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PUBLIC RELEASE DATE:
4-Mar-2014

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Contact: David Cameron
david_cameron@hms.harvard.edu
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The JAMA Network Journals
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Moving out of high poverty appears to affect the mental health of boys, girls differently

For families who moved out of high-poverty neighborhoods, boys experienced an increase and girls a decrease in rates of depression and conduct disorder, according to a study in the March 5 issue of JAMA.

Observational studies have consistently found that youth in high-poverty neighborhoods have high rates of emotional problems. These findings raise the possibilities that neighborhood characteristics affect emotional functioning and neighborhood-level interventions may reduce emotional problems. Available data from observational studies are unclear, according to background information in the article. "Understanding neighborhood influences on mental health is crucial for designing neighborhood-level interventions."

Ronald C. Kessler, Ph.D., of Harvard Medical School, Boston, and colleagues analyzed the outcomes of an intervention to encourage moving out of high-poverty neighborhoods and subsequent changes in mental disorders from childhood to adolescence. The intervention (Moving to Opportunity Demonstration) randomized 4,604 volunteer public housing families with 3,689 children in high-poverty neighborhoods from 1994 to 1998 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 = 1,430) received vouchers to move to low-poverty neighborhoods. The traditional voucher group (n = 1,081) received geographically unrestricted vouchers. Controls (n = 1,178) received no intervention.

The children were ages 0 through 8 years at the beginning of the study, and 13 through 19 years of age at the time of follow-up interviews (10 to 15 years later, June 2008 - April 2010). A total of 2,872 adolescents were interviewed (1,407 boys and 1,465 girls from 2,134 families). The presence of mental disorders was assessed with the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition).

The researcher found that compared with the control group, a higher proportion of boys in the low-poverty voucher group had major depression (7.1 percent vs 3.5 percent), posttraumatic stress disorder (6.2 percent vs 1.9 percent), and conduct disorder (6.4 percent vs 2.1 percent). A higher proportion of boys in the traditional voucher group had PTSD compared with the control group (4.9 percent vs 1.9 percent). However, compared with the control group, a lower proportion of girls in the traditional voucher group had major depression (6.5 percent vs 10.9 percent) and conduct disorder (0.3 percent vs 2.9 percent).

The authors speculate that the sex differences found in this study "were due to girls profiting more than boys from moving to better neighborhoods because of sex differences in both neighborhood experiences and in the social skills needed to capitalize on the new opportunities presented by their improved neighborhoods."

"It is nonetheless difficult to draw policy implications from these results, because the findings suggest that the interventions might have had harmful effects on boys but protective effects on girls. Future governmental decisions regarding widespread implementation of changes in public housing policy will have to grapple with this complexity based on the realization that no policy decision will have benign effects on both boys and girls."

"Better understanding of interactions among individual, family, and neighborhood risk factors is needed to guide future public housing policy changes in light of these sex differences," the authors conclude.

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(doi:10.1001/jama.2014.607; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

There will also be a digital news release available for this study, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 3 p.m. CT Tuesday, March 4 at this link.



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