Indirect effect, through aspects of neighborhood affluence and racial/ethnic composition, of receiving a Section 8 voucher on the prevalence of psychiatric disorders among boys and girls in the Moving to Opportunity study

The Moving to Opportunity (MTO) experiment randomized low-income predominantly Black and Hispanic families in high-poverty neighborhoods to a housing voucher, resulting in moves that changed neighborhood affluence and racial/ethnic composition. Unexpectedly, voucher receipt increased the risk of harmful mental health outcomes among boys but decreased it among girls. Black and Hispanic adolescents aged 10 to 19 years at final follow-up were selected. We estimated natural indirect effects of voucher receipt on past-year: 1) mood disorder, 2) externalizing disorder, and 3) post-traumatic stress disorder (PTSD), through mediators capturing the proportion of time spent in low-poverty census tracts, share of college graduates, Black, and Hispanic residents, stratified by sex. We used a nonparametric, multiply robust estimator. Voucher receipt increased time living in more affluent and slightly less segregated neighborhoods, which was protective against externalizing disorders among boys and girls, and mood disorders among girls. However, among boys, these neighborhood changes explained most of the harmful effect of voucher receipt on mood disorders. We estimated null indirect effects on PTSD among boys and girls. These findings indicate that the mediated effects of voucher receipt through neighborhood poverty and racial/ethnic composition vary by mental health outcome and sex.