS 2023

Abstract

Background: Mental health conditions are a growing public health concern among U.S. adolescents, particularly high school students. Emerging data show a strong link between exposure to neighborhood violence and increased risk of poor mental health outcomes, such as depression, anxiety, and persistent sadness. Objective: This study examined the relationship between neighborhood violence exposure and mental health outcomes among high school students. Method: This is a cross-sectional study using the 2023 Youth Risk Behavior Survey. The sample included 19,910 students in grades 9–12 across gender and race. Mental health status and exposure to neighborhood violence were analyzed using chi-square tests and logistic regression models. Results: Students exposed to neighborhood violence had significantly higher odds of reporting poor mental health outcomes (AOR = 1.789, 95% CI: 1.573–2.035, p < 0.001) than the unexposed. Additionally, female, Hispanic/Latino, and multiracial students reported higher rates of mental health disorders than the male students. Conclusions: Neighborhood violence exposure was significantly associated with poor mental health outcomes among high school students. These findings signify the need for targeted interventions to support affected students and reduce neighborhood violence exposure, particularly in marginalized communities. The findings will inform public health professionals, educators, and policymakers to make targeted school-based mental health interventions and community-centered policies addressing neighborhood safety and adolescent mental health.

1. Introduction

In the United States, mental health conditions are a growing public health concern among adolescents, particularly high school students. In 2016, 17.4% of children aged 2–8 had a diagnosed mental, behavioral, or developmental disorder (CDC, 2018), demonstrating the early onset of these conditions. Among adolescents aged 12–17, nearly 15% experienced a major depressive episode in 2018–2019, and 37% reported persistent sadness or hopelessness, marking a notable increase from 26% in 2009 (Bitsko et al., 2022; American Psychological Association, 2021). These trends indicate the need to identify and address underlying risk factors contributing to adolescent mental health conditions. Exposure to neighborhood violence is a significant and well-documented risk factor contributing to poor mental health conditions in this population (Aisenberg & Herrenkohl, 2008; Egan et al., 2008; Kelly & Hall, 2009; Wilson-Genderson & Pruchno, 2013). Witnessing or experiencing neighborhood violence has been linked to increased rates of depression, anxiety, and post-traumatic stress disorder among adolescents (Clark et al., 2007; Gillespie et al., 2009; Tracy et al., 2014; Casciano & Massey, 2011; Goldmann et al., 2011). These adverse exposures can cause mental health conditions that may disrupt academic, emotional, and social trajectories during this critical developmental stage, leading to long-term consequences (Dark et al., 2020).

However, despite substantial evidence linking neighborhood violence to adolescent mental health challenges, few studies have examined this relationship using large, nationally representative samples of U.S. high school students, revealing a critical gap in the literature. To address this gap, the present study explores how exposure to neighborhood violence relates to mental health outcomes among U.S. high school students. Addressing this gap is essential for developing effective, evidence-based policies and interventions that support adolescent mental health.

Research studies have shown that neighborhood violence exposure is a significant risk factor for adverse mental health outcomes (Clark et al., 2007; Gillespie et al., 2009; Tracy et al., 2014; Casciano & Massey, 2011; Goldmann et al., 2011). These studies consistently show increased risks not only for direct victims but also for witnesses and those indirectly exposed (Jones-Webb & Wall, 2008; Fowler et al., 2009; Tandon & Solomon, 2008). Importantly, exposure is not evenly distributed; it is concentrated in low-income urban communities, with significant racial and ethnic disparities that disproportionately impact Black students (Stein et al., 2003; Kang, 2015; Kaynak et al., 2011; McDonald et al., 2011; CDC, 2023b). While several studies have explored the mental health consequences of neighborhood violence, many rely on regional samples or lack sufficient representation of diverse adolescent populations. Additionally, while several studies have documented links between neighborhood violence exposure and substance use behaviors, findings vary across populations and methodologies (Benjet et al., 2019; McDonald & Richmond, 2008; Sargent et al., 2019; Sharkey, 2018; Lerner et al., 2015), indicating the need for further research. Collectively, these gaps emphasize the need for analyses using large, nationally representative datasets to clarify these associations among U.S. high school students, a gap this study aims to fill.

Neighborhood violence is particularly prevalent in low-income urban communities, where estimates indicate that 50% to 96% of children and adolescents are exposed to some form of violence (Stein et al., 2003; Kang, 2015; Kaynak et al., 2011; McDonald et al., 2011). Moreover, there are clear racial disparities in exposure: 29.3% of Black students and 26% of American Indian, Alaska Native, or Native Hawaiian students report witnessing neighborhood violence, compared to lower rates among white (24.5%), Hispanic or Latino (21.3%), multiracial (14.8%), and Asian students (9.3%) (CDC, 2023a). Findings from the 2021 Youth Risk Behavior Survey (YRBS) showed that over 42% of high school students experienced persistent feelings of sadness or hopelessness, and nearly 29% reported poor mental health in the past month (CDC, n.d.-a, n.d.-b).

Addressing this issue is essential, given that approximately 20% of high school students reported witnessing neighborhood violence, and 3.5% reported carrying a gun in the past year (Clark et al., 2007). Students exposed to such environments frequently experience mental health conditions and externalizing behaviors such as aggression and conduct problems. These challenges can impair emotional regulation, concentration, academic performance, and school engagement, potentially resulting in chronic mental health conditions (Saxbe et al., 2018). Childhood exposure to violence also has lasting effects not only on individuals but on families, schools, and entire communities (Finkelhor et al., 2015; Mersky et al., 2018).

This study examines the association between neighborhood violence exposure and mental health conditions among high school students in the United States, using data from the 2023 Youth Risk Behavior Survey. The findings will guide public health professionals, educators, and policymakers in developing targeted school-based mental health interventions and community-centered policies that address neighborhood safety and support adolescent mental health.

2. Materials and Methods

2.1. Data Source

This study utilized data from the 2023 National Youth Risk Behavior Surveillance System (YRBS), the most recent publicly available dataset. Developed by the Centers for Disease Control and Prevention (CDC), the YRBS monitors self-reported health-related behaviors and experiences among students in grades 9 through 12 in the United States. Data are collected biennially from two coordinating sampling frameworks. In 2023, a total of 20,386 surveys were completed; however, 283 surveys were excluded due to failure to meet the quality control criteria. Surveys were excluded if fewer than 20 valid responses remained after data editing or if the same response was selected for 15 or more items. After applying the quality control measures, 20,103 usable questionnaires were retained for analysis. The study protocol for the 2023 YRBS was approved by the Institutional Review Board of both the CDC and ICF International. However, a waiver of Institutional Review Board approval was granted for this study.

A three-stage cluster sampling design was used to randomly select public and private schools across states, territories, and districts. Currently, state, tribal, territorial, and local education and health agencies use a two-stage cluster design to administer the surveys, ensuring data collection from a representative sample of students (CDC, 2024). Sampling weights were applied to both sets of survey data to enhance generalizability, allowing the results to reflect the broader U.S. student population, including those attending public and private schools.

2.2. Study Variables

The study focused on two survey items related to mental health status, defined to encompass stress, anxiety, and depression, and perceived neighborhood violence. Mental health status was assessed with the item: ‘In the last 30 days, how often was your mental health not good?’ Response options included: never, rarely, sometimes, most of the time, and always. For the purpose of analysis, responses were dichotomized, with ‘never’ and ‘rarely’ coded as ‘no,’ and ‘sometimes’, ‘most of the time’, and ‘always’ coded as ‘yes’, indicating the presence of mental health challenges (CDC, 2023b). Exposure to neighborhood violence was assessed using the item: ‘Have you ever seen someone get physically attacked, beaten, stabbed, or shot in your neighborhood?’ Responses to this item were coded in binary format as ‘yes’ and ‘no’ for analysis (CDC, 2023b).

Additional survey items included in this analysis were gender (male or female), grade (9th, 10th, 11th, 12th, or ungraded/other), and race. The race categories included Asian, American Indian/Alaskan Native, Black or African American, Native Hawaiian/Other Pacific Islander, White, Hispanic/Latino, Multiple Race—Hispanic, and Multiple Race—non-Hispanic. In this study, the racial categories ‘Multiple Races—Hispanic’ and ‘Multiple Races—non-Hispanic’ were analyzed separately.

2.3. Statistical Analysis

Descriptive statistics were computed to summarize the frequency and percentage distributions of categorical variables. Bivariate associations between current mental health status and categorical variables, including sex, grade, race, and perceived neighborhood violence, were assessed using chi-square tests. Unadjusted logistic regression models with 95% confidence intervals (CIs) were used to estimate the odds of reporting mental health in relation to exposure to neighborhood violence. Multiple logistic regression models, also with 95% CI, were employed to examine the association between mental health status and exposure to neighborhood violence, while adjusting for sex, age, and race. Sampling weights were not applied, as the dataset was nationally representative, and no substantial differences were identified between the sample and the population. Sensitivity analyses were not conducted, as missing data were appropriately handled within the statistical procedures, no outliers were detected, and the assumptions underlying the statistical models were not violated. Data were analyzed using IBM Statistical Package for the Social Sciences (SPSS), version 29.0.2.0.

3. Results

3.1. Descriptive Statistics

Descriptive statistical analysis was performed for the sample set in Table 1. Shown in this table is the total sample size of the listed categories: educational grading level (n = 19,910); race (n = 19,733); and gender (n = 19,945).

Table 1. Baseline Demographic Characteristics of Sample.

Characteristics	n	%
Education Level
9th Grade	5680	28.5
10th Grade	5410	27.2
11th Grade	4811	24.2
12th Grade	3961	19.9
Ungraded/Other Grade	48	0.2
Race
Asian	995	5.0
American Indian/Alaskan Native	1334	6.8
Black/African American	1791	9.1
Native Hawaiian/Pacific Islander	105	0.5
White	9700	49.2
Hispanic/Latino	1208	6.1
Multiple Races—Hispanic	2786	14.1
Multiple Races—non-Hispanic	1814	9.2
Gender
Female	9884	49.6
Male	10,061	50.4

Table 1 exhibits the highest percentage of students classified in the 9th grade at 28.5%, with a noticeable decrease as the grade level increases (12th graders; 19.9%). In terms of race, White students accounted for 49.2% of the sample. The table shows an equitable range of diversity within the data, as over 50% of students identify as non-White. Lastly, the gender distribution indicates a nearly equal average of male (n = 9884) and female (n = 10,061) students participating in the study.

3.2. Chi-Square Analysis

Table 2 shows the results of a chi-square test assessing the relationship between the independent variables (i.e., gender, race, and grade) (from Table 1) and mental health outcomes. These results support the concept that there is significant association between mental health complications and neighborhood violence. The p-value < 0.001 calculated across all variables indicates this association (Table 2).

Table 2. Chi-square analysis on mental health outcomes with independent variables.

	Mental Health Outcomes
Variable	Yes (%)	No (%)	p-Value
Gender
Female	7045 (55.0)	715 (25.4)	<0.001
Male	5755 (45.0)	2105 (74.6)
Race
Asian	635 (5.0)	139 (5.0)	<0.001
American Indian/Alaskan Native	761 (6.0)	197 (7.1)
Black/African American	1212 (9.5)	375 (13.5)
Native Hawaiian/Pacific Islander	60 (0.5)	24 (0.9)
White	6423 (50.5)	1210 (43.3)
Hispanic/Latino	568 (4.5)	141 (5.1)
Multiple Races—Hispanic	1818 (14.3)	453 (16.3)
Multiple Races—non-Hispanic	1235 (9.7)	246 (8.8)
Education Level
9th Grade	3247 (25.5)	828 (29.5)	<0.001
10th Grade	3549 (27.8)	750 (26.7)
11th Grade	3216 (25.2)	656 (23.4)
12th Grade	2711 (21.3)	567 (20.2)
Neighborhood Violence
Yes	2005 (28.7)	871 (19.6)	<0.001
No	4991 (71.3)	3563 (80.4)

There were significant relationships between mental health outcomes and gender (<0.001), race (<0.001), education (<0.001), and neighborhood violence (<0.001).

The key findings within Table 2 show that 55% of females reported mental health concerns compared to 45% of males. Subsequently, Table 2 indicates the wide range of male students reporting the denial of poor mental health outcomes as roughly 75%.

The data suggest a large representation of mental health disorders found in White students (n = 6423), averaging half of the study’s sample set, multiracial Hispanic (n = 1818), and African American students (n = 1212). However, the number of students who reported ‘no’ to experiencing poor mental health outcomes were comparatively lower than those who reported experiencing them.

Analysis by Grade level indicates that 9th graders (n = 3247) most commonly reported the absence of adverse mental health outcomes, while 10th graders (n = 3549) reported the highest incidence of mental health struggles. This could indicate an increase of exposure to stress or violence during teenage development. Lastly, the exposure to neighborhood violence and its association with reported poor mental health outcomes showed as 26.5%, versus roughly 19% that reported non-exposure. This variable also revealed that students who were not exposed to neighborhood violence were significantly less likely to report mental health issues, with 81.4% reporting no such concern. Thus, this table reinforces the research question that students who have experienced violence within their communities also have a significant relationship with mental health issues.

3.3. Logistic Regression

To further examine the established relationship between mental health outcomes and violence exposure among students, a multiple logistic regression analysis was conducted. Table 3 presents two models: Model I displays the unadjusted odds ratio for a single variable—neighborhood violence—while Model II presents an adjusted odds ratio accounting for race, education level, and gender. Both models include the adjusted odds ratios (AORs) with a 95% confidence interval, reflecting the strength of the association. Additionally, both models yielded significant findings with a p-value less than 0.001 (Table 3).

Table 3. Unadjusted and multiple logistic regression analysis of mental health outcomes and independent variables.

Variable	Mental Health Outcomes
	Model I (Unadjusted) OR (95% CI)	p-Value	Model II (Significant) AOR (95% CI)	p-Value
Neighborhood Violence
No	Referent (1.00)	<0.001	Referent (1.00)	<0.001
Yes	1.575 (1.394–1.780)		1.789 (1.573–2.035)
Race
Asian			Referent (1.00)	<0.001
American Indian/Alaskan Native			0.696 (0.510–0.949)
Black/African American			0.569 (0.424–0.765)
Native Hawaiian/Pacific Islander			0.649 (0.310–0.1.357)
White			1.098 (0.835–1.445)
Hispanic/Latino			0.762 (0.545–1.066)
Multiple Races—Hispanic			0.736 (0.552–0.983)
Multiple Races—non-Hispanic			1.091 (0.798–1.491)
Education Level
9th Grade			Referent (1.00)
10th Grade			1.166 (1.015–1.339)	<0.001
11th Grade			1.265 (1.096–1.459)
12th Grade			1.215 (1.051–1.404)
Ungraded/Other Grade			0.898 (0.242–3.329)
Gender
Male			Referent (1.00)
Female			3.843 (3.434–4.302)	<0.001

AOR, adjusted odds ratio; CI, confidence interval. p-value calculated with logistic regression.

Regarding those students exposed to previous neighborhood violence, the unadjusted model (Model I) shows the OR = 1.575 (95% CI, 1.394–1.780), while the adjusted model’s AOR = 1.789 (95% CI, 1.573–2.035). This indicates that students exposed to neighborhood violence had 1.789 times higher odds of reporting adverse mental health outcomes (95% CI: 1.573–2.035).

Within the race variable, the Asian community is considered the referent group, or the baseline category that all other groups are compared to. Research suggests that Asian youth have a lower risk of poor mental health outcomes among teens (Silveira & Pereira, 2023). In this model, the AOR of African American students was 0.569 (95% CI, 0.424–0.765), while the Hispanic/Latino and American Indian/Alaskan Native groups was 0.762 (95% CI, 0.545–1.066) and 0.696 (95% CI, 0.510–0.949), respectively. The corresponding communities demonstrated lower odds of mental health disorders relative to the referent group (1.00).

For education levels, the 9th grade group was assigned an AOR of 1.00 and served as the standard category. Table 3 shows an increase in AOR across grade levels: 10th grade (AOR, 1.166, 95% CI, 1.015–1.339), 11th grade (AOR, 1.265, 95% CI, 1.096–1.459), and 12th grade (AOR, 1.215, 95% CI, 1.051–1.404). These findings suggest that as grade level increased, the likelihood of reporting mental health disorders also increased.

Lastly, the gender variable showed the male participants as the reference group, with a standard AOR of 1.00. Female students, however, were nearly four times more likely to report adverse mental health outcomes (AOR, 3.843, 95% CI, 3.434–4.302). This represents a strong association showing that being female is a very strong predictor of poor mental health outcomes in this sample.

4. Discussion

Mental health challenges are significant public health issues due to their early onset, prevalence, and economic impact. Neighborhood violence has been identified as a significant environmental stressor that can negatively impact on adolescent mental health. Exposure to neighborhood violence correlates with elevated levels of depression, anxiety, and suicidal ideation. The study found significant association between exposure to neighborhood violence and adverse mental health outcomes among adolescents who participated in the Youth Risk Behavior Surveillance System (YRBS) survey. The association between neighborhood violence and mental health is consistent with ecological models of youth development and trauma theory (Fowler et al., 2009). Adolescents exposed to community violence may experience chronic stress and emotional dysregulation which predisposes the individual to negative mental health outcomes (Dark et al., 2020).

There was a balanced distribution of gender, grade level, and racial/ethnic background in the sample. The finding that 10th-grade students report the highest rates of mental health symptoms reinforces developmental theories identifying mid-adolescence as a period of heightened emotional reactivity and identity exploration. Steinberg noted that mid-adolescence is a critical time for emotional development and stress sensitivity (Steinberg, 2015). Students at this developmental period may be particularly more vulnerable due to identity formation, increasing academic pressure, and other external stressors. Recent research found that adolescents exposed to neighborhood violence had higher odds of attempting suicide compared to those who were not exposed (Baiden et al., 2024). Similarly, Silveira and Pereira (2023) found that adverse childhood experiences, including exposure to violence, are strongly linked to poor mental health outcomes.

A key finding of this study is the substantial gender disparity in reported mental health outcomes. Female students were nearly four times more likely to report adverse mental health outcomes compared to male students. Research suggests that adolescent girls may face unique emotional and psychosocial stressors, including body image concerns, gender-based discrimination, and internalizing coping styles, all of which may increase vulnerability to anxiety and depression (Yoon et al., 2022). Female adolescents experience higher rates of persistent sadness and suicidal ideation than their male peers (CDC, n.d.-b). The reasons for this disparity may include social and psychological factors, such as differences in coping mechanisms and societal expectations. The analysis further demonstrates that students exposed to neighborhood violence have significantly higher odds of reporting mental health disorders compared to their non-exposed counterparts. This supports the hypothesis that environmental stressors, such as community violence, contribute to psychological distress among youth (Copeland-Linder et al., 2010).

The analysis of racial components identified a complex pattern of disparities among the study population. White respondents had the highest overall number of reported mental health disorders. However, adjusted odds ratios indicate that African American, Hispanic/Latino, and American Indian/Alaska Native students were statistically less likely to report mental health issues compared to Asian students. This could be due to culturally variable expressions of psychological distress, access to culturally competent care, differential experiences of discrimination, and community-based resilience mechanisms (Plummer et al., 2023). This reflects systemic issues in mental health access and diagnosis accuracy in communities of color. Further mixed-methods research is needed to unpack the interplay of systemic, cultural, and social dynamics underlying these disparities.

This study emphasizes the need to address neighborhood violence as a public health issue and ensure that adolescents have the necessary support systems to mitigate the psychological impact. Understanding the implications of these findings will also help in designing targeted screenings and intervention strategies for adolescents and young adults. Schools and community organizations should implement trauma-informed care practices and provide accessible mental health resources for students affected by violence. Evidence-based school-wide approaches such as cognitive behavioral interventions for trauma in schools (CBITS), social–emotional learning (SEL) programs, and partnerships with community mental health providers are strategies that have demonstrated efficacy (Maynard et al., 2019). Trauma-informed training for educators and increased funding for school-based mental health professionals can improve identification and support of at-risk students. Additionally, policies changes aimed at reducing community violence could have a significant impact on improving youth mental health outcomes.

A major limitation of this study is its cross-sectional design, which precludes conclusion about cause and effect. The use of self-reported data may introduce bias, particularly across cultural groups where mental health symptoms may be expressed or interpreted differently. In addition, this assessment of neighborhood violence lacks detail about its duration, intensity, and situational context which are factors that could influence its psychological impact in varying ways. The study also does not account for key protective influences such as strong family bonds, supportive peer networks, coping strategies, or availability of mental health services. Without considering these factors, it becomes more difficult to fully understand the variation in adolescents’ responses to adversity. Future research should explore the long-term effects of neighborhood violence on mental health beyond high school to identify strategies and interventions that address the impacts of neighborhood violence.

5. Conclusions

This study found a strong and statistically significant association between exposure to neighborhood violence and poor mental health outcomes among U.S. high school students. Adolescents who reported witnessing neighborhood violence were significantly more likely to experience recent mental health struggles, even after adjusting for race, sex, and grade level. These results reinforce previous findings and underscore the urgent need to address environmental stressors as part of adolescent mental health strategies. Importantly, the study also revealed demographic disparities in mental health outcomes, with female and racially diverse students being disproportionately affected. These differences highlight the need for culturally responsive and gender-sensitive approaches in mental health interventions. However, several limitations should be noted. The cross-sectional design limits the ability to infer causality. The use of self-reported data may introduce bias, particularly across cultural groups where mental health symptoms may be expressed or interpreted differently. Additionally, the measure of neighborhood violence lacked information on duration, intensity, and situational context—factors that likely influence its psychological impact. Future research should use longitudinal designs to better understand causal pathways and examine the moderating roles of protective factors such as school connectedness or family support. Given these findings, schools—especially those in underserved communities—should work closely with public health agencies and local policymakers to implement evidence-based, trauma-informed mental health programs. Policies should also prioritize violence prevention and neighborhood safety improvements to reduce students’ exposure to harmful environments. By addressing both the environmental and individual-level factors that contribute to adolescent mental health, such coordinated efforts can promote resilience and well-being among high-risk youth.