Differential mental health effects of neighborhood relocation among youth in vulnerable families: Results from a randomized trial

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.