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Associations of housing mobility interventions for children in high poverty neighborhoods with subsequent mental disorders during adolescence
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March 05 2014
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Source: JAMA. 311(9):937-948
[PDF-1.42 MB]
Details:
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Alternative Title:JAMA
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Description:Importance
Youth in poor neighborhoods have high emotional problem rates. Understanding neighborhood influences on these rates is crucial for designing neighborhood-level interventions.
Objective
To do 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 (MTO) demonstration in 1994-1998 randomized 4,604 volunteer public housing families with children in high-poverty neighborhoods into Low-poverty voucher (LPV) or Traditional voucher (TRV) interventions to encourage moving to lower-poverty neighborhoods or a Control group. An evaluation 10-15 years later (June 2008-April 2010)interviewed (blinded to assignment) participants aged 0-8 at randomization and 13-19 at follow-up. Response rates were 86.9-92.9%.
Interventions
LPV (n=1,430) received vouchers to move to low-poverty neighborhoods with enhanced mobility counseling. TRV (n=1,081) received geographically unrestricted vouchers. Controls (n=1,178) received no intervention.
Main Outcomes and Measures
Twelve-month DSM-IV major depressive, panic, post-traumatic stress (PTSD), oppositional-defiant, intermittent explosive, and conduct disorders assessed post hoc with a validated research diagnostic interview.
Results
3,689 children were randomized and 2,872 interviewed (1,407 boys, median age 16 range: 13-19; 1,465 girls, median age 16, range 13-19). Boys had significantly elevated rates of major depression in LPV (7.1% [95% CI, 4.1-10.1%]; OR, 2.2 [95% CI, 1.2-3.9]) versus Controls (3.5% [95% CI, 2.3-4.6%]), PTSD in LPV (6.2% [95% CI, 4.7-7.7%]; OR, 3.4 [95% CI, 1.6-7.4]) and TRV (4.9% [95% CI, 3.0-6.8%]; OR, 2.7 [95% CI, 1.2-5.8]) versus Controls (1.9% [95% CI, 0.9-2.9%]), and conduct disorder in LPV (6.4% [95% CI, 4.7-8.1%];OR, 3.1[95% CI, 1.7-5.8]) versus Controls (2.1% [95% CI, 1.1-3.2%]). TRV girls had reduced rates of major depression (6.5% [95% CI, 4.5-8.4%]; OR, 0.6 [95% CI, 0.3-0.9 ]) versus Controls (10.9% [95% CI, 8.4-13.4%]) and conduct disorder (0.3% [95% CI, 0.0-0.7%]; OR, 0.1 [95% CI, 0.0-0.4]) versus Controls (2.9% [95% CI, 1.1-4.7%]).
Conclusions and Relevance
Interventions to encourage moving from high-poverty neighborhoods were associated with elevated depression, PTSD, and conduct disorder among boys and reduced 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.
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Source:
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Pubmed ID:24595778
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Pubmed Central ID:PMC4100467
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