Differential mental health effects of neighborhood relocation among youth in vulnerable families

Results from a randomized trial

Theresa L Osypuk, Eric J. Tchetgen Tchetgen, Dolores Acevedo-Garcia, Felton J. Earls, Alisa Lincoln, Nicole M Schmidt, M. Maria Glymour

Research output: Contribution to journalArticle

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Abstract

Context: Extensive observational evidence indicates that youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly. Objective: To use experimental evidence to assess whether gender and family health problems modify the mental health effects of moving from high- to lowpoverty neighborhoods. Design: Randomized controlled trial. Setting: Volunteer low-income families in public housing in 5 US cities between 1994-1997. Participants: We analyze 4- to 7-year outcomes in youth aged 12 to 19 years (n=2829, 89% effective response rate) in the Moving to Opportunity Study. Intervention: Families were randomized to remain in public housing (control group) or to receive government-funded rental subsidies to move into private apartments (experimental group). Intention-to-treat analyses included intervention interactions by gender and health vulnerability (defined as prerandomization health/developmental limitations or disabilities in family members). Main Outcome Measures: Past-year psychological distress (Kessler 6 scale [K6]) and the Behavioral Problems Index (BPI). Supplemental analyses used past-year major depressive disorder (MDD). Results: Male gender (P=.02) and family health vulnerability (P=.002) significantly adversely modified the intervention effect on K6 scores; male gender (P=.01), but not health vulnerability (P=.17), significantly adversely modified the intervention effect on the BPI. Girls without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6: β=-0.21; 95% CI, -0.34 to -0.07; P=.003; MDD: odds ratio=0.42; 95% CI, 0.20 to 0.85; P=.02). For boys with health vulnerabilities, intervention was associated with worse K6 (β=0.26; 95% CI, 0.09 to 0.44; P=.003) and BPI (β=0.24; 95% CI, 0.09 to 0.40; P=.002) values. Neither girls with health vulnerability nor boys without health vulnerability experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects twice as large. Patterns were similar for MDD, but estimates were imprecise owing to low prevalence. Conclusions: Although some girls benefited, boys and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies and may need additional program supports.

Original languageEnglish (US)
Pages (from-to)1284-1294
Number of pages11
JournalArchives of General Psychiatry
Volume69
Issue number12
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

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Mental Health
Health
Major Depressive Disorder
Public Housing
Family Health
Intention to Treat Analysis
Insurance Benefits
Poverty
Volunteers
Vulnerability
Randomized Controlled Trials
Odds Ratio
Outcome Assessment (Health Care)
Psychology
Control Groups
Problem Behavior
Boys

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Differential mental health effects of neighborhood relocation among youth in vulnerable families : Results from a randomized trial. / Osypuk, Theresa L; Tchetgen Tchetgen, Eric J.; Acevedo-Garcia, Dolores; Earls, Felton J.; Lincoln, Alisa; Schmidt, Nicole M; Glymour, M. Maria.

In: Archives of General Psychiatry, Vol. 69, No. 12, 01.12.2012, p. 1284-1294.

Research output: Contribution to journalArticle

Osypuk, Theresa L ; Tchetgen Tchetgen, Eric J. ; Acevedo-Garcia, Dolores ; Earls, Felton J. ; Lincoln, Alisa ; Schmidt, Nicole M ; Glymour, M. Maria. / Differential mental health effects of neighborhood relocation among youth in vulnerable families : Results from a randomized trial. In: Archives of General Psychiatry. 2012 ; Vol. 69, No. 12. pp. 1284-1294.
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abstract = "Context: Extensive observational evidence indicates that youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly. Objective: To use experimental evidence to assess whether gender and family health problems modify the mental health effects of moving from high- to lowpoverty neighborhoods. Design: Randomized controlled trial. Setting: Volunteer low-income families in public housing in 5 US cities between 1994-1997. Participants: We analyze 4- to 7-year outcomes in youth aged 12 to 19 years (n=2829, 89{\%} effective response rate) in the Moving to Opportunity Study. Intervention: Families were randomized to remain in public housing (control group) or to receive government-funded rental subsidies to move into private apartments (experimental group). Intention-to-treat analyses included intervention interactions by gender and health vulnerability (defined as prerandomization health/developmental limitations or disabilities in family members). Main Outcome Measures: Past-year psychological distress (Kessler 6 scale [K6]) and the Behavioral Problems Index (BPI). Supplemental analyses used past-year major depressive disorder (MDD). Results: Male gender (P=.02) and family health vulnerability (P=.002) significantly adversely modified the intervention effect on K6 scores; male gender (P=.01), but not health vulnerability (P=.17), significantly adversely modified the intervention effect on the BPI. Girls without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6: β=-0.21; 95{\%} CI, -0.34 to -0.07; P=.003; MDD: odds ratio=0.42; 95{\%} CI, 0.20 to 0.85; P=.02). For boys with health vulnerabilities, intervention was associated with worse K6 (β=0.26; 95{\%} CI, 0.09 to 0.44; P=.003) and BPI (β=0.24; 95{\%} CI, 0.09 to 0.40; P=.002) values. Neither girls with health vulnerability nor boys without health vulnerability experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects twice as large. Patterns were similar for MDD, but estimates were imprecise owing to low prevalence. Conclusions: Although some girls benefited, boys and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies and may need additional program supports.",
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AU - Earls, Felton J.

AU - Lincoln, Alisa

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AU - Glymour, M. Maria

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N2 - Context: Extensive observational evidence indicates that youth in high-poverty neighborhoods exhibit poor mental health, although not all children may be affected similarly. Objective: To use experimental evidence to assess whether gender and family health problems modify the mental health effects of moving from high- to lowpoverty neighborhoods. Design: Randomized controlled trial. Setting: Volunteer low-income families in public housing in 5 US cities between 1994-1997. Participants: We analyze 4- to 7-year outcomes in youth aged 12 to 19 years (n=2829, 89% effective response rate) in the Moving to Opportunity Study. Intervention: Families were randomized to remain in public housing (control group) or to receive government-funded rental subsidies to move into private apartments (experimental group). Intention-to-treat analyses included intervention interactions by gender and health vulnerability (defined as prerandomization health/developmental limitations or disabilities in family members). Main Outcome Measures: Past-year psychological distress (Kessler 6 scale [K6]) and the Behavioral Problems Index (BPI). Supplemental analyses used past-year major depressive disorder (MDD). Results: Male gender (P=.02) and family health vulnerability (P=.002) significantly adversely modified the intervention effect on K6 scores; male gender (P=.01), but not health vulnerability (P=.17), significantly adversely modified the intervention effect on the BPI. Girls without baseline health vulnerabilities were the only subgroup to benefit on any outcome (K6: β=-0.21; 95% CI, -0.34 to -0.07; P=.003; MDD: odds ratio=0.42; 95% CI, 0.20 to 0.85; P=.02). For boys with health vulnerabilities, intervention was associated with worse K6 (β=0.26; 95% CI, 0.09 to 0.44; P=.003) and BPI (β=0.24; 95% CI, 0.09 to 0.40; P=.002) values. Neither girls with health vulnerability nor boys without health vulnerability experienced intervention benefits. Adherence-adjusted instrumental variable analysis found intervention effects twice as large. Patterns were similar for MDD, but estimates were imprecise owing to low prevalence. Conclusions: Although some girls benefited, boys and adolescents from families with baseline health problems did not experience mental health benefits from housing mobility policies and may need additional program supports.

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