Rollins School of Public Health, Atlanta, GA, USA,
J Urban Health. 2014 Apr;91(2):223-41. doi: 10.1007/s11524-013-9844-5.
USA is experiencing a paradigm shift in public housing policy: while policies used to place people who qualified for housing assistance into spatially concentrated housing complexes, they now seek to geographically disperse them, often to voucher-subsidized rental units in the private market. Programs that relocate residents from public housing complexes tend to move them to neighborhoods that are less impoverished and less violent. To date, studies have reached conflicting findings about the relationship between public housing relocations and depression among adult relocaters. The present longitudinal multilevel analysis tests the hypothesis that pre-/postrelocation improvements in local economic conditions, social disorder, and perceived community violence are associated with declines in depressive symptoms in a cohort of African-American adults; active substance misusers were oversampled. We tested this hypothesis in a cohort of 172 adults who were living in one of seven public housing complexes scheduled for relocation and demolition in Atlanta, GA; by design, 20% were dependent on substances and 50% misused substances but were not dependent. Baseline data captured prerelocation characteristics of participants; of the seven census tracts where they lived, three waves of postrelocation data were gathered approximately every 9 months thereafter. Surveys were administered at each wave to assess depressive symptoms measured using the Center for Epidemiologic Studies Depression Scale (CES-D), perceived community violence, and other individual-level covariates. Participants' home addresses were geocoded to census tracts at each wave, and administrative data sources were used to characterize tract-level economic disadvantage and social disorder. Hypotheses were tested using multilevel models. Between waves 1 and 2, participants experienced significant improvements in reported depressive symptoms and perceived community violence and in tract-level economic disadvantage and social disorder; these reductions were sustained across waves 2-4. A 1 standard deviation improvement in economic conditions was associated with a 1-unit reduction in CES-D scores; the magnitude of this relationship did not vary by baseline substance misuse or gender. Reduced perceived community violence also predicted lower CES-D scores. Our objective measure of social disorder was unrelated to depressive symptoms. We found that relocaters who experienced greater pre-/postrelocation improvements in economic conditions or in perceived community violence experienced fewer depressive symptoms. Combined with past research, these findings suggest that relocation initiatives should focus on the quality of the places to which relocaters move; future research should also identify pathways linking pre-/postrelocation changes in place characteristics to changes in mental health.
过去的政策是将有住房补贴资格的人安置在空间集中的住房综合体内，而现在则寻求将他们分散到地理上的地方，通常是私人市场上的代金券补贴租赁单位。将居民从公共住房综合体搬迁的计划往往会将他们转移到贫困程度和暴力程度较低的社区。迄今为止，研究对公共住房搬迁与成年搬迁者抑郁之间的关系得出了相互矛盾的结论。本纵向多层分析检验了这样一个假设，即在当地经济条件、社会混乱和感知社区暴力方面的搬迁前/后改善与亚特兰大 7 个公共住房综合体内的 172 名非裔美国成年人队列中的抑郁症状下降有关；抽样中包括了滥用药物的活跃者。我们在一个队列中测试了这一假设，该队列由居住在佐治亚州亚特兰大市计划搬迁和拆除的 7 个公共住房综合体内的 172 名成年人组成；通过设计，20%的人依赖物质，50%的人滥用物质但不依赖。基线数据捕捉了参与者搬迁前的特征；在他们居住的七个普查区内，在之后的大约 9 个月内收集了三波搬迁后数据。在每一波中都进行了调查，以评估使用流行病学研究中心抑郁量表（CES-D）测量的抑郁症状、感知社区暴力和其他个体水平的协变量。参与者的家庭住址在每一波都被地理编码到普查区，并且使用行政数据源来描述普查区层面的经济劣势和社会混乱。使用多层模型检验了假设。在第 1 波和第 2 波之间，参与者经历了报告的抑郁症状和感知社区暴力以及普查区层面经济劣势和社会混乱的显著改善；这些减少在第 2 波到第 4 波之间持续存在。经济状况改善 1 个标准差与 CES-D 评分降低 1 个单位相关；这种关系的大小不因基线物质滥用或性别而异。减少感知到的社区暴力也预测了 CES-D 评分的降低。我们的客观社会混乱指标与抑郁症状无关。我们发现，经历了更大的搬迁前/后经济条件或感知社区暴力改善的搬迁者经历了更少的抑郁症状。结合过去的研究，这些发现表明，搬迁计划应侧重于搬迁者迁往的地方的质量；未来的研究还应确定将地方特征的搬迁前/后变化与心理健康变化联系起来的途径。
