Mental health and prolonged exposure to unaffordable housing: a longitudinal analysis

Perceived Housing Problems and Depressive Symptoms Among Middle-Aged and Older Americans

Housing insecurity has been shown to be associated with worse mental health. However, previous studies mostly examined one aspect of housing insecurity (e.g., affordability), and few focused on older adults. This study examined the relationship between perceived housing problems and depressive symptoms among middle-aged and older Americans. Data from the Health and Retirement Study between 2006 and 2018 were used. A total of 7,119 respondents (aged 50+ at baseline in 2006) were followed up every 4 years. Respondents self-reported the status, severity, and duration of their housing problems. Depressive symptoms were assessed by the Center for Epidemiological Studies-Depression Scale. Mixed-effect models examined the association between perceived housing problems and depressive symptoms. Results show about 5%-7% of respondents had housing problems during every study visit and 5.73% of them experienced persistent housing problems over 12 years. Having housing problems was associated with a higher risk of depressive symptoms (incidence risk ratio = 1.29, 95% CI = 1.23, 1.36). A dose-response relationship was observed in the severity and duration of housing problems, with a greater increase of depressive symptoms risk among those experiencing more severe or prolonged housing problems. The dose-response pattern highlighted the importance of early intervention and persistent assistance to those experiencing housing problems.

Locus of control and the long-term effects of parental smoking on mental health

RATIONALE

Few studies take a life course perspective to explain if exposure to second-hand smoke in childhood influences mental health in adulthood. Importantly, no study provides empirical evidence on the pathways through which exposure to second-hand smoke in childhood influences mental health in adulthood. There is also limited evidence on the factors that moderate the relationship between second-hand smoke exposure and mental health. To inform policy, it is important to explore the pathways through which second-hand smoke influences mental health and understand factors that are likely to moderate this relationship.

OBJECTIVES

The objective of this paper is to examine if exposure to parental smoking in childhood influences mental health in adulthood. The study examines general health and smoking status in later life as potential channels and if locus of control (LoC), a personality trait developed in childhood and adolescence, moderates the relationship between exposure to parental smoking in childhood and mental health in adulthood.

METHODS

Using 21 waves of longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA), the study conducts regression analyses that adjust for the potential effects of confounders and other biases.

RESULTS

The results show that exposure to parental smoking in childhood is associated with a decline in mental health in later life, and that general health status and smoking status in adulthood are channels through which exposure to parental smoking in childhood influences mental health in adulthood. Specifically, those who are exposed to parental smoking in childhood tend to have poorer general health and a higher probability of being smokers in adulthood, both of which negatively impact mental health. The findings point to the moderating role of LoC, such that being more internal on LoC dampens the negative effects of exposure to parental smoking on mental health.

CONCLUSION

The findings from this study lend support to the need to address the long-term implications of behaviours that are harmful to health. The findings also suggest that LoC has implications for an individual's psychological resilience against the negative effects from exposure to parental smoking in childhood.

Disparities in the Quality of Working Life Among Older Workers: Housing Conditions and Life Satisfaction With Latent Class Analysis

Little empirical research informs understanding of the disparate active aging experiences among working older adults, especially in terms of the association with living circumstances and life satisfaction. To address this knowledge gap, this study used latent class analysis on data from the 2020 Health and Retirement Study (HRS) core interview and focused on 1,194 employed adults aged 50 and above. The results revealed four subtypes of the quality of working life in older workers. Notably, in contrast to the other identified classes, higher levels of housing satisfaction and feelings of neighborhood safety were significantly associated with an increased likelihood of being a member of the group of older adults with the highest work capacities and the healthy work-life balance. Furthermore, participation in the class characterized by the highest work capacity and a healthy work-life balance was related to the highest levels of overall life satisfaction.

Does receipt of social housing impact mental health? Results of a quasi-experimental study in the Greater Toronto Area

Affordable housing is commonly described as an important determinant of health, but there are relatively few intervention studies of the effects of housing on health. In this paper, we describe the results of a quasi-experimental, longitudinal study investigating the impacts of receiving social housing among a cohort of 502 people on waitlists for social housing in the Greater Toronto Area, Canada. Specifically, we sought to determine if adults who received housing were more likely than a control group to show improvements in depression, psychological distress, and self-rated mental health 6, 12 and 18 months after moving to housing. Amongst the participants, 137 received social housing and completed at least one follow-up interview; 304 participants did not receive housing and completed at least one follow-up interview and were treated as a control group (47 people provided data to both groups). The difference-in-differences technique was used to estimate the effect of receiving housing by comparing changes in the outcomes over time in the housed (intervention) group and the group that remained on the waitlist for social housing (control group). Adjusted mixed effects linear models showed that receiving housing resulted in significant decreases in psychological distress and self-rated mental health between the groups. Improvements in self-rated mental health between the groups were observed 6, 12 and 18 months after receiving housing (6 months, +2.9, p < 0.05; 12 months, +2.6, p < 0.05; 18 months, +3.0, p < 0.05). Reductions in psychological distress (-1.4, p < 0.05) were observed 12 months after receiving housing. Overall findings suggest that receiving subsidized housing improves mental health over a 6-to-18-month time horizon. This has policy and funding implications suggesting a need to reduce wait times and expand access to subsidized housing.

Housing instability patterns among low-income, urban Black young adults in California and associations with mental health outcomes: baseline data from a randomized waitlist-controlled trial

BACKGROUND

Deep-rooted racial residential segregation and housing discrimination have given rise to housing disparities among low-income Black young adults in the US. Most studies have focused on single dimensions of housing instability, and thus provide a partial view of how Black young adults experience multiple, and perhaps overlapping, experiences of housing instability including homelessness, frequent moves, unaffordability, or evictions. We aimed to illuminate the multiple forms of housing instability that Black young adults contend with and examine relationships between housing instability and mental health outcomes.

METHODS

Using baseline data from the Black Economic Equity Movement (BEEM) guaranteed income trial with 300 urban low-income Black young adults (aged 18-24), we conducted a three-stage latent class analysis using nine housing instability indicators. We identified distinct patterns by using fit indices and theory to determine the optimal number of latent classes. We then used multinomial logistic regression to identify subpopulations disproportionately represented within unstable housing patterns. Finally, we estimated associations between housing experience patterns and mental health outcomes: depression, anxiety, and hope.

RESULTS

We found high prevalence of housing instability with 27.3% of participants reporting experiences of homelessness in the prior year and 39.0% of participants reporting multiple measures of housing instability. We found the 4-class solution to be the best fitting model for the data based on fit indices and theory. Latent classes were characterized as four housing experience patterns: 1) more stably housed, 2) unaffordable and overcrowded housing, 3) mainly unhoused, and 4) multiple dimensions of housing instability. Those experiencing unaffordable and overcrowded housing and being mainly unhoused were more than four times as likely to have symptoms of depression (Unaffordable: aOR = 4.57, 95% CI: 1.64, 12.72; Unhoused: aOR = 4.67, 95% CI:1.18, 18.48) and more than twice as likely to report anxiety (Unaffordable: aOR = 2.28, 95% CI: 1.03, 5.04; Unhoused: aOR = 3.36, 95% CI: 1.12, 10.05) compared to the more stably housed pattern. We found that hope scores were similarly high across patterns.

CONCLUSIONS

High prevalence of housing instability and mental health challenges among low-income Black young adults demands tailored interventions to reduce instability, given widening racial disparities and implications for future well-being into adulthood.

Depression, anxiety, and poor well-being at discharge from psychiatric hospitals: prevalence and risk factors

Background

Being ready for discharge is vital to successful hospital-to-home transitions. For many patients, however, the transition from psychiatric hospital care to outpatient care can be challenging. An in-depth understanding of the mental health conditions of patients at discharge is crucial and instructive for recovery research.

Objective

The purpose of this study was to determine the prevalence and risk factors of depression, anxiety, and poor well-being symptoms among patients who are about to be discharged from psychiatric units in Alberta, Canada. Our aim was to help determine the prevalence of anxiety, depression, and overall well-being among the general psychiatric inpatient population in Alberta before discharge and the potential factors which may influence this.

Methods

This epidemiological study used a cross-sectional quantitative survey from March 8, 2022, to November 5, 2023, to assess depression, anxiety, and well-being. Participants were invited to complete an online questionnaire that contained demographics, clinical information, and responses to the PHQ-9, GAD-7, and WHO-5 questionnaires. SPSS version 25 was used to analyze the data. Descriptive, univariate, and multivariate regression analyses were employed.

Result

The study found that the prevalence of likely depression, anxiety, and poor well-being among patients about to be discharged was 37.1%, 56.4%, and 48.3%, respectively. Based on a logistic regression model, there was a statistically significant association between anxiety, depression, and poor well-being diagnoses and multiple socio-demographic and clinical factors such as ethnicity, primary mental health diagnoses, education level, housing status, depression, anxiety, and well-being at baseline.

Conclusion

Mental health assessment at discharge is a critical step in the recovery and transition of care. There is still a need for further research to identify the underlying causes and robust predictors of mental health symptoms in patients about to be discharged and to provide appropriate interventions and supportive resources both before and following discharge. Future research utilizing these findings may help identify key opportunities to improve outcomes for patients after discharge.

The intersection of health and housing: Analysis of the research portfolios of the National Institutes of Health, Centers for Disease Control and Prevention, and U.S. Department of Housing and Urban Development

BACKGROUND

Housing is a major social determinant of health that affects health status and outcomes across the lifespan.

OBJECTIVES

An interagency portfolio analysis assessed the level of funding invested in "health and housing research" from fiscal years (FY) 2016-2020 across the National Institutes of Health (NIH), the United States Department of Housing and Urban Development (HUD), and the Centers for Disease Control and Prevention (CDC) to characterize the existing health and housing portfolio and identify potential areas for additional research and collaboration.

METHODS/RESULTS

We identified NIH, HUD, and CDC research projects that were relevant to both health and housing and characterized them by housing theme, health topic, population, and study design. We organized the assessment of the individual housing themes by four overarching housing-to-health pathways. From FY 2016-2020, NIH, HUD, and CDC funded 565 health and housing projects combined. The Neighborhood pathway was most common, followed by studies of the Safety and Quality pathway. Studies of the Affordability and Stability pathways were least common. Health topics such as substance use, mental health, and cardiovascular disease were most often studied. Most studies were observational (66%); only a little over one fourth (27%) were intervention studies.

DISCUSSION

This review of the research grant portfolios of three major federal funders of health and housing research in the United States describes the diversity and substantial investment in research at the intersection between housing and health. Analysis of the combined portfolio points to gaps in studies on causal pathways linking housing to health outcomes. The findings highlight the need for research to better understand the causal pathways from housing to health and prevention intervention research, including rigorous evaluation of housing interventions and policies to improve health and well-being.

Housing hardship and maternal mental health among renter households with young children

Maternal mental health is crucial to healthy family functioning and child well-being. Housing hardship may increase risk for mood disorders among mothers of young children in renter households. The present study used latent class analysis to investigate manifestations of housing hardship during the postpartum year in a sample of renter mothers in the United States (N = 2,329), as well as whether housing hardship types were associated with subsequent maternal depression and anxiety. The majority of mothers were relatively stably housed ("Stable"), one in six made do with governmental rental assistance ("Rent-Assisted"), and more than one in ten struggled to afford or maintain stable housing ("Cost-Burdened" or "Housing Insecure"). The most severe housing hardship was associated with the greatest depression risk, whereas the best determinant of anxiety risk was whether rent was paid each month; mothers whose rent was paid with government assistance did not differ on anxiety risk compared to those who paid their rent independently. Findings suggest that different types of housing hardship are linked with distinct mental health sequelae. Widely available housing assistance may reduce cost burden and prevent displacement, with the potential to reduce mental disorder among low-income mothers of young children.

Generational differences in mental health trends in the twenty-first century

Given the observed deterioration in mental health among Australians over the past decade, this study investigates to what extent this differs in people born in different decades-i.e., possible birth cohort differences in the mental health of Australians. Using 20 y of data from a large, nationally representative panel survey (N = 27,572), we find strong evidence that cohort effects are driving the increase in population-level mental ill-health. Deteriorating mental health is particularly pronounced among people born in the 1990s and seen to a lesser extent among the 1980s cohort. There is little evidence that mental health is worsening with age for people born prior to the 1980s. The findings from this study highlight that it is the poorer mental health of Millennials that is driving the apparent deterioration in population-level mental health. Understanding the context and changes in society that have differentially affected younger people may inform efforts to ameliorate this trend and prevent it continuing for emerging cohorts.

The reliability and validity of the TBI-CareQOL system in four diverse caregiver groups

PURPOSE

Establishing the psychometric reliability and validity of new measures is an ongoing process. More work is needed in to confirm the clinical utility of the TBI-CareQOL measurement development system in both an independent cohort of caregivers of traumatic brain injury (TBI), as well as in additional caregiver groups.

METHODS

An independent cohort of caregivers of people with TBI (n = 139), as well as three new diverse caregiver cohorts (n = 19 caregivers of persons with spinal cord injury, n = 21 caregivers for persons with Huntington disease, and n = 30 caregivers for persons with cancer), completed 11 TBI-CareQOL measures (caregiver strain; caregiver-specific anxiety; anxiety; depression; anger; self-efficacy; positive affect and well-being; perceived stress; satisfaction with social roles and activities; fatigue; sleep-related impairment), as well as two additional measures to examine convergent and discriminant validity (PROMIS Global Health; the Caregiver Appraisal Scale).

RESULTS

Findings support the internal consistency reliability (all alphas > 0.70 with the vast majority being > 0.80 across the different cohorts) of the TBI-CareQOL measures. All measures were free of ceiling effects, and the vast majority were also free of floor effects. Convergent validity was supported by moderate to high correlations between the TBI-CareQOL and related measures, while discriminant validity was supported by low correlations between the TBI-CareQOL measures and unrelated constructs.

CONCLUSION

Findings indicate that the TBI-CareQOL measures have clinical utility in caregivers of people with TBI, as well as in other caregiver groups. As such, these measures should be considered as important outcome measures for clinical trials aiming to improve caregiver outcomes.

Housing Supply and How It Is Related to Social Inequalities-Air Pollution, Green Spaces, Crime Levels, and Poor Areas-In Catalonia

We carried out a search of over 12,000 houses offered on the rental market in Catalonia and assessed the possibility of families below the poverty threshold being able to rent these homes. In this regard, we wanted to evaluate whether the economic situation of families is able to influence their social environment, surroundings, and safety. We observed how their economic situation can allow families the possibility of developing a life without exposure to health risks, and how economic constraints result in disadvantages in several areas of life. The results show how families at risk of poverty live in less favourable conditions and experience a widening of different gaps, with current prices leading to a possible poverty trap for the most disadvantaged groups. The higher the percentage of the population below the threshold, the lower the possibility of not being able to rent a house compared to areas with a lower prevalence of population below the threshold. This association was observed both when considering the risk linearly and non-linearly. Linearly, the probability of not renting a house was reduced by 8.36% for each 1% increase in the prevalence of population at risk of extreme poverty. In the second, third and fourth percentage quartiles, the probability of not being able to rent a house decreased by 21.13%, 48.61%, and 57.79%, respectively. In addition, the effect was different inside and outside of metropolitan areas, with the former showing a decrease of 19.05% in the probability of renting a house, whereas outside metropolitan areas the probability increased by 5.70%.

Development of a New Measure of Housing Security: The REDD-CAT Housing Security Measure

BACKGROUND

Housing security is a key social determinant of behavior related to health outcomes.

OBJECTIVE

The purpose of this study was to develop a new patient-reported outcome measure that evaluates aspects of housing security for use in the Re-Engineered Discharge for Diabetes-Computer Adaptive Test (REDD-CAT) measurement system.

DESIGN

Qualitative data, literature reviews, and cross-sectional survey study.

PARTICIPANTS

A total of 225 people with T2DM provided responses to the items in this item pool.

MAIN MEASURES

A new item pool that evaluates important aspects of housing security was developed using stakeholder data from focus groups of persons with T2DM.

KEY RESULTS

For the Housing Affordability scale, factor analysis (both exploratory and confirmatory) supported the retention of six items. Of these items, none exhibited sparse cells or problems with monotonicity; no items were deleted due to low item-adjusted total score correlations. For the six affordability items, a constrained graded response model indicated no items exhibited misfit; thus, all were retained. No items indicated differential item functioning (examined for age, sex, education, race, and socioeconomic status). Thus, the final Affordability item bank comprised six items. A Housing Safety index (three items) and a Home Features index (eight items) were also developed. Reliability (i.e., internal consistency and test-retest reliability) and validity (i.e., convergent, discriminant, and known-groups) of the new measures were also supported.

CONCLUSIONS

The REDD-CAT Housing Security Measure provides a reliable and valid assessment of housing affordability, safety, and home features in people with type 2 diabetes mellitus. Future work is needed to establish the clinical utility of this measure in other clinical populations.

Association of Promoting Housing Affordability and Stability With Improved Health Outcomes: A Systematic Review

IMPORTANCE

Housing insecurity-that is, difficulty with housing affordability and stability-is prevalent and results in increased risk for both homelessness and poor health. However, whether interventions that prevent housing insecurity upstream of homelessness improve health remains uncertain.

OBJECTIVE

To review evidence characterizing associations of primary prevention strategies for housing insecurity with adult physical health, mental health, health-related behaviors, health care use, and health care access.

EVIDENCE REVIEW

Pairs of independent reviewers systematically searched PubMed, Web of Science, EconLit, and the Social Interventions Research and Evaluation Network for quantitative studies published from 2005 to 2021 that evaluated interventions intended to directly improve housing affordability and/or stability either by supporting at-risk households (targeted primary prevention) or by enhancing community-level housing supply and affordability in partnership with the health sector (structural primary prevention). Risk of bias was appraised using validated tools, and the evidence was synthesized using modified Grading of Recommendations Assessment, Development, and Evaluation criteria.

FINDINGS

A total of 26 articles describing 3 randomized trials and 20 observational studies (16 longitudinal designs and 4 cross-sectional quasi-waiting list control designs) were included. Existing interventions have focused primarily on mitigating housing insecurity for the most vulnerable individuals rather than preventing housing insecurity outright. Moderate-certainty evidence was found that eviction moratoriums were associated with reduced COVID-19 cases and deaths. Certainty of evidence was low or very low for health associations of other targeted primary prevention interventions, including emergency rent assistance, legal assistance with waiting list priority for public housing, long-term rent subsidies, and homeownership assistance. No studies evaluated health system-partnered structural primary prevention strategies.

CONCLUSIONS AND RELEVANCE

This systematic review found mixed and mostly low-certainty evidence that interventions that promote housing affordability and stability were associated with improved adult health outcomes. Existing interventions may need to be paired with other efforts to address the structural determinants of health. As health care systems and insurers respond to increasing opportunities to invest in housing as a determinant of health, further research is needed to clarify where along the housing insecurity pathway interventions should focus for the most effective and equitable health impact.

The home environment: influences on the health of young-old and old-old adults in Australia

The physical and societal characteristics of home have been established as important in influencing the health and wellbeing of older adults, yet these have rarely been explored together. There is also limited research into variation across age groups, with older adults often examined as a homogenous group of those 65 years and over. This study advances the knowledge base by using the concept of person–environment (P-E) fit to analyse differences in personal and home environment (physical and societal) characteristics between young-old (65–74 years) and old-old (75 and above) age groups, and to assess how these characteristics influence their self-perceived health. This cross-sectional study draws upon survey data from 1,999 older adult participants from the Australian Housing Conditions Dataset. Descriptive statistics and inferential analysis were used to assess for significant differences between age groups and a binomial logistic regression was utilised to examine influences on health. The analysis found that the factors which influence health varies appreciably between age groups. For the young-old financial strain, being on the fixed-income pension and hypertension were important contributing factors, in contrast for the old-old gender (being male), having depression and the home being modified for disability were key influences. For both age groups heart disease was a contributing factor to perceived health. The results indicate the important contribution to knowledge of incorporating a wide range of person and environment characteristics when exploring P-E fit for older adults. The inclusion of societal aspects, such as financial strain, fixed-income pension, tenure and access to community aged care services when exploring influences on health, arises as a key conclusion of the study. In terms of impact, this research is significant given rising inequalities globally and specifically in the Australian context, the need for policy measures to address income inequality, and its health and social implications for older households.

Trajectories of housing affordability and mental health problems: a population-based cohort study

PURPOSE

With housing costs increasing faster than incomes and a limited supply of social housing options, many households face unaffordable housing. Housing affordability problems may negatively impact mental health; however, longitudinal evidence is limited. This study investigates the association between trajectories of housing affordability problems and mental health.

METHODS

We used data from 30,025 households from Understanding Society, a longitudinal household survey from the UK. Participants spending 30% or more of household income on housing were categorised as facing housing affordability problems. We estimated group-based trajectories of housing affordability problems from 9 waves of data (2009-2019). We used linear regression to calculate the association between the trajectories and mental health problems, as measured by General Health Questionnaire (GHQ) score in Wave 10 (2018-2020).

RESULTS

We found six distinct trajectories of housing affordability problems. Those in the 'stable low' group had a consistently low probability of affordability problems, whilst those in 'high falling' group had a sustained high probability in the earlier waves of the study, subsequently decreasing over time. The adjusted analysis showed that trajectory group membership over the first nine waves of data predicted GHQ score in 2018-2020 (Wave 10). Compared to the 'stable low' group, those in the 'high falling' group had a GHQ score that was 1.06 (95% CI 0.53-1.58) points higher.

CONCLUSION

This study provides evidence that sustained exposure to housing affordability problems is associated with long-term worse mental health, even in the absence of more recent problems.

Housing and health in vulnerable social groups: an overview and bibliometric analysis

Previous studies have confirmed that poor living conditions can lead to a wide range of health problems. However, in the context of the COVID-19 pandemic, vulnerable groups in unstable housing are more susceptible to disease. This study aims to systematically examine the housing and health problems of vulnerable groups using a bibliometric approach to explore how housing causes health problems, types of health illnesses, and coping strategies. It is found that the poor housing mechanism, persistent inequalities, and poor housing environments have a significant impact on the health of vulnerable groups. Therefore, the government must make concerted efforts across all sectors to ensure that the housing and health care needs of vulnerable groups are improved, and that housing security standards and related policies are improved; targeted safety plans are formulated with community as the carrier, taking into account the characteristics of vulnerable groups; and new information technology is widely used to provide medical convenience for vulnerable groups. It is hoped that the research in this paper can arouse social attention to the health of vulnerable groups and improve their health from the perspective of housing, so as to point out the direction for solving the housing health problems of vulnerable groups in the future.

Housing and health: an updated glossary

Recent crises have underscored the importance that housing has in sustaining good health and, equally, its potential to harm health. Considering this and building on Howden-Chapman's early glossary of housing and health and the WHO Housing and Health Guidelines, this paper introduces a range of housing and health-related terms, reflecting almost 20 years of development in the field. It defines key concepts currently used in research, policy and practice to describe housing in relation to health and health inequalities. Definitions are organised by three overarching aspects of housing: affordability (including housing affordability stress (HAS) and fuel poverty), suitability (including condition, accessibility and sustainable housing) and security (including precarious housing and homelessness). Each of these inter-related aspects of housing can be either protective of, or detrimental to, health. This glossary broadens our understanding of the relationship between housing and health to further promote interdisciplinarity and strengthen the nexus between these fields.

Disability, physical activity, and health-related quality of life in Australian adults: An investigation using 19 waves of a longitudinal cohort

Background

Any form of long-term physical or mental impairment might negatively influence health-related quality of life (HRQoL). HRQoL, as an independent concept, covers a wide range of characteristics that includes physical, mental, social, and spiritual functions. People with disabilities are continuously exposed to multiple barriers that deteriorate their HRQoL. It also creates impairment in performing physical activities. However, experts opine regular physical exercise as an intervention to help disabled people. This research aims to investigate the association between disability and physical activity with HRQoL among the adult population in Australia.

Design

A retrospective cohort study.

Methods

This study utilized the most recent 19 waves of data (2002–2020) from the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. Component summary scores such as physical component summary (PCS) and mental component summary (MCS), and SF-6D utility scores were utilized to measure HRQoL. Random-effects GLS regression technique was fitted to estimate the association between disability and physical activity with HRQoL, after adjusting for a range of socio-demographic and health-related characteristics.

Results

Disability was negatively associated with the PCS (-5.95), MCS (-2.70) and SF-6D (-0.060) compared with non-disabled counterparts. However, respondents engaged in the recommended level of physical activity had substantial gain in PCS (b = 0.96), MCS (1.57), and SF-6D (0.021) scores. Besides, the results showed that performing the recommended level of physical activity in the presence of disability has lessen the negative effect of disability/ positive moderating effect of physical activity on PCS, MCS, and SF-6D scores by 1.84 points, 0.82 points, and 0.013 percentage points, respectively.

Conclusion

This study found an inverse association between disability and HRQoL among Australian adults. However, physical activity was associated with improved HRQoL. Therefore, public health interventions, such as the orientation of physical activities, have a higher potential to dwindle the burden regarding HRQoL.

ON WAR, UNCERTAINTY, AND FUTURE: LESSONS LEARNED FROM THE EASTERN PHILOSOPHY

OBJECTIVE

The aim: The paper aims to examine the relationship between uncertainty and plans for the future in traumatic situations such as war, as well as the role of the Eastern philosophy and its practical implications in managing uncertainty.

PATIENTS AND METHODS

Materials and methods: The authors used integrative anthropological approach, interpretive research paradigm, hermeneutical approach along with narrative approach. The data collection was carried out using PubMed, Scopus, Web of Science, Google Scholar databases. Research papers were identified according to search terms "uncertainty", "mental health", "health", "refugee", "anxiety", "depression", "war", "future", "Eastern philosophy", "mindfulness".

CONCLUSION

Conclusions: Bearing a set of negative beliefs about uncertainty and reacting negatively to uncertain and unpredictable situations, individuals fall into a vicious cycle of uncertainty fueled by their fear of uncertainty. Uncertainty takes us to the future that seems threatening or returns us to the world of primordial chaos. In both cases, we are not in the present moment, "here and now". As far as we have no control over the past and future, we feel helpless and experience fear, anxiety, depression. Returning to the present gives us back control over the situation. By expanding the range of possible visions of the future, we stop focusing on the worst-case scenario. By accepting the situation and realizing what is subject to our control and what is not, we learn to comfort uncertainty by elaborating possible futures taking into account both our desires and the current situation. Our thoughts and actions today determine our tomorrow. We cannot overcome uncertainty since it is ontologically predetermined. But we can manage our responses to uncertainty turning to the Eastern philosophy thereby maintaining our mental and physical health and expanding the functional field of human capabilities to achieve freedom and self-realization.

Impact of changes in housing tenure and affordability status on depressive symptoms: Evidence from a longitudinal study

INTRODUCTION

Housing is an important social determinant of health. We investigated effects of changes in housing tenure and affordability on depressive symptoms.

METHODS

Data of 9,956 individuals aged >20 years from the Korea Welfare Panel Study (2015-2020) were analyzed. Housing tenure was categorized as homeowners or tenants. Individuals with housing-related expenditures exceeding 30% of household income were defined as having housing unaffordability. Analyses using generalized estimating equations were conducted to evaluate the relationship between changes in housing tenure and affordability on depressive symptoms measured with the Center for Epidemiologic Studies Depression Scale.

RESULTS

Individuals who became tenants (β = 0.326, p = 0.027) or were persistent tenants (β = 0.542, p<0.001) demonstrated significantly more severe depressive symptoms than persistent homeowners. Individuals with new (β = 0.562, p < 0.001) or consistent housing unaffordability (β = 1.032, p = 0.036) showed increased depressive symptoms compared with those with persistent housing affordability. Depressive symptoms were reduced in new homeowners and those who left housing unaffordability status (β = -0.807, p = 0.031). The interaction between housing tenure and affordability on depressive symptoms differed by age and household composition. Housing tenure at post-retirement age and single-person households were associated with a decrease in depressive symptoms, respectively.

LIMITATIONS

All housing-related factors, especially different domains of housing insecurity including unstable neighborhoods or reasons for moving, have not been identified.

CONCLUSIONS

Changes in housing tenure, affordability, and the two combined were significantly associated with depressive symptoms. Furthermore, the degree of interactive effect varied among age groups and household composition. Housing welfare policies that can stabilize housing tenure and affordability might help prevent depression.

Housing insecurity and sleep among welfare recipients in California

STUDY OBJECTIVES

To estimate the effect of housing insecurity on sleep duration and sleep quality.

METHODS

Using longitudinal data from a sample of 1,046 welfare recipients in the state of California followed from 2015-2016 through 2017-2018, we regressed self-reported measures of sleep duration and sleep quality recorded in 2017-2018 on experiences of housing insecurity in the prior year. We applied propensity score weights to attenuate potential bias from an array of observed covariates, including sleep duration and sleep quality measured prior to experiences with housing insecurity.

RESULTS

Sample members who were unable to make their rent/mortgage payments slept on average 22 fewer minutes a night and had lower quality sleep than those who were able to make their rent/mortgage payments. Sample members who were forced to move because of an inability to make rent/mortgage payments slept on average 32 fewer minutes a night and had lower quality sleep than those who were not forced to move.

CONCLUSIONS

By compromising sleep health, housing insecurity represents a distinct form of stress in the lives of economically-disadvantaged adults, which could also contribute to other health disparities.

Does rental assistance improve mental health? Insights from a longitudinal cohort study

Almost half of renters in the United States are rent-burdened, meaning that they pay more than 30% of their income toward housing costs. Rental assistance through programs administered by the U.S. Department of Housing and Urban Development, alleviates these financial strains for around 5 million households. However, due to budgetary constraints, fewer than one in four eligible households actually receive this assistance and waitlists average two years nationally. Using longitudinal data from a cohort of 400 low-income adults living in New Haven, CT, this paper investigates how access to rental assistance affects mental health through two analytical methods that address selection into rental assistance. First, we performed a cross-sectional analysis to identify how psychological distress differs among those receiving and those on a waitlist for rental assistance. Second, we used a within-person fixed-effects analysis to compare changes in individuals following entry into rental assistance. We find that those receiving rental assistance report significantly less psychological distress than those on waiting lists and that transitions into rental assistance are associated with statistically non-significant decreases in psychological distress. Our findings suggest that expanding rental assistance may be one potential step toward improving the mental health of low-income individuals in the United States.

[Debts, loans and unpaid bills among day patients and inpatients in psychiatric care in Berlin, Germany]

Hintergrund

Bisherige Studien der Allgemeinbevölkerung weisen auf eine Assoziation zwischen psychischen Erkrankungen und verschiedenen Formen finanzieller Schwierigkeiten wie Verschuldung hin.

Ziel der Arbeit

Untersuchung der finanziellen Belastungen und assoziierter Faktoren bei Patient*Innen in (teil-)stationärer psychiatrischer Behandlung.

Material und Methoden

Insgesamt 488 Teilnehmer*Innen einer querschnittlichen Patientenbefragung mittels eines strukturierten Interviews zu soziodemografischen sowie klinischen Variablen in (teil-)stationärer psychiatrischer Behandlung in der psychiatrischen Universitätsklinik der Charité im St. Hedwig, zuständig für einen spezifischen Versorgungsbereich in Berlin, gaben Auskunft zu finanziellen Belastungen.

Ergebnisse

Insgesamt 269 (55,1 %) Teilnehmer*Innen wiesen Schulden, Kredite oder offene Rechnungen auf. Unter den Teilnehmer*Innen, die Auskunft zur Kredit- oder Schuldenhöhe machten (n = 215), wies der größte Teil (47,0 %) Schulden oder Kredite in der Höhe zwischen 1000 und 9999 € auf, gefolgt von 36,3 % mit Schulden/Krediten zwischen 10.000 und 99.999 €. In den Regressionsmodellen hinsichtlich des Vorliegens von Schulden erwiesen sich ein jüngeres Alter und das Vorliegen einer Substanzabhängigkeit als signifikant assoziierte Faktoren. 22,3 % der Befragten wiesen Schulden in Höhe >10.000 € auf und lebten von Sozialleistung, sodass eine Überschuldung angenommen werden könnte.

Diskussion

Finanzielle Belastungen und bestehende Schulden sollten im psychiatrischen Bereich stärker in der Praxis erfragt und beachtet werden. Geeignete Unterstützungsformen sollten entwickelt und evaluiert werden.

Zusatzmaterial online

Die Onlineversion dieses Beitrags (10.1007/s00115-020-01013-9) enthält weitere Infomaterialien. Beitrag und Zusatzmaterial stehen Ihnen auf www.springermedizin.de zur Verfügung. Bitte geben Sie dort den Beitragstitel in die Suche ein, das Zusatzmaterial finden Sie beim Beitrag unter „Ergänzende Inhalte“.