The neighbourhood is an essential arena for adolescents’ health development and research suggests that perceived neighbourhood insecurity (PNI) is associated with socio-economic status and self-rated health. The present study explored the distribution of adolescents’ PNI and its association with psychosomatic health complaints across districts. It also examined gender differences and whether family socio-economic position, foreign background and previous exposure to crime could explain part of the association. Data came from classroom-surveys within Stockholm municipality’s 14 districts in 2010, 2012 and 2014 (n=10,291). Linear and logistic multilevel regression models were applied. Results showed that the average level of PNI varied considerably between districts and were strongly connected to its socio-demographic composition. However, individual characteristics in terms of family background and previous exposure to crime only explained a minor part of the variation in PNI across districts. Girls reported more insecurity than boys in all districts. Gender differences in PNI decreased in absolute numbers, but increased in relative numbers, as the overall ‘neighbourhood safety’ increased. Between-district differences in health were minor, but PNI was still a strong predictor of individual-level health, especially for boys. Furthermore, the predictive power of PNI on health was stronger in districts perceived as safer.