Revisiting the relationship among housing tenure, affordability and mental health: Do dwelling conditions matter?

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.

Association of housing tenure and unaffordable housing with preterm birth and other adverse birth outcomes in Canada: a population-based study

BACKGROUND

Socioeconomic risk factors are known drivers of adverse birth outcomes. Housing is a key target for policy interventions.

OBJECTIVE

To estimate the associations of housing tenure (renting vs owning) and unaffordable housing with preterm birth and other adverse birth outcomes.

METHODS

We used 2014-2016 Canadian birth registration data linked with the 2016 long-form census and included singleton births among homeowners and renters. Unaffordable housing was defined at the family level as the proportion of pre-tax income spent on shelter, using a 30% cut-off. The primary outcome was preterm birth. Secondary outcomes were stillbirth and infant death. Log-binomial regression estimated the association of housing tenure and unaffordability with outcomes adjusting for sociodemographic risk factors and parity.

RESULTS

Among 162 700 live births and stillbirths (52 740 renters, 109 960 owners), 31% of renters and 17% of owners experienced unaffordable housing. Renting was associated with an increased risk of preterm birth (7.5% vs 6.1%; adjusted risk ratio (aRR) 1.13; 95% CI 1.08 to 1.17), stillbirth (9.5 vs 6.6 per 1000; aRR 1.33, 95% CI 1.14 to 1.56) and infant death (4.2 vs 3.0 per 1000; aRR 1.52, 95% CI 1.26 to 1.82). There was no association of housing unaffordability with preterm birth or other adverse birth outcomes among owners or renters.

CONCLUSIONS

This nationally representative study in Canada found associations between renting versus owning and preterm birth, stillbirth and infant death, as well as a high burden of unaffordable housing, particularly among renters. This study suggests that home tenure itself is a social determinant of adverse birth outcomes.

The effect of housing tenure on health status of migrant populations in China: are health service utilization and social integration mediating factors?

BACKGROUND

Current research suggests that there is an association between housing tenure and the health status of migrant populations, but the potential mediators of this association remain to be explored. We aimed to examine the effect of housing tenure on migrant populations' health in China and how this effect is mediated by health service utilization and social integration.

METHODS

Data from the 2017 China Migrants Dynamic Survey of 47,459 participants was used. Logistic regression models were used to explore the effects of housing tenure, health service utilization, and social integration on the health status of migrant populations. Mediated effects models were used to explore the association among them. This study used the bootstrap method and KHB method to test the mediating effect of health service utilization and social integration.

RESULTS

Compared to private renters, owners with mortgages (OR: 0.828, 95% CI: 0.765-0.896) were significantly associated with a higher risk of poor health. Compared with private renters, outright owners were associated with a lower risk of poor health (OR: 1.016, 95% CI: 0.935, 1.104), but the association was not statistically significant (p > 0.05). Moreover, health service utilization (OR: 1.422, 95% CI: 1.268, 1.594) and social integration (OR: 4.357, 95% CI: 3.555, 5.341) were both significantly associated with a higher probability of good health (p < 0.001).

CONCLUSION

Among migrant populations, homeowners with mortgages had a lower likelihood of good health than private renters, while there was no significant difference in the health status between outright owners and private renters. Moreover, health service utilization and social integration mediate the effect of housing tenure on the health status of migrant populations. Policies and interventions can be designed to improve the health service utilization and social inclusion of migrant populations to reduce health disparities across housing tenure types.

Stress and Health Status Among Members of a Disadvantaged Community in Flint, Michigan in the Early Phase of the COVID-19 Pandemic

The COVID-19 pandemic creates psychological concerns and stress and its impacts are more extreme for those with health concerns residing in socially and economically disadvantaged communities, such as residents of Flint, Michigan. This study assesses the stress level among people who received community assistance in the first 3 months of COVID lockdowns. Further, it examines associations between stress and physical and mental health status. We measured perceived stress, health concerns, mental distress, and perceived physical and mental health from 106 survey respondents. Comparisons of stress levels by demographics showed that females, high school graduates, and homeowners had higher stress levels than its counterparts. Results from general linear models showed that stress was highest among those with high levels of psychological distress, perceived poor mental health, and more health concerns. The associations between poor perceived physical health and stress were marginal. Homeowners and high school diploma holders showed lower stress levels. This research suggests community health practices tailored to community characteristics and culture will have the greatest impact on stress and health problems in underserved communities.

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.

The Impacts of Housing Characteristics and Built-Environment Features on Mental Health

In this study, we examined the relationships between housing characteristics, neighborhood built-environment features, and people's mental health in Hong Kong, an Asian city well known for its high-density and high-rise housing. The potential mediating effects of people's perceived living environment were also considered in the analysis. We collected data from 221 participants from two communities in Hong Kong, i.e., Sham Shui Po (SSP) and Tin Shui Wai (TSW), using a stratified random sampling approach. Big datasets were also used to derive relevant built-environment features at the street block level. We used structural equation modeling to explore the complex relationships among housing characteristics, built-environment features, and mental health. The results indicate that the associations between built-environment quality and people's mental health are weak. For communities with relatively poor housing conditions (i.e., SSP in this study), the impact of housing characteristics on mental health may be more direct; for communities with relatively good housing conditions (i.e., TSW in this study), the effect of housing characteristics on mental health may be indirect. Our findings shed light on the importance of considering different contexts in developing policies related to housing and built environment and mental health.

The importance of home: Satisfaction with accommodation, neighborhood, and life in adults with autism

Although good quality housing and a socially cohesive neighborhood are associated with a higher well‐being in the general population, housing is a rarely studied topic in autism research. In the present study, we describe the housing situation of a large sample of adults with autism and mostly (above) average intellectual abilities (n = 1429; 17 to 84 years), and examine predictors of independent living, accommodation satisfaction, neighborhood satisfaction, and satisfaction with life based on an online survey. The outcomes of independently living adults were compared with those from a Dutch community sample (n = 929). Nearly 80% of the autistic adults lived independently. Older participants, women, and those with higher self‐reported IQ's were more likely to live independently. Autistic adults living independently were equally satisfied with their accommodation and neighborhood as the comparison group, but were less satisfied with their life in general. In both groups, higher satisfaction with accommodation and neighborhood was associated with higher life satisfaction. We advocate further research to better understand and anticipate the housing needs of the growing group of adults with autism.

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.

The Influence of Living Conditions on Self-Rated Health: Evidence from China

Despite growing attention to living conditions as a social determinant of health, few studies have focused on its diverse impacts on self-rated health. Using data from the China Family Panel Study in 2018, this study used logistic regression analysis to examine how living conditions affect self-rated health in China, finding that people cooking with sanitary water and clean fuel were more likely to report good health, and that homeownership was associated with higher self-rated health. The self-rated health of people living in high-quality housing was lower than that of people living in ordinary housing, and people living in tidy homes were more likely to report good health. The findings suggest that the link between multiple living conditions and self-rated health is dynamic. Public health policies and housing subsidy programs should therefore be designed based on a comprehensive account of not only housing grade or income status, but also whole dwelling conditions.

Housing and Cardiometabolic Risk Among Older Renters and Homeowners

Scholars consistently find that renters have poorer health outcomes when compared with homeowners. Health disparities between renters and homeowners likely widen over the life course, yet few studies have examined this link among older adults, and the connection is not fully understood. Homeowners' relative socioeconomic advantage may explain their better health; renters also more commonly experience adverse housing conditions and financial challenges, both of which can harm health. In this paper, we analyze the extent to which socioeconomic advantage, housing conditions, and financial strain explain the relationship between homeownership and health among adults over age 50, using Health and Retirement Study 2010/2012 data to assess cardiometabolic risk levels using biomarkers for inflammation, cardiovascular health, and metabolic function. We find that people living with poor housing conditions and financial strain have higher cardiometabolic risk levels, even taking socioeconomic advantage into account. This analysis sheds light on the housing-related health challenges of older adults, especially older renters.

Housing, Living Arrangements and Mental Health of Young Adults in Independent Living

Young adults are prone to psychological stress and anxiety induced by major transitions to adulthood. While employment has predominated in previous research on the social determinants of young people’s mental health, this study examines the association between young people’s housing problems and mental health in the context of an unaffordable housing market. Using the Survey on the Living Conditions and Welfare Needs of Youths (n = 1308) in Korea, the study found that perceived poor housing quality and material hardship are negatively associated with the mental health of young adults living independently. Specifically, while poor housing quality and material hardship induced by housing cost burden were negatively associated with single-person households’ mental health, only poor housing quality was associated with non-single-person households’ mental health. This study is one of the few studies examining the linkage between housing problems and mental health of young adults and informs the interventions aimed at promoting the psychological well-being of young adults in the transition from parents’ homes to independent living.

Associations between Objective and Subjective Housing Status with Individual Mental Health in Guangzhou, China

Housing is an important social determinant of mental health. However, few studies simultaneously measure the objective housing status (i.e., housing tenure, living space, housing conditions, and housing stability) and subjective housing status (i.e., housing satisfaction) as well as examine their effects on people's mental health (i.e., stress, anxiety, and depression). Thus, using a sample size of 1003 participants by two-stage random sampling survey in Guangzhou, China, this study applies multivariate ordinary least square regression models to comprehensively explore and compare the associations between objective and subjective housing status with mental health, and then analyze the moderating effects of subjective housing status on the relationships between objective housing status and mental health. The findings suggest that there are significant differences in people's mental health based on different housing status. The subjective housing status can better explain the variances in mental health than objective housing status. Also, subjective housing status may partly mitigate the adverse impacts of objective housing disadvantages on some aspects of an individual's mental health. Therefore, housing improvement policies and public health initiatives should be designed based on a comprehensive account of objective and subjective housing characteristics as well as their influences on specific aspects of mental health.