Complex Take-home Message for Public Housing Policy
• Science Update
Girls in public housing benefited emotionally from a move to a better neighborhood while boys fared worse than if they’d stayed in the poor neighborhood, a study partly funded by NIMH has found. Rates of depression and conduct disorder markedly increased in boys and decreased in girls. Boys also experienced significantly increased rates of post-traumatic stress disorder (PTSD).
“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,” concluded the research team, which was headed by Ronald Kessler, Ph.D., of Harvard University, Jens Ludwig, Ph.D. , of the University of Chicago, and Jeffrey Kling, Ph.D. , of the National Bureau of Economic Research. Although not addressed by the study, they suggested that girls might have had better social skills to take advantage of opportunities offered by the better neighborhoods and presumably had different experiences there than boys.
The researchers reported their results March 4, 2014 in the Journal of the American Medical Association.
The findings are the latest to emerge from a public housing experiment in 5 major cities* during the mid-to-late 1990s, in which randomly selected families with young children were offered the opportunity to move out of impoverished neighborhoods. They were offered either restricted vouchers to move to lower poverty neighborhoods or unrestricted vouchers to move to any neighborhood of their choice. The primary goals were to increase educational achievement and economic self-sufficiency, but by far the most common reason for moving that families gave was to get away from gangs and drugs. After a year, families that accepted either type of vouchers were living in neighborhoods with poverty rates averaging 34 percent, compared to 50 percent for control group families.
Mental illness is more prevalent among youth in impoverished neighborhoods, suggesting that an upscale move might be beneficial. Among adult family members, health and well-being had improved when surveyed a decade later. Yet among their offspring, there were hints by middle childhood that girls were doing better and boys were doing worse psychologically. The researchers followed-up with a more formal evaluation of the children’s mental health in 2008-2010, when they were in their mid-to-late teens – 1407 boys and 1465 girls from 2134 families.
The one-year prevalence of depression was 7.1 percent among boys whose families had received the restricted vouchers and moved into low poverty neighborhoods, compared to 3.5 percent among boys in control group families who did not receive vouchers. Rates of conduct disorder among low poverty group boys were 6.4 percent, compared to 2.1 percent in the control group. Rates of PTSD were 6.2 percent in the low poverty group, compared to 3.5 percent among boys in the control group, and 4.9 percent in families with unrestricted vouchers. This effect of neighborhood is comparable to the impact of combat exposure on PTSD rates in the military, the researchers noted.
Girls showed a contrasting trend, with 6.5 percent in families receiving unrestricted vouchers developing depression, compared to 10.9 percent among control group families. Rates of conduct disorder among unrestricted voucher group girls were .3 percent, compared to 2.9 percent in control group families. The protective effect of neighborhood on depression in girls was comparable to the inverse effect of sexual assault on depression rates in young women, according to Kessler and colleagues.
Given the complexities posed by these results, the researchers suggest that a challenge for future research may be to “develop nuanced decision rules for matching public housing families with neighborhoods to maximize the health and well-being of all family members.”
Associations of housing mobility interventions for children in high-poverty neighborhoods with subsequent mental disorders during adolescence. Kessler RC, Duncan GJ, Gennetian LA, Katz LF, Kling JR, Sampson NA, Sanbonmatsu L, Zaslavsky AM, Ludwig J. JAMA. 2014 Mar 5;311(9):937-48. doi: 10.1001/jama.2014.607. PMID: 24595778
Neighborhood effects on the long-term well-being of low-income adults. Ludwig J, Duncan GJ, Gennetian LA, Katz LF, Kessler RC, Kling JR, Sanbonmatsu L. Science. 2012 Sep 21;337(6101):1505-10.
*The Moving to Opportunity experiment was conducted in Baltimore, Boston, Chicago, Los Angeles and New York City, from 1994 to 1998.