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Anxiety, Depression Tied to Housing Insecurity in Childhood, Adulthood
Housing insecurity was linked with anxiety and depression occurrence in childhood and depression occurrence in adulthood. Results from the prospective cohort study were published in JAMA Pediatrics.
“Our [fixed-effects] models suggested that transitioning from housing secure to housing insecure was associated with more anxiety and depression than transitioning from living above to living below the federal poverty level,” said Ryan Keen, PhD, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and co-authors. “This finding was supported by the [random-effects] models demonstrating that the [standardized mean differences] for the associations between poverty and anxiety and depression during childhood were smaller than those for childhood housing insecurity.”
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The study included individuals aged 9, 11, and 13 years at baseline from the Great Smoky Mountains Study in Western North Carolina. Participants were assessed up to 11 times between January 1993 and December 2015, and data was analyzed from October 2021 to October 2022. Childhood housing insecurity was assessed based on several factors, including frequent residential moves, reduced standard of living, forced separation from home, and foster care status. Factors were reported annually by participants and their parents. The Child and Adolescent Psychiatric Assessment was used between ages 9 and 16 to evaluate anxiety and depression symptoms during childhood. Adult anxiety and depression symptoms were assessed at ages 19, 21, 26, and 30 using the Young Adult Psychiatric Assessment.
The 1339 participants had a mean age of 11.3 years and were 55.2% male. Baseline anxiety and depression symptom scores were higher among children who experienced housing insecurity compared to those who did not (anxiety: 0.49 [1.15] vs 0.22 [1.02]; depression: 0.20 [1.08] vs −0.06 [0.82]). Participants who experienced childhood housing insecurity were found to have higher anxiety (fixed effects: standardized mean difference [SMD], 0.21; 95% CI, 0.12-0.30; random effects: SMD, 0.25; 95% CI, 0.15-0.35) and depression symptom scores (fixed effects: SMD, 0.18; 95% CI, 0.09-0.28; random effects: SMD, 0.26; 95% CI, 0.14-0.37) during childhood, and higher depression symptom scores in adulthood (SMD, 0.11; 95% CI, 0.00-0.21).
These results build on findings from previous studies, including a meta-analysis from 2015 that found that children aged 6-11 years experiencing homelessness had twice the prevalence of internalizing problems as children with low-income housing. Researchers cited disruption from routine, social environments, education, and caregiving as well as exposure to stressors like bullying, isolation, violence, and food insecurity as potential challenges children in this population may face that can affect mental health. Researchers note that formal poverty status may provide more access to public benefits than housing insecurity.
Authors noted some study limitations including the limited sample of participants and the reliance on subjective evidence of housing insecurity.
“While the housing insecurity constructs were not assessed in the previous investigation, future studies may benefit from considering the potential mediating role of housing security,” researchers concluded. “By improving our understanding of the impact of housing insecurity as both a broad construct and in terms of its various dimensions…practitioners may work more collaboratively to maximize the benefits to children and their families affected by housing insecurity.”
