Racial/Ethnic Residential Segregation and Mental Health Outcomes

  • Kellee WhiteEmail author
  • Jourdyn A. Lawrence
Part of the Current Clinical Psychiatry book series (CCPSY)


Racial/ethnic residential segregation is widely considered a spatial manifestation of institutionalized racism and plays a significant role in the well-being and health of African Americans and Latinos in the USA and immigrant groups in the UK. This chapter highlights residential segregation as a key factor influencing symptom onset, service utilization, management of mental health outcomes, and perpetuation of mental health inequities. The number of studies testing the association of residential segregation with mental health outcomes and service utilization has grown; however, the findings from this body of research are largely mixed, with a majority of the studies demonstrating a beneficial association and several reporting adverse or no associations. A brief summary of the empirical literature and patterns of population mental health outcomes by race/ethnicity is provided. Differential exposure to neighborhood economic, physical, and social stressors—as well as the health-promoting resources that are cultivated in segregated neighborhoods to promote resilience and buffer against material disadvantage—are discussed. The chapter concludes with remarks on future directions for research, clinical practice, and population-based approaches that have an important role to play in stimulating meaningful efforts to reduce the burden of mental health and sustaining action toward achieving mental health equity.


Racial/ethnic residential segregation Mental health Blacks Latinos Ethnicity Ethnic density 


  1. 1.
    Du Bois WEB. The souls of black folk: essays and sketches. Chicago: AC McClurg; 1903.Google Scholar
  2. 2.
    Massey DS, Denton NA. The dimensions of residential segregation. Soc Forces. 1988;67(2):281–315.CrossRefGoogle Scholar
  3. 3.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116(5):404–16.CrossRefGoogle Scholar
  4. 4.
    Kramer MR, Hogue CR. Is segregation bad for your health? Epidemiol Rev. 2009;31(1):174–94.Google Scholar
  5. 5.
    Acevedo-Garcia D, Lochner KA, Osypuk TL, Subramanian SV. Future directions in residential segregation and health research: a multilevel approach. Am J Public Health. 2003;93(2):215–21.CrossRefGoogle Scholar
  6. 6.
    White K, Borrell LN. Racial/ethnic residential segregation: framing the context of health risk and health disparities. Health Place. 2011;17(2):438–48.CrossRefGoogle Scholar
  7. 7.
    Shaw RJ, Atkin K, Becares L, Albor CB, Stafford M, Kiernan KE, et al. Impact of ethnic density on adult mental disorders: narrative review. Br J Psychiatry. 2012;201(1):11–9.CrossRefGoogle Scholar
  8. 8.
    Pickett KE, Wilkinson RG. People like us: ethnic group density effects on health. Ethn Health. 2008;13(4):321–34.CrossRefGoogle Scholar
  9. 9.
    Denton EGD, Shaffer JA, Alcantara C, Cadermil E. Neighborhood matters: the impact of Hispanic ethnic density on future depressive symptoms 1-year following an ACS event among Hispanic patients. J Behav Med. 2016;39(1):28–40.CrossRefGoogle Scholar
  10. 10.
    Dinwiddie GY, Gaskin DJ, Chan KS, Norrington J, McCleary R. Residential segregation, geographic proximity and type of services used: evidence for racial/ethnic disparities in mental health. Soc Sci Med. 2013;80:67–75.CrossRefGoogle Scholar
  11. 11.
    Reardon SF, O’Sullivan DO. Measures of spatial segregation. Sociol Methodol. 2004;34:121–62.CrossRefGoogle Scholar
  12. 12.
    Dawkins CJ. Measuring the spatial pattern of residential segregation. Urban Stud. 2004;41(4):833–51.CrossRefGoogle Scholar
  13. 13.
    Massey DS, Denton NA. Hypersegregation in US metropolitan areas: black and Hispanic segregation along five dimensions. Demography. 1989;26(3):373–91.CrossRefGoogle Scholar
  14. 14.
    Jurcik T, Ahmed R, Yakobov E, Solopieieva-Jurcikova I, Ryder AG. Understanding the role of the ethnic density effect: issues of acculturation, discrimination, and social support. J Community Psychol. 2013;41(6):662–78.CrossRefGoogle Scholar
  15. 15.
    Kershaw KN, Albrecht SS. Racial/ethnic residential segregation and cardiovascular disease risk. Curr Cardiovasc Risk Rep. 2015;9(3):12.CrossRefGoogle Scholar
  16. 16.
    Maguire A, French D, O’Reilly D. Residential segregation, dividing walls and mental health: a population-based record linkage study. J Epidemiol Community Health. 2016;70(9):845–54.CrossRefGoogle Scholar
  17. 17.
    Glaeser E, Vigdor J. The end of the segregated century: racial separation in America’s neighborhoods, 1890–2010. New York: Manhattan Institute; 2012.Google Scholar
  18. 18.
    Firebaugha G, Acciaia F. For blacks in America, the gap in neighborhood poverty has declined faster than segregation. Proc Natl Acad Sci U S A. 2016;113(47):13372–7.CrossRefGoogle Scholar
  19. 19.
    Iceland J, Sharp G, Timberlake JM. Sun belt rising: regional population change and the decline in black residential segregation, 1970–2009. Demography. 2013;50(1):97–123.CrossRefGoogle Scholar
  20. 20.
    Massey DS. Residential segregation is the linchpin of racial stratification. City Community. 2016;15(1):4–7.CrossRefGoogle Scholar
  21. 21.
    Massey DS, Tannen J. A research note on trends in black hypersegregation. Demography. 2015;52(3):1025–34.CrossRefGoogle Scholar
  22. 22.
    Massey DS, Denton NA. American apartheid: segregation and the making of the underclass. Cambridge: Harvard University Press; 1993.Google Scholar
  23. 23.
    Intrator J, Tannen J, Massey DS. Segregation by race and income in the United States 1970–2010. Soc Sci Res. 2016;60:45–60.CrossRefGoogle Scholar
  24. 24.
    Jones M, Pebley AR. Redefining neighborhoods using common destinations: social characteristics of activity spaces and home census tracts compared. Demography. 2014;51(3):727–52.CrossRefGoogle Scholar
  25. 25.
    Wilkes R, Iceland J. Hypersegregation in the twenty-first century. Demography. 2004;41(1):23–36.CrossRefGoogle Scholar
  26. 26.
    Iceland J, Weinberg D, Hughes L. The residential segregation of detailed Hispanic and Asian groups in the United States: 1980–2010. Demogr Res. 2014;31:593–624.CrossRefGoogle Scholar
  27. 27.
    Iceland J, Scopilliti M. Immigrant residential segregation in US metropolitan areas, 1990–2000. Demography. 2008;45(1):79–94.CrossRefGoogle Scholar
  28. 28.
    Purtle J. Population mental health and community violence: advancing the role of local health departments. Am J Public Health. 2017;107(9):1358–60.CrossRefGoogle Scholar
  29. 29.
    Kubzansky LD, Subramanian SV, Kawachi I, Fay ME, Soobader MJ, Berkman LF. Neighborhood contextual influences on depressive symptoms in the elderly. Am J Epidemiol. 2005;162(3):253–60.CrossRefGoogle Scholar
  30. 30.
    Becares L, Nazroo J. In: Li Y, editor. Social capital, ethnic density and mental health among ethnic minority people in England: a mixed-methods study. Cheltenham: Edward Elgar; 2015. p. 242–61.Google Scholar
  31. 31.
    Schulz AJ, Williams DR, Israel BA, Lempert LB. Racial and spatial relations as fundamental determinants of health in Detroit. Milbank Q. 2002;80(4):677–707, iv.CrossRefGoogle Scholar
  32. 32.
    White K, Haas JS, Williams DR. Elucidating the role of place in health care disparities: the example of racial/ethnic residential segregation. Health Serv Res. 2012;47(3):1278–99.CrossRefGoogle Scholar
  33. 33.
    Turney K, Kissane R, Edin K. After moving to opportunity: how moving to a low-poverty neighborhood improves mental health among African American women. Soc Ment Health. 2013;3(1):1–21.CrossRefGoogle Scholar
  34. 34.
    Knibbe M, de Vries M, Horstman K. Engaging cultural resources to promote mental health in Dutch LSES neighborhoods: study of a community-based participatory media project. Health Promot Int. 2017;32(3):567–76.PubMedGoogle Scholar
  35. 35.
    Geronimus AT. The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethn Dis. 1992;2:207–21.PubMedGoogle Scholar
  36. 36.
    Schrier AC, Peen J, de Wit MAS, van Ameijden EJC, Erdem O, Verhoeff AP, et al. Ethnic density is not associated with psychological distress in Turkish–Dutch, Moroccan–Dutch and Surinamese–Dutch ethnic minorities in the Netherlands. Soc Psychiatry Psychiatr Epidemiol. 2014;49(10):1557–67.CrossRefGoogle Scholar
  37. 37.
    Aneshensel CS, Sucoff CA. The neighborhood context of adolescent mental health. J Health Soc Behav. 1996;37(4):293–310.CrossRefGoogle Scholar
  38. 38.
    Sanbonmatsu L, Ludwig J, Katz LF, Gennetian LA, Duncan GJ, Kessler RC, et al. Moving to opportunity for fair housing demonstration program: final impacts evaluation. Washington, DC: US Department of Housing and Urban Development, Office of Policy Development and Research; 2011.Google Scholar
  39. 39.
    Nobles CJ, Valentine SE, Zepeda ED, Wang Y, Ahles EM, Shtasel DL, et al. Residential segregation and mental health among Latinos in a nationally representative survey. J Epidemiol Community Health. 2017;71(4):318–23.CrossRefGoogle Scholar
  40. 40.
    Laveist TA. Segregation, poverty, and empowerment: health consequences for African Americans. Milbank Q. 1993;71(1):41–64.CrossRefGoogle Scholar
  41. 41.
    Hong S, Zhang W, Walton E. Neighborhoods and mental health: exploring ethnic density, poverty, and social cohesion among Asian Americans and Latinos. Soc Sci Med. 2014;111:117–24.CrossRefGoogle Scholar
  42. 42.
    Kawachi I, Berkman LF, editors. Neighborhoods and Health. Oxford: Oxford University Press; 2003.Google Scholar
  43. 43.
    Mair C, Roux AVD, Galea S. Are neighbourhood characteristics associated with depressive symptoms? A review of evidence. J Epidemiol Community Health. 2008;62(11):940–U21.Google Scholar
  44. 44.
    Kawachi I. Social capital and community effects on population and individual health. In: Adler NE, Marmot M, McEwen B, Stewart J, editors. Socioeconomic status and health in industrial nations: social, psychological, and biological pathways, Annals of the New York Academy of Sciences, vol. 896. New York: New York Academy of Sciences; 1999. p. 120–30.Google Scholar
  45. 45.
    De Silva MJ, McKenzie K, Harpham T, Huttly SRA. Social capital and mental illness: a systematic review. J Epidemiol Community Health. 2005;59(8):619–27.CrossRefGoogle Scholar
  46. 46.
    Ehsan AM, De Silva MJ. Social capital and common mental disorder: a systematic review. J Epidemiol Community Health. 2015;69(10):1021–8.CrossRefGoogle Scholar
  47. 47.
    Berkman LF, Kawachi I, editors. Social cohesion, social capital, and health. New York: Oxford University Press; 2000.Google Scholar
  48. 48.
    Carpiano RM. Neighborhood social capital and adult health: an empirical test of a Bourdieu-based model. Health Place. 2007;13(3):639–55.CrossRefGoogle Scholar
  49. 49.
    Dean LT, Hillier A, Chau-Glendinning H, Subramanian SV, Williams DR, Kawachi I. Can you party your way to better health? A propensity score analysis of block parties and health. Soc Sci Med. 2015;138:201–9.CrossRefGoogle Scholar
  50. 50.
    Cook BL, Zuvekas SH, Chen J, Progovac A, Lincoln AK. Assessing the individual, neighborhood, and policy predictors of disparities in mental health care. Med Care Res Rev. 2017;74(4):404–30.CrossRefGoogle Scholar
  51. 51.
    Le Cook B, Doksum T, Chen CN, Carle A, Alegria M. The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the US. Soc Sci Med. 2013;84:102–9.CrossRefGoogle Scholar
  52. 52.
    Becares L, Nazroo J, Jackson J, Heuvelman H. Ethnic density effects on health and experienced racism among Caribbean people in the US and England: a cross-national comparison. Soc Sci Med. 2012;75(12):2107–15.CrossRefGoogle Scholar
  53. 53.
    Becares L, Cormack D, Harris R. Ethnic density and area deprivation: neighbourhood effects on Maori health and racial discrimination in Aotearoa/New Zealand. Soc Sci Med. 2013;88:76–82.CrossRefGoogle Scholar
  54. 54.
    English D, Lambert SF, Evans MK, Zonderman AB. Neighborhood racial composition, racial discrimination, and depressive symptoms in African Americans. Am J Community Psychol. 2014;54(3–4):219–28.CrossRefGoogle Scholar
  55. 55.
    Mair C, Roux AVD, Osypuk TL, Rapp SR, Seeman T, Watson KE. Is neighborhood racial/ethnic composition associated with depressive symptoms? The multi-ethnic study of atherosclerosis. Soc Sci Med. 2010;71(3):541–50.CrossRefGoogle Scholar
  56. 56.
    Pennap D, Burcu M, Safer DJ, Zito JM. Hispanic residential isolation, ADHD diagnosis and stimulant treatment among Medicaid-insured youth. Ethn Dis. 2017;27(2):85–94.CrossRefGoogle Scholar
  57. 57.
    Neeleman J, Wessely S. Ethnic minority suicide: a small area geographical study in south London. Psychol Med. 1999;29(2):429–36.CrossRefGoogle Scholar
  58. 58.
    Neeleman J, Wilson-Jones C, Wessely S. Ethnic density and deliberate self harm; a small area study in south east London. J Epidemiol Community Health. 2001;55(2):85–90.CrossRefGoogle Scholar
  59. 59.
    Scott SM, Wallander JL, Cameron L. Protective mechanisms for depression among racial/ethnic minority youth: empirical findings, issues, and recommendations. Clin Child Fam Psychol Rev. 2015;18(4):346–69.CrossRefGoogle Scholar
  60. 60.
    Le Cook B, Trinh NH, Li ZH, Hou SSY, Progovac AM. Trends in racial–ethnic disparities in access to mental health care, 2004–2012. Psychiatr Serv. 2017;68(1):9–16.CrossRefGoogle Scholar
  61. 61.
    Becares L, Nazroo J, Jackson J. Ethnic density and depressive symptoms among African Americans: threshold and differential effects across social and demographic subgroups. Am J Public Health. 2014;104(12):2334–41.CrossRefGoogle Scholar
  62. 62.
    Lee MJ, Liechty JM. Longitudinal associations between immigrant ethnic density, neighborhood processes, and Latino immigrant youth depression. J Immigr Minor Health. 2015;17(4):983–91.CrossRefGoogle Scholar
  63. 63.
    Ostir GV, Eschbach K, Markides KS, Goodwin JS. Neighbourhood composition and depressive symptoms among older Mexican Americans. J Epidemiol Community Health. 2003;57(12):987–92.CrossRefGoogle Scholar
  64. 64.
    Lee MA. Neighborhood residential segregation and mental health: a multilevel analysis on Hispanic Americans in Chicago. Soc Sci Med. 2009;68(11):1975–84.CrossRefGoogle Scholar
  65. 65.
    Galster G, Santiago A. Neighbourhood ethnic composition and outcomes for low-income Latino and African American children. Urban Stud. 2017;54(2):482–500.CrossRefGoogle Scholar
  66. 66.
    Walsemann KM, Bell BA, Maitra D. The intersection of school racial composition and student race/ethnicity on adolescent depressive and somatic symptoms. Soc Sci Med. 2011;72(11):1873–83.CrossRefGoogle Scholar
  67. 67.
    Walsemann KM, Gee GC, Ro A. Educational attainment in the context of social inequality: new directions for research on education and health. Am Behav Sci. 2013;57(8):1082–104.CrossRefGoogle Scholar
  68. 68.
    Alang SM. “Black folk don’t get no severe depression”: meanings and expressions of depression in a predominantly black urban neighborhood in Midwestern United States. Soc Sci Med. 2016;157:1–8.CrossRefGoogle Scholar
  69. 69.
    Chen J, Bloodworth R, Novak P, Le Cook B, Goldman HH, Rendall MS, et al. Reducing preventable hospitalization and disparity: association with local health department mental health promotion activities. Am J Prev Med. 2018;54(1):103–12.CrossRefGoogle Scholar
  70. 70.
    Substance Abuse Mental Health Services Administration. Behavioral health in primary care/SAMHSA–HRSA. 2017. Accessed 31 Jan 2017.
  71. 71.
    Petersen I, Evans-Lacko S, Semrau M, Barry MM, Chisholm D, Gronholm P, et al. Promotion, prevention and protection: interventions at the population- and community-levels for mental, neurological and substance use disorders in low- and middle-income countries. Int J Ment Heal Syst. 2016;10:13.CrossRefGoogle Scholar
  72. 72.
    Kwate NOA. “Racism still exists”: a public health intervention using racism “countermarketing” outdoor advertising in a black neighborhood. J Urban Health. 2014;91(5):851–72.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and BiostatisticsUniversity of South Carolina—Arnold School of Public HealthColumbiaUSA

Personalised recommendations