Background: Health inequalities reflect the cumulative and intersecting effects of social disadvantage and adversity. The biopsychosocial model offers an integrative means of explaining these disparities beyond the biological, incorporating psychosocial processes through which mental health shapes health inequalities. Community adversity can impact both mental and physical health, yet its role in health inequality research is underexplored. Intersectionality provides a framework for capturing how multiple structural and social adversities can combine to synergistically impact outcomes, whilst the Stress Process Model explains how adversities and resilience might interact to jointly shape outcomes.
Methods: Data were drawn from the Born in Bradford Age of Wonder, prospective birth cohort study, n = 10,684 adolescents. Internalising distress was measured using the Revised Children’s Anxiety & Depression Scale, food insecurity using a community designed questionnaire, perceived discrimination using the Adolescent Discrimination Distress Index, and resilience using the Brief Resilience Scale. Multivariable linear regression and interaction effects investigated relationships between food insecurity, perceived discrimination and resilience with relation to internalising distress. Mediation analysis explored whether resilience partially mediated the relationship between discrimination and food insecurity with internalising distress.
Results: Perceived discrimination and food insecurity were positively associated with internalising distress, while resilience showed a negative association. Resilience partially mediated the association between perceived discrimination and food insecurity on distress, and significant two-way interactions indicated that certain intersections of adversity and identity intersected to produce synergistically poorer internalising distress.
Conclusion: Community-based adversity is a key modifiable determinant of adolescent mental health. Its association operates through both exposure to adversity and reduced resilience with intersectional effects demonstrating unequal impact across social groups. Adolescence represents a critical window of opportunity for preventative, socially informed, and systemic interventions to reduce health inequalities across the lifespan.
