The Surprising Effects of Gender on Youth Mental Health

The Surprising Effects of Gender on Youth Mental Health

Previous issues of PD&R’s The Edge have featured articles about the Moving to Opportunity (MTO) demonstration, which helped poor families in public or private assisted housing in high-poverty neighborhoods move to lower-poverty neighborhoods. A study by Ronald Kessler and colleagues that was published in the Journal of the American Medical Association (JAMA) in March 2014 uses MTO data to show that relocating to low-poverty neighborhoods affects the mental health of poor youth in surprising ways.

The MTO demonstration assigned participating families by lottery to one of three groups. Families in the experimental group received a voucher that could be used only for housing in low-poverty areas, families in the Section 8 group received ordinary housing vouchers that could be used anywhere, and families in the control group received no special assistance from MTO but continued to be eligible for whatever services and assistance they had before. A little under half of the families in the experimental group and just under two-thirds of those in the Section 8 group actually moved. The lottery process allows researchers to study the effects of moving to a low-poverty neighborhood while controlling for external factors such as differences among the families and other external factors such as the effects of the economy. The 2001 and 2011 follow-up surveys of more than 4,000 MTO families have generated a number of important papers about how neighborhood poverty affects families.

Each MTO family was randomly assigned to one of the three groups between 1994 and 1998. Between the time of random assignment and May 2008, the average control group household in the average month lived in a neighborhood in which 40 percent of the population lived at or below the federal poverty level. Families in the Section 8 group who moved lived in neighborhoods with a poverty rate that was 11 percent lower than that of the control group in the average month, and families in the experimental group who moved lived in neighborhoods with a poverty rate that averaged 18 percent lower.

We have previously highlighted the extremely positive health outcomes for adult women who participated in the MTO demonstration; a study in the New England Journal of Medicine in 2013 reports that these women have much lower rates of diabetes and severe obesity after moving to low-poverty neighborhoods. Prior research has also shown that such a move has no effect on employment, earnings, or educational outcomes. The JAMA study, however, raises further questions about how neighborhoods influence outcomes for male youth. Since the HUD-published interim evaluation of the MTO program in 2003, researchers have been puzzled over results showing that moving to a low-poverty neighborhood leads to positive outcomes for female youth but possible negative outcomes for male youth.

The JAMA study uses data collected on youth that averaged 15 years of age at followup,but were an average of 3-years old when their family was offered a voucher to move from a high poverty public housing development to a lower poverty neighborhood with a housing voucher The researchers find the following impacts on mental health for female youth:

• The rate of clinical depression among female youth in both the experimental and Section 8 groups (6.5%) was 40 percent lower than that of the control group (10.9%).
• Female youth in the Section 8 group were 90 percent less likely than those in the control group to report having a conduct disorder (consisting of self-described oppositional defiant disruptive behavior). Female youth in the experimental group were also less likely than those in the control group to report symptoms of conduct disorder, but not at statistically significant levels.

Male youth, on the other hand, showed the opposite effects:

• Male youth in the experimental group were more than twice as likely as those in the control group to experience depression. (Male youth in the Section 8 group also were more likely to experience depression than those in the control group, but not at statistically significant levels.)
• The rate of post-traumatic stress disorder (PTSD) among male youth in the experimental group (6.9%) and Section 8 group (4.9%) were 340 percent and 170 percent higher, respectively, than that of male youth in the control group (1.9%). Differences in PTSD rates among female youth were not significant.
• Male youth in the experimental group experienced conduct disorder at roughly triple the rate of those in the control group, and the rate among male youth in the Section 8 group was nearly double that of the control group.

The MTO demonstration is much better at telling us how neighborhoods affect families than it is at telling us why these effects occur. To better understand the latter, HUD’s Office of Policy Development and Research and others have supported in-depth qualitative interviews with the MTO families.

In a recent issue of Cityscape, Robin Smith and colleagues report on their in-depth interviews with female youth who moved and did not move during the MTO demonstration. Their findings indicate a dramatic reduction in exposure to a sexually coercive environment, which is currently the most likely explanation for the improved mental health outcomes of female youth.

Explaining the mental health outcomes for male youth is somewhat more complex. In 2006, Susan Clampet-Lundquist and colleagues proposed three possible explanations based on their own qualitative interviewing:

• Some of the boys in the experimental group moved back to high-poverty neighborhoods but seemed to lack the conscious strategies for staying out of trouble observed among those in the control group.
• In low-poverty neighborhoods, male youth were more likely than female youth to “hang out” in ways that attracted the negative attention of neighbors and the police.
• Male youth in the control group were much more likely than those in the experimental group to find nonbiological father figures.

Might these possibilities explain the negative mental health outcomes for male youth? We don’t know, but we hope our colleagues in the mental health field will take note of these findings. Perhaps they can offer us some insight that can help us design policies that benefit all youth, male and female alike.

Mark Shroder is Associate Deputy Assistant Secretary for Research, Evaluation, and Monitoring and Todd Richardson is Acting Deputy Assistant Secretary for Policy Development. Together they have been involved with the MTO demonstration since its inception more than 20 years ago.