Moving to opportunity and mental health: Exploring the spatial context of neighborhood effects

Abstract

Studies of housing mobility and neighborhood effects on health often treat neighborhoods as if they were isolated islands. This paper argues that conceptualizing neighborhoods as part of the wider spatial context within which they are embedded may be key in advancing our understanding of the role of local context in the life of urban dwellers. Analyses are based on mental health and neighborhood context measurements taken on over 3,000 low-income families who participated in the Moving to Opportunity for Fair Housing Demonstration Program (MTO), a large field experiment in five major U.S. cities. Results from analyses of two survey waves combined with Census data at different geographic scales indicate that assignment to MTO's experimental condition of neighborhood poverty <10% significantly decreased average exposure to immediate and surrounding neighborhood disadvantage by 97% and 59% of a standard deviation, respectively, relative to the control group. Escaping concentrated disadvantage in either the immediate neighborhood or the surrounding neighborhood, but not both, was insufficient to make a difference for mental health. Instead, the results suggest that improving both the immediate and surrounding neighborhoods significantly benefits mental health. Compared to remaining in concentrated disadvantage in the immediate and surrounding neighborhood, escaping concentrated disadvantage in both the immediate and surrounding neighborhood on average over the study duration as a result of the intervention predicts an increase of 25% of a standard deviation in the composite mental health scores.

Influence of Individual and Contextual Perceptions and of Multiple Neighborhoods on Depression

“…This score can be considered as an alternative approach to analyze the effects of contextual characteristics in the investigation of socio-territorial inequalities in health. However, the contextual effect of the three combined neighborhoods could be improved if the relative time spent within each neighborhood were measured, which would permit a more complete study on the impact of an individual's contextual exposure and his/her risk of depression [58,59]. For future research in this area, one interesting challenge to consider would be to shift towards more dynamic forecasts, by using short-term time scales.…”

Trajectories of Depressive Symptoms and Neighborhood Changes from Adolescence to Adulthood: Latent Class Growth Analysis and Multilevel Growth Curve Models

“…Few studies have examined the effect of changes in neighborhood SES over time on long-term depressive symptoms. Using data from the Moving to Opportunity (MTO) study, Graif et al found that mental health improved for females who moved to low poverty neighborhoods compared to those who did not move or those who moved to a neighborhood of similar SES [19]. It also found that among those who moved to low poverty neighborhoods, both the immediate and surrounding neighborhood-level poverty were key in improving mental health outcomes [19].…”

No man is an Island: spatial clustering and access to primary care as possible targets for the development of new community mental health approaches.

“…Characterization and localization of the patient's residence allows not only to identify clusters, but also to cross-link them with the existing primary and secondary care network, in order to understand their relationship with accessibility to care. [5,16]…”

“…to reside non-randomly [5] and there are, although sometimes weak, correlations with various ecological factors, such as social organization / safety [6], increased urbanicity [7][8][9], or increased need of social support [10 -15].…”