Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence

Abstract

Importance: Youth in high-poverty neighborhoods have high rates of emotional problems. Understanding neighborhood influences on mental health is crucial for designing neighborhood-level interventions.

Objective: To perform an exploratory analysis of associations between housing mobility interventions for children in high-poverty neighborhoods and subsequent mental disorders during adolescence.

Design, setting, and participants: The Moving to Opportunity Demonstration from 1994 to 1998 randomized 4604 volunteer public housing families with 3689 children in high-poverty neighborhoods into 1 of 2 housing mobility intervention groups (a low-poverty voucher group vs a traditional voucher group) or a control group. The low-poverty voucher group (n=1430) received vouchers to move to low-poverty neighborhoods with enhanced mobility counseling. The traditional voucher group (n=1081) received geographically unrestricted vouchers. Controls (n=1178) received no intervention. Follow-up evaluation was performed 10 to 15 years later (June 2008-April 2010) with participants aged 13 to 19 years (0-8 years at randomization). Response rates were 86.9% to 92.9%.

Main outcomes and measures: Presence of mental disorders from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) within the past 12 months, including major depressive disorder, panic disorder, posttraumatic stress disorder (PTSD), oppositional-defiant disorder, intermittent explosive disorder, and conduct disorder, as assessed post hoc with a validated diagnostic interview.

Results: Of the 3689 adolescents randomized, 2872 were interviewed (1407 boys and 1465 girls). Compared with the control group, boys in the low-poverty voucher group had significantly increased rates of major depression (7.1% vs 3.5%; odds ratio (OR), 2.2 [95% CI, 1.2-3.9]), PTSD (6.2% vs 1.9%; OR, 3.4 [95% CI, 1.6-7.4]), and conduct disorder (6.4% vs 2.1%; OR, 3.1 [95% CI, 1.7-5.8]). Boys in the traditional voucher group had increased rates of PTSD compared with the control group (4.9% vs 1.9%, OR, 2.7 [95% CI, 1.2-5.8]). However, compared with the control group, girls in the traditional voucher group had decreased rates of major depression (6.5% vs 10.9%; OR, 0.6 [95% CI, 0.3-0.9]) and conduct disorder (0.3% vs 2.9%; OR, 0.1 [95% CI, 0.0-0.4]).

Conclusions and relevance: Interventions to encourage moving out of high-poverty neighborhoods were associated with increased rates of depression, PTSD, and conduct disorder among boys and reduced rates of depression and conduct disorder among girls. Better understanding of interactions among individual, family, and neighborhood risk factors is needed to guide future public housing policy changes.

Figure. Study flow of the long-term MTO adolescent sample evaluation^a

^aTarget respondents for the adolescent long-term evaluation included all baseline residents of randomized MTO households who were ages 0-8 at randomization between 1994-1998, 13-17 at selection in December 2007, and 13-19 at interview between June 2008 and April 2010. All adolescents in the eligible age range who lived at baseline in households containing three or fewer youth ages 10 to 20 were targeted for follow-up, while a random three youth were targeted from baseline households with four or more youth. A weight of n/3, where n = the number of eligible youths in the baseline household, was used to adjust for the under-sampling of youths from baseline households containing more than three eligible youth. The term “Phase 1” data collection refers to the efforts made to contact and interview all target respondents until the end of the field period, at which point a random 35% of target respondents who had not yet either been interviewed, were deceased, declined to participate, or were incapacitated (incarcerated or unable to be interviewed due to a barrier related to health or language) were selected for a more intensive “Phase 2” data collection effort that included expanded tracing efforts (e.g., using private investigators to trace target respondents who had not yet been located) and increased financial incentives to obtain interviews from hard-to-recruit youths. A weight of 1/.35 was used to adjust for the under-sampling of the hard-to-recruit youths who were interviewed.