Author Insights: Moving From Poor Neighborhoods to Better Ones Improves Mental Health of Girls but Not Boys

Ronald C. Kessler, PhD, professor of health care policy at Harvard Medical School in Boston, and colleagues found that girls may experience mental health benefits when moving out of high-poverty neighborhood while boys face increased risk of mental health disorders. (Image: Joshua Touster)

Ronald C. Kessler, PhD, professor of health care policy at Harvard Medical School in Boston, and colleagues found that girls may experience mental health benefits when moving out of high-poverty neighborhood while boys face increased risk of mental health disorders. (Image: Joshua Touster)

It seems self-evident that moving young girls and boys out of high-poverty neighborhoods and into communities with lower poverty and crime rates benefits these children. But what appears obvious may not be so clear-cut: new findings appearing today in JAMA suggest that although girls who are relocated to less economically distressed areas are less likely to experience some mental health problems during adolescence, the risk for boys is increased.

These findings are based on data generated by the Moving to Opportunity study, which studied 4604 families residing in public or project-based assisted housing in high-poverty areas (in which more than 40% of families live in poverty) in Baltimore, Boston, Chicago, Los Angeles, or New York from 1994 to 1998. The families were randomly assigned to 3 groups. One group received vouchers to move to and live in “low-poverty neighborhoods” (in which less than 10% of families live in poverty) for at least a year, the second group received traditional vouchers that enabled them to move but did not impose a geographic restriction, and a control group had no change in the level of assistance they received.

The researchers evaluated enrolled children 10 to 15 years later (from June 2008 to April 2010). Compared with girls in the control group, girls in the traditional voucher group had decreased rates of major depression (6.5% vs 10.9%), and conduct disorder (0.3% vs 2.9%); rates of posttraumatic stress disorder were not affected. Girls in the low-poverty voucher group had no statistical differences compared with those in the control group.

Boys in the low-poverty voucher group when compared with those in the control group had increased rates of major depression (7.1% vs 3.5%), posttraumatic stress disorder (6.2% vs 1.9%), and conduct disorder (6.4% vs 2.1%). The only statistical difference for boys in the traditional voucher group was an increased rate of posttraumatic stress disorder, 4.9% compared with 1.9% for boys in the control group.

Lead author, Ronald C. Kessler, PhD, a professor of health care policy at Harvard Medical School, Boston, discusses his team’s findings.

news@JAMA: Were you surprised to find that not all children benefit from moving away from high-poverty neighborhoods?

Dr Kessler: We didn’t anticipate this. We figured moving to better neighborhoods would demonstrate at least some good, but we didn’t think it would create something that would be bad. The effects were very good for girls and much worse for boys. That doesn’t mean you don’t do it because it harms boys, it means you need to figure out how to make it work for all.

news@JAMA: Why were there differences between boys and girls?

Dr Kessler: It looks like when little girls move, they get embraced in ways the boys don’t. Girls appear to have better coping mechanisms than boys. Boys may appear to be “tough guys” and people then say they are “problem kids.” So the communities are responding to the boys in a different way than they do to girls.

news@JAMA: Why did girls do better in the traditional voucher group rather than in the low-poverty voucher group, which one would think could provide even greater benefit?

Dr Kessler: HUD [the Department of Housing and Urban Development] designed this demonstration project to test a variety of housing interventions. We studied the effects of moving on mental health using the HUD data as best we could and it becomes kind of an apples and oranges thing. But the key point was getting to these better neighborhoods was what benefited girls and harmed boys.

news@JAMA: Is there a solution?

Dr Kessler: The US government spends an extraordinary amount on public housing, and obviously, the primary goal is to put roofs over people’s heads. But the government should also be thinking about these people’s overall good. You just don’t provide a new house with a lawn and tell them “good luck”—these people need help. And we provide that help for others. There’s an enormous amount of work done helping prisoners transition back into society so they don’t go on to commit crimes again. We help military personnel transition back to civilian life. We need to help people trying to move out of high-poverty, high-crime neighborhoods. I want it to work for everybody.



Categories: Adolescent Medicine, Depression, Post Traumatic Stress Disorder, Psychiatry