1
|
Portella MJ, González-González I, Jubero M, Trujols J, Pérez V. Depressive-Like Effects of Foreclosing: A Cross-Sectional Study of Hair Cortisol Concentration. Psychopathology 2023; 57:10-17. [PMID: 37331349 DOI: 10.1159/000530706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/12/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Foreclosing and home eviction have been associated with various negative health outcomes, probably due to exposure to such stressful circumstance, but there is no evidence about foreclosure and home eviction to elicit cortisol responses. METHODS Participants who recently had received a court eviction notice were compared to subjects suffering a depressive disorder and to healthy controls in terms of hair cortisol concentrations. RESULTS Subjects under the stressful circumstance of foreclosure and patients with depression showed comparable concentrations in most of the hair segments while healthy subjects displayed the lowest levels of cortisol. CONCLUSION The findings show that foreclosure and home eviction are associated with increased cumulative hair cortisol and with depressive-like symptoms. Foreclosing procedures yielded to maintain high levels of cortisol which may increase the risk to develop major depression.
Collapse
Affiliation(s)
- Maria J Portella
- Mental Health, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Miriam Jubero
- Mental Health, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Joan Trujols
- Mental Health, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Víctor Pérez
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- INAD Parc de Salut Mar, Barcelona, Spain
| |
Collapse
|
2
|
Kim H, Burgard SA. Housing instability and mental health among renters in the michigan recession and recovery study. Public Health 2022; 209:30-35. [PMID: 35780516 PMCID: PMC10470256 DOI: 10.1016/j.puhe.2022.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether housing instability-inclusive of eviction, homelessness, moving in with others, moving for cost reasons, or frequent moves-is associated with mental health among renters in the aftermath of the Great Recession of 2007-09. STUDY DESIGN A panel survey study. METHODS We used data from the Michigan Recession and Recovery Study (2009-10, 2011 and 2013), a population-representative sample of working-aged adults, and logistic regression with propensity score weights to examine the association between housing instability over a year and a half and anxiety attack or depression symptoms at follow-up. RESULTS Respondents with any housing instability were 14 percentage points more likely to have had a recent anxiety attack, and those who had moved for cost reasons were 16 percentage points more likely. Respondents who experienced eviction were significantly more likely to meet criteria for major or minor depression at follow-up, by 13 percentage points. CONCLUSIONS Prior evidence of an association between housing instability and mental health is supported by these findings, which are robust to potential confounders, including financial and life shocks, housing quality, and neighborhood poverty concentration.
Collapse
Affiliation(s)
- H Kim
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA.
| | - S A Burgard
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
3
|
Gold S, Wagner B. Acute care utilization and housing hardships in American children. CHILDREN AND YOUTH SERVICES REVIEW 2022; 136:106447. [PMID: 35342214 PMCID: PMC8955135 DOI: 10.1016/j.childyouth.2022.106447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Millions of families in the United States are economically vulnerable: one shock can lead to hardship. We use data from the Fragile Families and Child Wellbeing Study to examine the association between acute healthcare utilization - emergency room visits or hospitalizations - and subsequent housing hardships, such as being evicted for financial reasons. Further, we explore whether this association differs by who in the family utilized the care and whether perceived social support protects against hardship when these experiences occur. Using lagged dependent variable regression models, we find that families that visited the emergency room or were hospitalized, regardless if it was a child or parent with this experience, were five percentage points more likely to experience any housing hardship than families that did not use acute care. Among families in which a child utilized acute care, perceived social support buffered the impact of using acute care. That perceived social support is associated with a lower likelihood of housing hardship among families that experienced acute care utilization for a child, but not parent, suggests that social support may be able to offset the challenges arising from children's, but not adults', use of acute care. In the face of economic precarity, informal safety nets may be insufficient to reduce the impact of acute care utilization on housing hardships.
Collapse
Affiliation(s)
- Sarah Gold
- Bendheim-Thoman Center for Research on Child Wellbeing, School of Public and International Affairs, Princeton University, Princeton, NJ 08544
| | - Brandon Wagner
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, 63 Holden Hall, Lubbock, TX 79409
| |
Collapse
|
4
|
Vásquez-Vera C, Fernández A, Borrell C. Gender-based inequalities in the effects of housing on health: A critical review. SSM Popul Health 2022; 17:101068. [PMID: 35360438 PMCID: PMC8961216 DOI: 10.1016/j.ssmph.2022.101068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
Gender and its power relations are produced and reproduced in the housing sphere, leading to inequalities in living conditions and, therefore, in gender inequalities in health outcomes. The aim of the study is to review the published literature on gender, housing and health, to critically evaluate the incorporation of the gender perspective, and to incorporate this perspective into the conceptual framework of housing and health. Using the critical review method, we conducted a literature review in MEDLINE, Scopus, WOS and Redalyc, without restriction of publication date, including studies published up to October 2020. We analyzed the gender perspective in health research using the Gender Perspective in Health Research Questionnaire and described the results according to main housing dimensions. Of the 20,988 articles identified, we selected 90 for full-text analysis, of which 18 were included in the feminist research category, 27 in gender-sensitive, 31 in sex difference and 14 did not include any gender perspective. Regarding the association between housing and health, most studies analyzed affordability (36%) and physical conditions (32%), and trends in health outcomes by gender varied according to each exposure analyzed, although overall the effects were worse for women and non-binary or trans people. To date, very few studies consider the gender perspective. It is urgent to address gender relations in housing and health studies, and to open an interdisciplinary and intersectoral agenda to address this complex relationship.
Collapse
|
5
|
De PK, Segura-Escano R. Drinking during downturn: New evidence from the housing market fluctuations in the United States during the Great Recession. ECONOMICS AND HUMAN BIOLOGY 2021; 43:101070. [PMID: 34700198 DOI: 10.1016/j.ehb.2021.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
We investigate how the decline in home prices over the Great Recession in the U.S. impacted drinking behavior. We match data on actual and shadow home prices (from Zillow Research) to individuals' drinking behavior from the Behavioral Risk Factor Surveillance System (BRFSS) by county of residence and year/month of the interview. We improve upon the existing literature by using new measures of exogenous macroeconomic shocks captured by fluctuations in home prices and finding heterogeneous impacts of the downturn based on homeownership. We find that decline in home prices is commonly associated with increases in alcohol consumption, both on extensive and intensive margins. Additionally, we find that the effects are more consistent among homeowners compared to renters. Given that alcohol consumption is one of the leading causes of death in the U.S. and that the COVID-19 pandemic has triggered an economic crisis in many societies, the results have important public health implications.
Collapse
Affiliation(s)
- Prabal K De
- Department of Economics, Colin Powell School at City College and The Graduate Center, City University of New York, New York, New York, USA; The Graduate Center, City University of New York, 365 5th Ave, New York, NY 10016, USA.
| | - Raul Segura-Escano
- The Graduate Center, City University of New York, 365 5th Ave, New York, NY 10016, USA.
| |
Collapse
|
6
|
Evans M. The unequal housing and neighborhood outcomes of displaced movers. JOURNAL OF URBAN AFFAIRS 2021; 43:1214-1234. [PMID: 34916734 PMCID: PMC8673713 DOI: 10.1080/07352166.2020.1730697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Involuntary housing displacement is a stress-inducing life event that can cause and exacerbate both psychological and material hardship. Forced moves may invoke a disattainment process, whereby displaced movers move into lower quality housing and neighborhoods, placing them in a precarious housing position. Employing propensity score analyses, this study uses data from the recent mover module of the American Housing Survey to match recent movers whose moves were voluntary to recent movers whose moves were forced. Results show that moves caused by displacement compared to voluntary moves generally lead to worse housing and neighborhood outcomes. However, these results are dependent on the type of displacement experienced. Movers forced to leave their homes due to eviction move into worse housing and neighborhoods while forced moves caused by private action and foreclosure do not. Meanwhile, forced moves caused by natural hazards or government action result in worse housing, but not neighborhoods.
Collapse
|
7
|
Reece J. More Than Shelter: Housing for Urban Maternal and Infant Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3331. [PMID: 33805125 PMCID: PMC8037986 DOI: 10.3390/ijerph18073331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 11/28/2022]
Abstract
Housing quality, stability, and affordability have a direct relationship to socioemotional and physical health. Both city planning and public health have long recognized the role of housing in health, but the complexity of this relationship in regard to infant and maternal health is less understood. Focusing on literature specifically relevant to U.S. metropolitan areas, I conduct a multidisciplinary literature review to understand the influence of housing factors and interventions that impact infant and maternal health. The paper seeks to achieve three primary goals. First, to identify the primary "pathways" by which housing influences infant and maternal health. Second, the review focuses on the role and influence of historical housing discrimination on maternal health outcomes. Third, the review identifies emergent practice-based housing interventions in planning and public health practice to support infant and maternal health. The literature suggests that the impact of housing on infant health is complex, multifaceted, and intergenerational. Historical housing discrimination also directly impacts contemporary infant and maternal health outcomes. Policy interventions to support infant health through housing are just emerging but demonstrate promising outcomes. Structural barriers to housing affordability in the United States will require new resources to foster greater collaboration between the housing and the health sectors.
Collapse
Affiliation(s)
- Jason Reece
- Knowlton School of Architecture, Faculty Affiliate, The Kirwan Institute for the Study of Race & Ethnicity, The Ohio State University, 275 West Woodruff Avenue, Columbus, OH 43210, USA
| |
Collapse
|
8
|
Kauffman K, Horvat Davey C, Dolata J, Figueroa M, Gunzler D, Huml A, Pencak J, Sajatovic M, Sehgal AR. Changes in Self-Reported Depressive Symptoms Among Adults in the United States From 2005 to 2016. J Am Psychiatr Nurses Assoc 2021; 27:148-155. [PMID: 32052677 PMCID: PMC7423721 DOI: 10.1177/1078390320906194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: This study examined interview data from the National Health and Nutrition Examination Survey from 2005 to 2016. AIM: To determine national trends in self-reported depressive symptoms. METHOD: Depressive symptoms were assessed using self-reported data on the nine-item Patient Health Questionnaire (PHQ-9), with a total score ≥10 and an individual item score of 2 or 3, indicating greater severity. RESULTS: A total of 31,191 individuals contributed PHQ-9 data from 2005 to 2016. The absolute proportion of individuals with total PHQ-9 score ≥10 increased from 6.2% to 8.1%. After adjustment for participant demographic characteristics and comorbid conditions, the odds ratio for high PHQ-9 score at the end versus the beginning of the study interval was 1.27 (95% confidence interval [CI: 1.07, 1.50]). Anhedonia, guilt/worthlessness, appetite, and hypoactivity/hyperactivity had the largest increases in individual item risk after adjusting for demographic and comorbid characteristics. CONCLUSIONS: There were sizeable increases in the prevalence of self-reported depressive symptoms in the United States over an 11-year period. Further work is needed to understand the reasons for and implications of this increase. However, the results suggest greater efforts should be made by health care providers to screen for depressive symptoms that may warrant further assessment, treatment, or referral to mental health services as needed.
Collapse
Affiliation(s)
- Kelley Kauffman
- Kelley Kauffman, MSN, APRN-CNP, PMHNP-BC, Center for Reducing Health Disparities, Cleveland, OH, USA
| | - Christine Horvat Davey
- Christine Horvat Davey, PhD, BSPS, RN, Case Western Reserve University, Cleveland, OH, USA
| | - Jacqueline Dolata
- Jacqueline Dolata, MBA, Center for Reducing Health Disparities, Cleveland, OH, USA
| | - Maria Figueroa
- Maria Figueroa, Center for Reducing Health Disparities, Cleveland, OH, USA
| | - Douglas Gunzler
- Douglas Gunzler, PhD, Center for Health Care Research & Policy, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - Anne Huml
- Anne Huml, MD, Center for Reducing Health Disparities, Cleveland, OH, USA
| | - Julie Pencak
- Julie Pencak, Center for Reducing Health Disparities, Cleveland, OH, USA
| | - Martha Sajatovic
- Martha Sajatovic, MD, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ashwini R Sehgal
- Ashwini R. Sehgal, MD, Center for Reducing Health Disparities, Cleveland, OH, USA
| |
Collapse
|
9
|
Musa GJ, Cheslack-Postava K, Svob C, Hernández D, Tang H, Duque-Villa Y, Keating W, Amsel L, Bresnahan M, Ryan M, Baccarelli AA, Prada D, Huang-Chiang P, Jardines C, Geronazzo-Alman L, Goodwin RD, Wicks J, Hoven CW. Mental Health of High-Risk Urban Youth: The Housing Subsidies Paradox. RACE AND SOCIAL PROBLEMS 2021; 13:22-33. [PMID: 34149954 PMCID: PMC8211093 DOI: 10.1007/s12552-021-09322-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 06/12/2023]
Abstract
Housing subsidies, including public housing and Section 8 vouchers, are key components of the social safety net, intended to promote family and child welfare. Studies evaluating the impact of housing subsidies on child and adolescent mental health, however, are generally inconclusive. This may reflect variation in the influence by type of subsidies to income, improved physical environment, increased access to resources, and improved perception of neighborhood safety. Further, most prior research focused on housing subsidies failed to simultaneously formally assess child psychopathology. In the present study, we examine, among adolescents (ages 9-17) from a low-income, urban minority area, the association of housing with psychiatric symptoms and disorders, as well as with their social functioning. The data were obtained from the Stress & Justice Study (S&J) baseline survey, an investigation designed to examine impact of parental criminal justice system involvement (CJSI) on their children's mental health. Housing type during the past year was categorized from parental report as public housing, section 8, both, or neither. Child mental health was assessed with the Diagnostic Interview Schedule for Children (DISC). Additionally, family resources and physical quality of the housing environment by housing type was assessed, and we tested whether these dimensions mediated associations of housing type with the adolescent's current mental health outcomes. We found that while internalizing and externalizing disorders and impairment were attenuated by individual characteristics (e.g., SES, CJSI), internalizing and externalizing symptom counts were significantly more prevalent among children in subsidized housing, compared to those in non-subsidized housing, after controlling for individual characteristics. These findings have the potential to inform whether, and through which mechanisms, housing subsidies are associated with adolescent mental health.
Collapse
Affiliation(s)
- George J. Musa
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Keely Cheslack-Postava
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - Connie Svob
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - Diana Hernández
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Huilan Tang
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - Yuly Duque-Villa
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - William Keating
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - Lawrence Amsel
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - Michaeline Bresnahan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Megan Ryan
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - Andrea A. Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
| | - Diddier Prada
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, USA
- Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Po Huang-Chiang
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
- National Health Research Institute, Taipei, Taiwan, R.O.C
| | - Christopher Jardines
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - Lupo Geronazzo-Alman
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, USA
| | - Judith Wicks
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
| | - Christina W. Hoven
- Global Psychiatric Epidemiology Group, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University-New York State Psychiatric Institute, room 5217, 1051 Riverside Drive, New York, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| |
Collapse
|
10
|
Henry ML, Lichtman JH, Hanlon K, Keene DE. Clinical management of Type II Diabetes among the unstably housed: a qualitative study of primary care physicians. Fam Pract 2020; 37:418-423. [PMID: 31781768 PMCID: PMC7377290 DOI: 10.1093/fampra/cmz085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Housing is a growing challenge for US adults in an increasingly unaffordable housing market. These housing challenges can create barriers to effective management and control of Type II Diabetes. However, little is known about how housing challenges are perceived and navigated by clinicians who care for patients with Type II Diabetes. OBJECTIVE To examine how primary care clinicians perceive and navigate their patients' housing challenges in the context of Type II Diabetes management. METHODS We conducted semi-structured interviews with 18 primary care clinicians practising in four clinical settings in New Haven, Connecticut. Two investigators systematically coded the interviews. Analysis of coded data was used to determine themes. RESULTS Participants considered housing as significant to their patients' health and a potential barrier to optimal diabetes management. Participants sought to improve their patients' housing through advocacy, referrals and interdisciplinary collaborations. They also adjusted clinical decisions to adapt to patients' housing challenges. In making clinical adjustments, participants struggled to find a balance between what they perceived to be feasible for unstably housed patients and maintaining a standard of care. Some participants navigated this balanced by employing creative strategies and individualized care. CONCLUSION In highlighting the challenges that clinicians face in maintaining a standard of care for unstably housed diabetes patients, our findings speak to the need for more guidance, resources and support to address housing in a clinical setting.
Collapse
Affiliation(s)
- Mariana L Henry
- Department of Chronic Disease Epidemiology, New Haven, CT, USA
| | | | - Kendra Hanlon
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| |
Collapse
|
11
|
Damon W, McNeil R, Milloy MJ, Nosova E, Kerr T, Hayashi K. Residential eviction predicts initiation of or relapse into crystal methamphetamine use among people who inject drugs: a prospective cohort study. J Public Health (Oxf) 2020; 41:36-45. [PMID: 29425315 DOI: 10.1093/pubmed/fdx187] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 11/30/2017] [Accepted: 12/20/2017] [Indexed: 02/03/2023] Open
Abstract
Reports of increasing methamphetamine use among vulnerable populations may be attributed in part to the adaptive use of stimulants in response to the loss of stable housing through residential eviction. We employed multivariable recurrent event extended Cox regression to examine the independent association between recent evictions and initiation of or relapse into crystal methamphetamine use among people who inject drugs in Vancouver, Canada enrolled in two prospective cohort studies. In a multivariable analysis, eviction remained independently associated with methamphetamine initiation or relapse (adjusted hazard ratio = 1.90; 95% confidence interval: 1.31-2.75). Findings demonstrate the need to secure tenancies for drug-using populations to reduce harms.
Collapse
Affiliation(s)
- William Damon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Ryan McNeil
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Ekaterina Nosova
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada.,Faculty of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, British Columbia, Canada.,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada
| |
Collapse
|
12
|
Risk of suicide in households threatened with eviction: the role of banks and social support. BMC Public Health 2019; 19:1250. [PMID: 31510963 PMCID: PMC6737669 DOI: 10.1186/s12889-019-7548-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background One of the greatest effects of the financial crisis in Spain has been the enormous increase in the number of evictions. Several studies have shown the association of evictions with different aspects of the physical and mental health. Furthermore, evictions have been associated with an increased risk of suicide. Our objective was to evaluate the risk of suicide among victims of eviction and investigate whether it is associated with specific characteristics of households and interviewees, the eviction process and social support, and health needs. Methods A total of 205 participants from households threatened with eviction in Granada, Spain, and 673 being the total number of members of these households, were interviewed in one-on-one sessions between April 2013 and May 2014. Through a questionnaire, information was obtained on physical and mental health, characteristics of their eviction process and support networks, and the use of health services. Results Almost half of the sample (46.7%) were at low (11.8%), moderate (16.9%), or high suicide risk (17.9%). Household and interviewee features had a limited association with suicide risk. On the contrary, the risk of suicide is greater with a longer exposure to the eviction process. In addition, threatening phone calls from banks increased significantly the risk of suicide, especially among men. Suicide risk was also associated with low social support, especially among women. Interviewees at risk of suicide received more help from nongovernmental organizations than those who were not at risk. In interviewees at risk, the main unmet needs were emotional and psychological help, especially in men. A high percentage of those at risk of suicide declare having large unmeet health needs. Finally, there was a tendency among the evicted at risk of suicide to visit emergency room and primary care more often than those not at risk, especially among women. Conclusions To our knowledge, this is the first study showing that when banks adopt a threatening attitude, suicide risk increases among the evicted. As hypothesized, when the evicted felt socially supported, suicide risk decreased. Emotional help was the main mediator of suicide risk and the main unmet need, especially among men.
Collapse
|
13
|
Associations between Home Foreclosure and Health Outcomes in a Spanish City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060981. [PMID: 30893804 PMCID: PMC6466329 DOI: 10.3390/ijerph16060981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/17/2019] [Accepted: 03/17/2019] [Indexed: 11/16/2022]
Abstract
The financial crisis has caused an exponential increase of home foreclosures in Spain. Recent studies have shown the effects that foreclosures have on mental and physical health. This study explores these effects on a sample of adults in the city of Granada (Spain), in terms of socio-demographic, socio-economic and process characteristics. A cross-sectional survey was administered to obtain information on self-perceived changes in several indicators of physical and mental health, consumption of medications, health-related behaviors and use of health services. A total of 205 persons, going through a foreclosure process, participated in the study. 85.7% of the sample reported an increase of episodes of anxiety, depression, and stress; 82.6% sleep disturbances; 42.8% worsening of previous chronic conditions, and 40.8% an increase in consumption of medication. Women, married persons and persons already in the legal stage of the foreclosure process reported higher probability of worsening health according to several indicators, in comparison with men, not married, and individuals in the initial stages of the foreclosure process. The results of this study reveal a general deterioration of health associated with the foreclosure process. These results may help to identify factors to prevent poor health among populations going through a foreclosure process.
Collapse
|
14
|
Eboh RN, Giurgescu C, Misra DP. Relationship With the Father of the Baby and Perceived Stress Among Black Women. MCN Am J Matern Child Nurs 2019; 43:259-264. [PMID: 29944477 PMCID: PMC6118217 DOI: 10.1097/nmc.0000000000000459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine whether the relationship with the father of the baby was related to psychological stress among Black women. METHODS This is a secondary analysis of data derived from a retrospective cohort study of 1,410 Black new mothers participating in the Life-course Influences on Fetal Environments (LIFE) study conducted in the Detroit Metropolitan area. Data were obtained from maternal interview and medical records abstraction. Perceived stress was measured by the Cohen's Perceived Stress Scale. The mother's relationship with the father of the baby before and after pregnancy was measured using two questions. RESULTS Women who reported sometimes close/sometimes distant relationship with the father of the baby prior to pregnancy had higher levels of perceived stress compared with women who reported close relationship with the father of the baby prior to pregnancy (38.73 and 35.10, respectively, p < .001). Women who reported current distant relationship (38.82 and 34.45, respectively, p < .001) and sometimes close/sometimes distant relationship (38.83 and 34.45, respectively, p < .001) reported higher levels of perceived stress compared with women who had current close relationship with the father of the baby. CLINICAL IMPLICATIONS Women who reported to have a close relationship with the father of the baby before and during the pregnancy reported lower levels of stress compared with women with a distant relationship with the father of the baby. Nurses should assess women's relationship with the father of the baby and their levels of stress.
Collapse
Affiliation(s)
- Relicious N Eboh
- Relicious N. Eboh is an undergraduate student, ReBUILDetroit Scholar, Department of Biology, University of Detroit Mercy, Detroit, MI. Carmen Giurgescu is an Associate Professor, College of Nursing, The Ohio State University, Columbus, OH. The author can be reached via e-mail at Dawn P. Misra is a Professor, Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI
| | | | | |
Collapse
|
15
|
Weinberger AH, Gbedemah M, Martinez AM, Nash D, Galea S, Goodwin RD. Trends in depression prevalence in the USA from 2005 to 2015: widening disparities in vulnerable groups. Psychol Med 2018; 48:1308-1315. [PMID: 29021005 DOI: 10.1017/s0033291717002781] [Citation(s) in RCA: 332] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Major depression is associated with significant disability, morbidity, and mortality. The current study estimated trends in the prevalence of major depression in the US population from 2005 to 2015 overall and by demographic subgroups. METHODS Data were drawn from the National Survey on Drug Use and Health (NSDUH), an annual cross-sectional study of US persons ages 12 and over (total analytic sample N = 607 520). Past-year depression prevalence was examined annually among respondents from 2005 to 2015. Time trends in depression prevalence stratified by survey year were tested using logistic regression. Data were re-analyzed stratified by age, gender, race/ethnicity, income, and education. RESULTS Depression prevalence increased significantly in the USA from 2005 to 2015, before and after controlling for demographics. Increases in depression were significant for the youngest and oldest age groups, men, and women, Non-Hispanic White persons, the lowest income group, and the highest education and income groups. A significant year × demographic interaction was found for age. The rate of increase in depression was significantly more rapid among youth relative to all older age groups. CONCLUSIONS The prevalence of depression increased significantly in the USA from 2005 to 2015. The rate of increase in depression among youth was significantly more rapid relative to older groups. Further research into understanding the macro level, micro level, and individual factors that are contributing to the increase in depression, including factors specific to demographic subgroups, would help to direct public health prevention and intervention efforts.
Collapse
Affiliation(s)
- A H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University,Bronx, NY,USA
| | - M Gbedemah
- Department of Epidemiology and Biostatistics,CUNY School of Public Health,New York, NY,USA
| | - A M Martinez
- Department of Epidemiology,Mailman School of Public Health, Columbia University,New York, NY,USA
| | - D Nash
- Department of Epidemiology and Biostatistics,CUNY School of Public Health,New York, NY,USA
| | - S Galea
- Department of Epidemiology,Boston University School of Public Health,Boston, MA, NY,USA
| | - R D Goodwin
- Department of Epidemiology and Biostatistics,CUNY School of Public Health,New York, NY,USA
| |
Collapse
|
16
|
Keene DE, Guo M, Murillo S. "That wasn't really a place to worry about diabetes": Housing access and diabetes self-management among low-income adults. Soc Sci Med 2018; 197:71-77. [PMID: 29222997 PMCID: PMC5771430 DOI: 10.1016/j.socscimed.2017.11.051] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/21/2017] [Accepted: 11/27/2017] [Indexed: 12/29/2022]
Abstract
Lack of affordable housing access represents a significant and growing problem for low-income households in the United States and these housing challenges may present barriers to the management of chronic diseases such as type 2 diabetes. In this qualitative study, we examined how both housing challenges and housing resources shaped diabetes self-management behaviors. We conducted semi-structured interviews with 40 low-income residents of one US city, New Haven, Connecticut, who had a diagnosis of type 2 diabetes and either resided in or qualified for subsidized housing. We purposively constructed our sample to include a range of housing experiences (subsidized, unsubsidized, homeless) and treatment regimes. We analyzed the data using grounded theory techniques of inductive coding and memo writing. Our findings suggest multiple ways that housing access can affect diabetes self-management with implications for blood glucose levels and future complications. Specifically, we describe the ways that housing access affected participants' ability to: 1) prioritize their diabetes care, 2) establish and maintain diabetes routines, and 3) afford diabetes-related expenses. Together, our findings show how housing challenges increased the cost of adherence to diabetes management regimes such that inadequately housed individuals had to both invest and sacrifice more for the same outcomes. Our findings suggest that improved affordable housing access may represent an opportunity to improve outcomes and reduce socioeconomic disparities among those living with type 2 diabetes.
Collapse
|
17
|
Post-Traumatic Stress Disorder Symptomatology in People affected by Home Eviction in Spain. SPANISH JOURNAL OF PSYCHOLOGY 2017; 20:E57. [PMID: 29076802 DOI: 10.1017/sjp.2017.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Despite the higher proportion of foreclosures and home evictions executed in Spain, compared to other countries, and the known link between social exclusion and mental health problems, studies exploring this association in Spain remain scarce. This study investigated the link between the process of home eviction and the appearance of symptomatology of post-traumatic stress disorder (PTSD), anxiety, depression, and perceived stress. Two hundred and five people affected by the process of home eviction were assessed using a structured interview that included three validated assessment instruments for PTSD, perceived stress, anxiety and depression. Analysis involved comparison with the normative groups that formed the validation studies together with regression analysis to determine the major psychological and socio-demographic predictors of perceived stress. Of the participants, 95.1% reported that they were experiencing the process of home eviction with fear, helplessness, or horror. In PTSD symptomatology, they scored higher than the normative PTSD group in symptoms of avoidance (t = 5.01; p < .05), activation (t = 5.48; p < .01), and total score (t = 4.15; p < .05). Of this subgroup, 72.5% fulfilled the DSM-IV symptom criteria for PTSD. The major predictor of perceived stress was PTSD symptomatology (B = .09; p < .001). The process of home eviction in Spain is having an alarming impact on mental health of affected people calling for effective measures to provide psychological and social support.
Collapse
|
18
|
Pool LR, Needham BL, Burgard SA, Elliott MR, de Leon CFM. Negative wealth shock and short-term changes in depressive symptoms and medication adherence among late middle-aged adults. J Epidemiol Community Health 2017; 71:758-763. [PMID: 28416571 DOI: 10.1136/jech-2016-208347] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/01/2017] [Accepted: 03/27/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Experiencing a negative wealth shock in late middle age may cause high levels of stress and induce reductions in health-related consumption. METHODS We used data on late middle age individuals (51-64 years) from the longitudinal US-based Health and Retirement Study (N=19 281) to examine the relationship between negative wealth shock and short-term outcomes that serve as markers of the pathways from wealth shock to health: elevated depressive symptoms, as a marker of the stress pathway and cost-related medication non-adherence (CRN), as a marker of the consumption pathway. Negative wealth shock was considered to be a loss of total net worth of 75% or more. RESULTS Using a nested cross-over approach-a within-person design among exposed individuals only that adjusts by design for all time-invariant individual characteristics-we found that negative wealth shock was significantly associated with increased odds of elevated depressive symptoms (OR=1.50, CI 1.10 to 2.05), but was not significantly associated with higher odds of CRN (OR=1.18, CI 0.76 to 1.82), even after further adjustment for time-varying sociodemographic and health covariates. CONCLUSIONS Negative wealth shock during late middle age confers an increased risk of elevated depressive symptoms, but does not change levels of CRN. Personal and policy factors that may buffer the mental health risks of negative wealth shock, such as social support and social welfare policy, should be considered.
Collapse
Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Belinda L Needham
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah A Burgard
- Departments of Sociology and Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael R Elliott
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
19
|
Houle JN, Light MT. The harder they fall? Sex and race/ethnic specific suicide rates in the U.S. foreclosure crisis. Soc Sci Med 2017; 180:114-124. [PMID: 28343110 PMCID: PMC6076432 DOI: 10.1016/j.socscimed.2017.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 11/22/2022]
Abstract
Previous work shows suicide rates increase during economic recessions, but little research has examined the extent to which the foreclosure crisis-a unique aspect of the Great Recession-has contributed to disparities in rising suicide rates by race and sex. We develop and test two competing hypotheses regarding the association between foreclosures and race by sex specific suicide rates. We link foreclosure data (RealtyTrac) and suicide data (CDC) from 174 metropolitan areas from 2005 to 2010 (1044 MSA-year observations) and find that-net of time invariant unobserved between-metro area differences, national time trends, and time-varying confounders-a rise in the foreclosure rate is associated with a marginal increase in suicide, but this main effect masks considerable heterogeneity across groups. The association is particularly strong for white males, and weaker or non-existent for other race by sex groups.
Collapse
|
20
|
Isabel RP, Miguel RB, Antonio RG, Oscar MG. Economic crisis and suicides in Spain. Socio-demographic and regional variability. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:313-320. [PMID: 26935181 DOI: 10.1007/s10198-016-0774-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 02/16/2016] [Indexed: 05/28/2023]
Abstract
BACKGROUND Evidence from previous recessions suggests that at times of economic deterioration, suicides increase. Spain has been one of the European countries hardest hit by the financial crisis that started in 2008. The aim of this paper is to examine the impact of the double-dip recession in Spain on the most recent trends in suicide. METHODS Suicide data from the years 2002-2012 were obtained from the 'Death Statistic according to Cause of Death' of the National Statistics Institute (NSI). Population figures were obtained from the population estimates of the NSI. RESULTS While the suicide rate decreased between 2002 and 2012, the downward trend has reversed twice, in 2008-2009, and in 2012. This rise was particularly pronounced in males, with the rate ratio of 1.12 (95 % CI 1.05-1.20) in 2008 and 1.10 (95 % CI 1.03-1.18) in 2009. Following a decrease in 2010 and 2011, suicides among males have increased again in 2012-with RR of 1.10 (95 % CI 1.03-1.18) compared to 2007, however the difference between 2011 amounted to 14 % rise-the biggest interannual change in a decade. There was a similar but less pronounced pattern in females. Regional data showed variable results. CONCLUSIONS These results suggest that the Spanish economic crisis has been associated with suicide rates in 2008, 2009, and 2012. These findings are consistent with the double-dip recession that Spain experienced.
Collapse
Affiliation(s)
- Ruiz-Perez Isabel
- Escuela Andaluza de Salud Publica, Granada, Granada, Spain.
- CIBER de Epidemiologia y Salud Publica (CIBERESP), Granada, Granada, Spain.
| | | | | | | |
Collapse
|
21
|
Desmond M, Gershenson C. Who gets evicted? Assessing individual, neighborhood, and network factors. SOCIAL SCIENCE RESEARCH 2017; 62:362-377. [PMID: 28126112 DOI: 10.1016/j.ssresearch.2016.08.017] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/30/2016] [Accepted: 08/31/2016] [Indexed: 06/06/2023]
Abstract
The prevalence and consequences of eviction have transformed the lived experience of urban poverty in America, yet little is known about why some families avoid eviction while others do not. Applying discrete hazard models to a unique dataset of renters, this study empirically evaluates individual, neighborhood, and social network characteristics that explain disparities in displacement from housing. Family size, job loss, neighborhood crime and eviction rates, and network disadvantage are identified as significant and robust predictors of eviction, net of missed rental payments and other relevant factors. This study advances urban sociology and inequality research and informs policy interventions designed to prevent eviction and stem its consequences.
Collapse
Affiliation(s)
- Matthew Desmond
- Harvard University, William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, USA.
| | - Carl Gershenson
- Harvard University, William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, USA
| |
Collapse
|
22
|
Christine PJ, Moore K, Crawford ND, Barrientos-Gutierrez T, Sánchez BN, Seeman T, Diez Roux AV. Exposure to Neighborhood Foreclosures and Changes in Cardiometabolic Health: Results From MESA. Am J Epidemiol 2017; 185:106-114. [PMID: 27986705 DOI: 10.1093/aje/kww186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 04/11/2016] [Indexed: 11/12/2022] Open
Abstract
Home foreclosures can precipitate declines in health among the individuals who lost their homes. Whether home foreclosures can "spillover" to affect the health of other neighborhood residents is largely unknown. Using longitudinal data from the Multi-Ethnic Study of Atherosclerosis that were linked to foreclosure data from 2005 to 2012, we assessed whether greater exposure to neighborhood foreclosures was associated with temporal changes in 3 objectively measured cardiometabolic risk factors: body mass index, systolic blood pressure, and fasting glucose level. We used fixed-effects models to estimate mean changes in cardiometabolic risk factors associated with changes in neighborhood foreclosures over time. In models in which we controlled for time-varying income, working status, medication use, neighborhood poverty, neighborhood unemployment, and interactions of age, sex, race, and state foreclosure laws with time, a standard-deviation increase in neighborhood foreclosures (1.9 foreclosures per quarter mile) was associated with increases in fasting glucose (mean = 0.22 mg/dL, 95% confidence interval: -0.05, 0.50) and decreases in blood pressure (mean = -0.27 mm Hg, 95% confidence interval: -0.49, -0.04). Changes in neighborhood foreclosure rates were not associated with changes in body mass index. Overall, greater exposure to neighborhood foreclosures had mixed associations with cardiometabolic risk factors over time. Given the millions of mortgages still in default, further research clarifying the potential health effects of neighborhood foreclosures is needed.
Collapse
|
23
|
Daponte Codina A, Mateo Rodríguez I, Vásquez-Vera H. [Evictions and health, a response from the public health in Spain is needed]. GACETA SANITARIA 2016; 30:239-41. [PMID: 27184757 DOI: 10.1016/j.gaceta.2016.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Antonio Daponte Codina
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Granada, España.
| | - Inmaculada Mateo Rodríguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Granada, España
| | - Hugo Vásquez-Vera
- Agència de Salut Pública de Barcelona, Barcelona, España; Universitat Pompeu Fabra, Barcelona, España; Centro de Estudios para la Equidad en Salud, Universidad de La Frontera, Chile
| |
Collapse
|
24
|
Vásquez-Vera H, Rodríguez-Sanz M, Palència L, Borrell C. Foreclosure and Health in Southern Europe: Results from the Platform for People Affected by Mortgages. J Urban Health 2016; 93:312-30. [PMID: 26940706 PMCID: PMC4835360 DOI: 10.1007/s11524-016-0030-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Housing instability has been shown to be related to poorer health outcomes in various studies, mainly in the USA and UK. Affected individuals are more prone to psychiatric (e.g., major depression, anxiety) and physical disorders (e.g., hypertension). This situation has deteriorated with the onset of the economic crisis. One of the most affected countries is Spain, which has high rates of foreclosure and eviction that continue to rise. In response, a civil movement, The Platform for People Affected by Mortgages (PAH), works to provide solutions to its members affected by foreclosure and advocates for the right to decent housing. The aims of this study ware to describe and compare the health status of PAH members from Catalonia to a sample of the general population and to analyze the association between health status and mortgage status, foreclosure stage, and other socioeconomic variables, among members of the PAH. We conducted a cross-sectional study using a self-administered online questionnaire (2014) administered to 905 PAH members in Catalonia (>18 years; 559 women and 346 men). Results were compared with health indicators from The Health Survey of Catalonia 2013 (n = 4830). The dependent variables were poor mental health (GHQ 12 ≥ 3), and poor self-reported health (fair or poor). All analyses were stratified by sex. We computed age-standardized prevalence and prevalence ratios of poor mental and self-reported health in both samples. We also analyzed health outcomes among PAH members according to mortgage status (mortgage holders or guarantors), stage of foreclosure, and other socioeconomic variables by computing prevalence ratios from robust Poisson regression models. The prevalence of poor mental health among PAH members was 90.6 % in women and 84.4 % in men, and 15.5 and 10.2 % in the general population, respectively. The prevalence of poor self-reported health was 55.6 % in women and 39.4 % in men from the PAH, and 19.2 and 16.1 % in the general population, respectively. These health inequalities were independent of socioeconomic status. The prevalence of poor mental health was higher among individuals in the non-payment stage of foreclosure than among those who were up to date with their payments (e.g., PRc = 1.16 [95 % CI 1.04-1.28]). In contrast, self-reported poor health was more prominent in later stages of foreclosure, such as in post-eviction without dation in payment stage in men (PRc = 2.24 [95 %CI = 1.35-3.72]). We observed a considerably higher prevalence of poor mental and self-reported health among male and female PAH members than in the general population. Public policies that tackle housing instability and its consequences are urgently needed in Spain.
Collapse
Affiliation(s)
- Hugo Vásquez-Vera
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Estudios para la Equidad en Salud, Universidad de La Frontera, Temuco, Chile
| | - Maica Rodríguez-Sanz
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain
- Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain
| | - Carme Borrell
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
- Agència de Salut Pública de Barcelona, Barcelona, Spain.
- CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain.
- Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
- Agència de Salut Pública de Barcelona, Avinguda Lesseps 1, ES-08023, Barcelona, Spain.
| |
Collapse
|
25
|
Margerison-Zilko C, Goldman-Mellor S, Falconi A, Downing J. Health Impacts of the Great Recession: A Critical Review. CURR EPIDEMIOL REP 2016; 3:81-91. [PMID: 27239427 DOI: 10.1007/s40471-016-0068-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The severity, sudden onset, and multipronged nature of the Great Recession (2007-2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies reported detrimental impacts of the Recession on health, particularly mental health. Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide, although traffic fatalities and population-level alcohol consumption declined. Health impacts were stronger among men and racial/ethnic minorities. Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. This literature, however, still faces multiple methodological challenges, and more time may be needed to observe the Recession's full health impact. We conclude with suggestions for future work in this field.
Collapse
Affiliation(s)
- Claire Margerison-Zilko
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Rd., Rm 601, East Lansing, MI 48824, Ph: 517-353-8623
| | - Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, 5200 N. Lake Rd., Merced, CA 95342, Ph: (209) 228-2498
| | - April Falconi
- General Internal Medicine, Stanford University, Palo Alto, CA 94305, Ph: (703) 328-4851
| | - Janelle Downing
- School of Public Health, University of California, Berkeley, 545 University Hall, University of California, Berkeley, CA 94720-7360, Ph: (510) 643-8571
| |
Collapse
|
26
|
[The health of adults undergoing an eviction process]. GACETA SANITARIA 2015; 30:4-10. [PMID: 26548977 DOI: 10.1016/j.gaceta.2015.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 09/23/2015] [Accepted: 10/01/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To analyze perceived health status and other health-related indicators in the adult population in Granada (Spain) undergoing an eviction process from their homes, whether rented or owned, in comparison with health indicators in the general adult population in Andalusia. METHODS A cross-sectional survey was administered by trained staff. The survey included instruments from the Andalusian Health Survey 2011 for measuring variables related to physical and mental health, as well as health-related habits. We compared the results with those obtained from the Andalusian general population through the Andalusian Health Survey. A bivariate analysis using the χ2 test and a multivariate logistic regression analysis were conducted. RESULTS We obtained a total sample of 205 people in the process of eviction. A total of 59.5% (n=122) were women, and 40.5% (n=83) were men. Participants were more likely to have poor health (odds ratio [OR]: 12.63, 95% confidence interval [95%CI]: 8.74-18.27), have cardiovascular diseases (OR: 3.08; 95%CI: 1.54- 6.16), or to smoke (OR: 1.68; 95% CI: 1.21-2.33) compared with the Andalusian general population. Most of the health indicators analyzed showed a worse outcome for women undergoing an eviction process. CONCLUSIONS Our results suggest that, in the current context of economic crisis, people undergoing a process of eviction in Granada and its metropolitan area show poorer health than the Andalusian general population. Further research is needed on health and evictions from different methodological approaches, for a better understanding of the topic.
Collapse
|
27
|
How substandard dwellings and housing affordability problems are associated with poor health in a vulnerable population during the economic recession of the late 2000s. Int J Equity Health 2015; 14:120. [PMID: 26530721 PMCID: PMC4632653 DOI: 10.1186/s12939-015-0238-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Given the increasing number of people in Spain struggling to pay housing-related costs during the economic recession, it is important to assess the health status of these communities as compared to the general population and to better understand the different housing dimensions that are related with poor mental health. This study aims to describe the housing conditions and health status of a sample of people assisted by Caritas Barcelona (Spain) and living in inadequate housing and/or struggling to pay their rent or mortgage, to compare the health outcomes of this population with those of the overall population of Barcelona, and to analyze the association between housing dimensions and mental health. Methods We used a cross-sectional design. The participating adults (n = 320) and children (n = 177) were those living in the dioceses of Barcelona, Sant Feliu and Terrassa (Spain) in 2012 and assisted by Cáritas. They were asked to answer to three questionnaires on housing and health conditions. Eight health related variables were used to compare participants with Barcelona’s residents and associations between housing conditions and poor mental health were examined with multivariate logistic regression models. Results In Barcelona, people seeking Caritas’s help and facing serious housing problems had a much poorer health status than the general population, even when compared to those belonging to the most deprived social classes. For example, 69.4 % of adult participants had poor mental health compared to 11.5 % male and 15.2 % female Barcelona residents. Moreover, housing conditions were associated with poor mental health. Conclusions This study has shown how, in a country hit by the financial recession, those people facing housing problems have much worse health compared to the general population.
Collapse
|
28
|
Cutshaw CA, Woolhandler S, Himmelstein DU, Robertson C. Medical Causes and Consequences of Home Foreclosures. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 46:36-47. [DOI: 10.1177/0020731415614249] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to elucidate the medical causes and consequences of foreclosure. We surveyed 90 households undergoing foreclosure in 2013–2014 in Maricopa County, Arizona on two occasions approximately five months apart. At baseline, median monthly household income was $3,000, and median mortgage payment $1,350. Only 10% of respondents lacked health insurance when surveyed, although 28% had experienced a gap in coverage within the past two years. Fifty-seven percent identified a medical debt or another medical cause of their foreclosure, and 54% had taken on new debt to pay medical bills; 10% had mortgaged their home for this reason. Although 57% of respondents had a chronic condition requiring ongoing care, more than half reported delaying or skipping a needed medical visit. At follow-up, one-third of respondents had been unable to afford food, and 3 respondents reported becoming homeless; 46% said foreclosure had worsened their health; and 63% had already incurred new medical debts. Medical debt and medical problems frequently contribute to foreclosure, even among insured families. Foreclosure compromises access to care and basic necessities like food and shelter, and worsens self-reported health.
Collapse
Affiliation(s)
- Christina A. Cutshaw
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Steffie Woolhandler
- The City University of New York School of Public Health at Hunter College, Harvard Medical School, NY, USA
| | - David U. Himmelstein
- The City University of New York School of Public Health at Hunter College, Harvard Medical School, NY, USA
| | | |
Collapse
|
29
|
Tsai AC. Home foreclosure, health, and mental health: a systematic review of individual, aggregate, and contextual associations. PLoS One 2015; 10:e0123182. [PMID: 25849962 PMCID: PMC4388711 DOI: 10.1371/journal.pone.0123182] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/01/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The U.S. foreclosure crisis intensified markedly during the Great Recession of 2007-09, and currently an estimated five percent of U.S. residential properties are more than 90 days past due or in the process of foreclosure. Yet there has been no systematic assessment of the effects of foreclosure on health and mental health. METHODS AND FINDINGS I applied systematic search terms to PubMed and PsycINFO to identify quantitative or qualitative studies about the relationship between home foreclosure and health or mental health. After screening the titles and abstracts of 930 publications and reviewing the full text of 76 articles, dissertations, and other reports, I identified 42 publications representing 35 unique studies about foreclosure, health, and mental health. The majority of studies (32 [91%]) concluded that foreclosure had adverse effects on health or mental health, while three studies yielded null or mixed findings. Only two studies examined the extent to which foreclosure may have disproportionate impacts on ethnic or racial minority populations. CONCLUSIONS Home foreclosure adversely affects health and mental health through channels operating at multiple levels: at the individual level, the stress of personally experiencing foreclosure was associated with worsened mental health and adverse health behaviors, which were in turn linked to poorer health status; at the community level, increasing degradation of the neighborhood environment had indirect, cross-level adverse effects on health and mental health. Early intervention may be able to prevent acute economic shocks from eventually developing into the chronic stress of foreclosure, with all of the attendant benefits this implies for health and mental health status. Programs designed to encourage early return of foreclosed properties back into productive use may have similar health and mental health benefits.
Collapse
Affiliation(s)
- Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
- * E-mail:
| |
Collapse
|
30
|
Keene DE, Cowan SK, Baker AC. "When you're in a crisis like that, you don't want people to know": mortgage strain, stigma, and mental health. Am J Public Health 2015; 105:1008-12. [PMID: 25790383 DOI: 10.2105/ajph.2014.302400] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We analyzed experiences of stigmatization, concealment, and isolation among African American homeowners who were experiencing mortgage strain. METHODS We conducted semistructured interviews between March 2012 and May 2013 with 28 African American homeowners in a northeastern US city who were experiencing mortgage strain. We coded all of the transcripts and reviewed data for codes relating to stigma, sharing information, social support, social isolation, and the meaning of homeownership. RESULTS Our data showed that mortgage strain can be a concealable stigma. Participants internalized this stigma, expressing shame about their mortgage situation. Additionally, some participants anticipated that others would view them as less worthy given their mortgage trouble. In an effort to avoid stigmatization, many concealed their mortgage trouble, which often led to isolation. This stigmatization, concealment, and isolation seemed to contribute to participants' depression, anxiety, and emotional distress. CONCLUSIONS Stigma may exacerbate stress associated with mortgage strain and contribute to poor mental health, particularly among upwardly mobile African Americans who have overcome significant structural barriers to home ownership. Reducing stigma associated with mortgage strain may help to reduce the health consequences of this stressful life event.
Collapse
Affiliation(s)
- Danya E Keene
- Danya E. Keene is with the Social Behavioral Sciences Division, Yale School of Public Health, New Haven, CT. Sarah K. Cowan is with the Department of Sociology, New York University, New York, NY, and the Robert Wood Johnson Foundation Health & Society Scholars Program, Columbia University, New York, NY. Amy Castro Baker is with the College of Health Sciences, University of Wyoming, Laramie
| | | | | |
Collapse
|
31
|
Giurgescu C, Misra DP, Sealy-Jefferson S, Caldwell CH, Templin TN, Slaughter-Acey JC, Osypuk TL. The impact of neighborhood quality, perceived stress, and social support on depressive symptoms during pregnancy in African American women. Soc Sci Med 2015; 130:172-80. [PMID: 25703670 DOI: 10.1016/j.socscimed.2015.02.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Living in a lower-quality neighborhood is associated with higher levels of depressive symptoms in the general population as well as among pregnant and postpartum women. However, little is known of the important pathways by which this association occurs. We proposed a model in which perceived stress and social support mediated the effects of neighborhood quality on depressive symptoms during pregnancy (measured by the 20-item Center for Epidemiologic Studies-Depression, CES-D, scale) in a sample of 1383 African American women from the Detroit metropolitan area interviewed during their delivery hospitalization. Using structural equation modeling (SEM), we built a latent variable of neighborhood quality using 4 measures (neighborhood disorder, neighborhood safety/danger, walking environment, overall rating). We then tested two SEM mediation models. We found that lower neighborhood quality was associated with higher prevalence of depressive symptoms during pregnancy (standardized total effect = .16, p = .011). We found that perceived stress partially mediated the neighborhood quality association with depressive symptoms. Although the association of social support with depressive symptoms was negligible, social support mediated associations of neighborhood quality with perceived stress [standardized path coefficient = .38 (.02), p = .009]. Our results point to the need for public health, health care, as well as non-health related interventions (e.g. crime prevention programs) to decrease overall exposure to stressors, as well as stress levels of women living in poor quality neighborhoods. Interventions that increase the levels of social support of women during pregnancy are also needed for their potential to decrease stress and ultimately improve mental health at this important time in the life course.
Collapse
Affiliation(s)
| | - Dawn P Misra
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Shawnita Sealy-Jefferson
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Cleopatra H Caldwell
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Theresa L Osypuk
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
32
|
Houle JN, Keene DE. Getting sick and falling behind: health and the risk of mortgage default and home foreclosure. J Epidemiol Community Health 2014; 69:382-7. [PMID: 25430548 DOI: 10.1136/jech-2014-204637] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND An emerging literature shows that mortgage strain can lead to poor health outcomes, but less work has focused on whether and how health shocks influence mortgage distress. We examine the link between changes in health status and default/foreclosure risk among older middle-aged adults. METHOD We used National Longitudinal Study of Youth 1979 data and multivariate logistic regression models to examine the relationship between changes in health limitations and chronic conditions across survey waves and risk of mortgage default and foreclosure. RESULTS We found that changes in health limitations and chronic conditions increased the risk of default and foreclosure between 2007 and 2010. These associations were partially mediated by changes in family income and loss of health insurance. CONCLUSIONS From a policy perspective, the strong link between the onset of illness and foreclosure suggests a need to re-examine the safety-nets that are available to individuals who become ill or disabled.
Collapse
Affiliation(s)
- Jason N Houle
- Department of Sociology, Dartmouth College, Hanover, New Hampshire, USA
| | - Danya E Keene
- Social Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| |
Collapse
|
33
|
Houle JN. Mental health in the foreclosure crisis. Soc Sci Med 2014; 118:1-8. [PMID: 25084488 DOI: 10.1016/j.socscimed.2014.07.054] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 11/17/2022]
Abstract
Current evidence suggests that the rise in home foreclosures that began in 2007 created feelings of stress, vulnerability, and sapped communities of social and economic resources. Minority and low SES communities were more likely to be exposed to predatory lending and hold subprime mortgages, and were the hardest hit by the foreclosure crisis. Little research has examined whether and how the foreclosure crisis has undermined population mental health. I use data from 2245 counties in 50 U.S. states to examine whether living in high foreclosure areas is associated with residents' mental health and whether the foreclosure crisis has the potential to exacerbate existing disparities in mental health during the recessionary period. I use county-level data from RealtyTrac and other data sources, and individual-level data from the Behavioral Risk Factor Surveillance Survey from 2006 to 2011. I find that - net of time invariant unobserved between-county differences, national time trends, and observed confounders - a rise in a county's foreclosure rate is associated with a decline in residents' mental health. This association is especially pronounced in counties with a high concentration of low SES and minority residents, which supports the perspective that the foreclosure crisis has the potential to exacerbate existing social disparities in mental health.
Collapse
Affiliation(s)
- Jason N Houle
- Dartmouth College, 6104 Silsby Hall, Room 111, Hanover, NH 03755, USA.
| |
Collapse
|
34
|
Ragins BR, Lyness KS, Williams LJ, Winkel D. Life Spillovers: The Spillover of Fear of Home Foreclosure to the Workplace. PERSONNEL PSYCHOLOGY 2014. [DOI: 10.1111/peps.12065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Karen S. Lyness
- Baruch College & Graduate Center; City University of New York
| | | | | |
Collapse
|
35
|
Mason KE, Baker E, Blakely T, Bentley RJ. Housing affordability and mental health: does the relationship differ for renters and home purchasers? Soc Sci Med 2013; 94:91-7. [PMID: 23931950 DOI: 10.1016/j.socscimed.2013.06.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 06/17/2013] [Accepted: 06/19/2013] [Indexed: 01/05/2023]
Abstract
There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship. Type of housing tenure may be an important factor in determining how individuals experience and respond to housing affordability problems. This study investigated whether a relationship exists between unaffordable housing and mental health that differs for home purchasers and private renters among low-income households. Data from 2001 to 2010 of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey were analysed using fixed-effects linear regression to examine change in the SF-36 Mental Component Summary (MCS) score of individuals aged 25-64 years, associated with changes in housing affordability, testing for an interaction with housing tenure type. After adjusting for age, survey year and household income, among individuals living in households in the lower 40% of the national income distribution, private renters in unaffordable housing experienced somewhat poorer in mental health than when their housing was affordable (difference in MCS = -1.18 or about 20% of one S.D. of the MCS score; 95% CI: -1.95,-0.41; p = 0.003) while home purchasers experienced no difference on average. The statistical evidence for housing tenure modifying the association between unaffordable housing and mental health was moderate (p = 0.058). When alternatives to 40% were considered as income cut-offs for inclusion in the sample, evidence of a difference between renters and home purchasers was stronger amongst households in the lowest 50% of the income distribution (p = 0.020), and between the 30th and 50th percentile (p = 0.045), with renters consistently experiencing a decline in mental health while mean MCS scores of home purchasers did not change. In this study, private renters appeared to be more vulnerable than home purchasers to mental health effects of unaffordable housing. Such a modified effect suggests that tenure-differentiated policy responses to poor housing affordability may be appropriate.
Collapse
Affiliation(s)
- Kate E Mason
- Centre for Women's Health, Gender & Society, Melbourne School of Population Health, University of Melbourne, Melbourne, VIC 3010, Australia.
| | | | | | | |
Collapse
|