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

Ronald C. Kessler, Greg J. Duncan, Lisa Gennetian, Lawrence F. Katz, Jeffrey R. Kling, Nancy A. Sampson, Lisa Sanbonmatsu, Alan M. Zaslavsky, Jens Ludwig

Research output: Contribution to journalArticle

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 encouragemoving 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.

Original languageEnglish (US)
Pages (from-to)937-947
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume311
Issue number9
DOIs
StatePublished - Jan 1 2014

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Poverty
Mental Disorders
Conduct Disorder
Odds Ratio
Post-Traumatic Stress Disorders
Public Housing
Depression
Control Groups
Disruptive, Impulse Control, and Conduct Disorders
Attention Deficit and Disruptive Behavior Disorders
Panic Disorder
Major Depressive Disorder
Public Policy
Random Allocation
Diagnostic and Statistical Manual of Mental Disorders
Counseling
Volunteers
Mental Health
Outcome Assessment (Health Care)
Interviews

ASJC Scopus subject areas

  • Medicine(all)

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Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence. / Kessler, Ronald C.; Duncan, Greg J.; Gennetian, Lisa; Katz, Lawrence F.; Kling, Jeffrey R.; Sampson, Nancy A.; Sanbonmatsu, Lisa; Zaslavsky, Alan M.; Ludwig, Jens.

In: JAMA - Journal of the American Medical Association, Vol. 311, No. 9, 01.01.2014, p. 937-947.

Research output: Contribution to journalArticle

Kessler, Ronald C. ; Duncan, Greg J. ; Gennetian, Lisa ; Katz, Lawrence F. ; Kling, Jeffrey R. ; Sampson, Nancy A. ; Sanbonmatsu, Lisa ; Zaslavsky, Alan M. ; Ludwig, Jens. / Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence. In: JAMA - Journal of the American Medical Association. 2014 ; Vol. 311, No. 9. pp. 937-947.
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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 encouragemoving 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.",
author = "Kessler, {Ronald C.} and Duncan, {Greg J.} and Lisa Gennetian and Katz, {Lawrence F.} and Kling, {Jeffrey R.} and Sampson, {Nancy A.} and Lisa Sanbonmatsu and Zaslavsky, {Alan M.} and Jens Ludwig",
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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

AU - Katz, Lawrence F.

AU - Kling, Jeffrey R.

AU - Sampson, Nancy A.

AU - Sanbonmatsu, Lisa

AU - Zaslavsky, Alan M.

AU - Ludwig, Jens

PY - 2014/1/1

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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 encouragemoving 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.

AB - 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 encouragemoving 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.

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