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Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence.
JAMA. 2014 03 05; 311(9):937-48.JAMA

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.

Authors+Show Affiliations

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.School of Education, University of California Irvine, Irvine.National Bureau of Economic Research, Cambridge, Massachusetts.National Bureau of Economic Research, Cambridge, Massachusetts4Department of Economics, Harvard University, Cambridge, Massachusetts.National Bureau of Economic Research, Cambridge, Massachusetts5Congressional Budget Office, Washington, DC.Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.National Bureau of Economic Research, Cambridge, Massachusetts.Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.National Bureau of Economic Research, Cambridge, Massachusetts6Harris School of Public Policy, University of Chicago, Chicago, Illinois.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

24595778

Citation

Kessler, Ronald C., et al. "Associations of Housing Mobility Interventions for Children in High-poverty Neighborhoods With Subsequent Mental Disorders During Adolescence." JAMA, vol. 311, no. 9, 2014, pp. 937-48.
Kessler RC, Duncan GJ, Gennetian LA, et al. Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence. JAMA. 2014;311(9):937-48.
Kessler, R. C., Duncan, G. J., Gennetian, L. A., Katz, L. F., Kling, J. R., Sampson, N. A., Sanbonmatsu, L., Zaslavsky, A. M., & Ludwig, J. (2014). Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence. JAMA, 311(9), 937-48. https://doi.org/10.1001/jama.2014.607
Kessler RC, et al. Associations of Housing Mobility Interventions for Children in High-poverty Neighborhoods With Subsequent Mental Disorders During Adolescence. JAMA. 2014 03 5;311(9):937-48. PubMed PMID: 24595778.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence. AU - Kessler,Ronald C, AU - Duncan,Greg J, AU - Gennetian,Lisa A, AU - Katz,Lawrence F, AU - Kling,Jeffrey R, AU - Sampson,Nancy A, AU - Sanbonmatsu,Lisa, AU - Zaslavsky,Alan M, AU - Ludwig,Jens, PY - 2014/3/6/entrez PY - 2014/3/7/pubmed PY - 2014/3/19/medline SP - 937 EP - 48 JF - JAMA JO - JAMA VL - 311 IS - 9 N2 - 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. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/24595778/Associations_of_housing_mobility_interventions_for_children_in_high_poverty_neighborhoods_with_subsequent_mental_disorders_during_adolescence_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2014.607 DB - PRIME DP - Unbound Medicine ER -