Elsevier

Nursing Outlook

Volume 60, Issue 3, May–June 2012, Pages 134-142.e1
Nursing Outlook

Article
Policy
Housing strain, mortgage foreclosure, and health

https://doi.org/10.1016/j.outlook.2011.08.004Get rights and content

Abstract

Background

Foreclosure rates have risen rapidly since 2005, reaching historically high levels. The purpose of this study was to examine the health implications of the current housing crisis.

Methods

We conducted a cross-sectional online consumer panel survey including residents of California, Arizona, Nevada, and Florida (n = 798) to determine the feasibility of contacting distressed homeowners via the Internet and to assess mental and physical health among respondents across the spectrum from those having no housing strain to those in loan default or home foreclosure.

Results

Homeowners in default or foreclosure exhibited poorer mental health and more physical symptoms than renters, homeowners with moderate strain, and homeowners with no strainöfollowing a gradient that was consistent across multiple health indicators.

Conclusions

Internet panel sampling was an efficient method of contacting distressed homeowners. Record-high foreclosure rates may have broad implications for nursing and public health. Homeowners in default or foreclosure represent an identifiable high-risk group that may benefit from coordinated, affordable health and social services.

Introduction

After a dramatic increase in subprime lending beginning in 2003,1 foreclosure rates increased rapidly through 2008, sending 1.84% of all homes in the United States—more than 2.3 million properties—into some stage of foreclosure during that year.2 A recent forecast by Credit Suisse predicted that 8.1 million mortgages (16% of all mortgages) will be in foreclosure by 2012.3

Considerable evidence suggests that health and wealth are tightly connected, and that financial strain is associated with poor health, but few studies have examined mortgage default or foreclosure, especially in the context of the current US housing crisis.4, 5, 6 Economic stresses such as job loss are associated with health declines and increases in depressive symptoms.7, 8, 9, 10 Debt and self-reported financial strain are also associated with worse health,11, 12, 13 and difficulty making mortgage payments is associated with lower general well-being.14, 15 One recent study demonstrated high rates of uninsurance, major depression, and unfilled prescription medications in Philadelphia-area residents undergoing mortgage foreclosure.4 In contrast, wealth is positively associated with health, and the largest source of wealth for American families is home equity.16 Home ownership has been associated with greater life satisfaction, better psychological health, higher self-esteem and perceived control, and better self-rated health.17 Thus, people undergoing mortgage foreclosure may be more likely to experience poor health.

We address the health implications of the current economic crisis by asking the question: What is the health status of Americans facing foreclosure? We expected this group would exhibit the highest prevalence of poor health of any housing group studied. To date, few studies have demonstrated the interplay between the housing crisis and well-being to inform appropriate interventions.18 In the discussion section, we examine how the results of this study may guide nursing, public health, and community practice and inform policies to assist homeowners in default or foreclosure. These distressed homeowners may benefit from coordinated financial assistance and targeted social and health services. This article first presents empirical data on the health status of distressed homeowners and then explores potential community-based strategies for reaching out to this vulnerable population.

Section snippets

Study Design and Sample

This cross-sectional study relied on 2 sources of data: (1) analysis of foreclosure Internet discussion board posts to identify categories of distressed homeowners’ perceived health and social concerns and inform survey development, and (2) collection of survey data from an online consumer panel to examine whether these health issues were differentially reported by distressed homeowners compared with secure homeowners and renters.

Analysis of Discussion Board Posts and Survey Development

Between January 1 and April 30, 2008, we reviewed all online

Results

Table 1 provides sample characteristics by housing status. Homeowners in the default or foreclosure group spent an average of 63.7% of their monthly income on housing costs. On average, participants in the default or foreclosure group were younger than other homeowners but older than renters. Homeowners in default or foreclosure were less likely to be married and had lower education and income relative to other homeowners. Hispanic and black survey respondents were disproportionately

Key Findings and Implications

This study demonstrated an association between housing strain and poor health. Persons with homes in default or foreclosure reported a particularly high prevalence of mental and physical health impairments. For every measure examined, homeowners in default or foreclosure experienced poorer health relative to homeowners with no housing strain. These differences were observed for general health measures, indicators of days lost because of physical and mental health concerns, a scale of

Conclusion

Because of the poor health status of homeowners in default or foreclosure, increasing foreclosure rates may have important population health implications. Homeowners in default or foreclosure represent an identifiable high-risk group that can be reached using a range of modalities, including foreclosure mediation courts and Internet-based outreach. Distressed homeowners may benefit from coordinated, affordable health and social services, and nurses can lead the way in advocating for effective

Acknowledgments

We gratefully acknowledge the support provided by Jeannette Schroeder, as well as funding support from the Robert Wood Johnson Foundation Health & Society Scholars Program, University of Pennsylvania Center for Public Health Initiatives, and the Office of Practice and Community Affairs, University of Pennsylvania School of Nursing, Investment for the Future Funds. Drs. Asch and Cannusio are supported by the Department of Veterans Affairs, Office of Health Services Research and Development,

References (43)

  • M. Bartley et al.

    Employment status, employment conditions, and limiting illness: prospective evidence from the British household panel survey 1991-2001

    J Epidemiol Commun Health

    (2004)
  • S. Burgard et al.

    Toward a better estimation of the effect of job loss on health

    J Health Soc Behav

    (2007)
  • M. Dew et al.

    Mental health effects of job loss in women

    Psychol Med

    (1992)
  • G.C. Murphy et al.

    The effect of unemployment on mental health

    J Occup Organ Psychol

    (1999)
  • D. Blazer et al.

    Perception of unmet basic needs as a predictor of mortality among community-dwelling older adults

    Am J Public Health

    (2005)
  • S. Szanton et al.

    Effect of financial strain on mortality in community-dwelling older women

    J Gerontol B Psychol Sci Soc Sci

    (2008)
  • S. Nettleton et al.

    Mortgage debt, insecure home ownership and health: an exploratory analysis

    Sociol Health Illness

    (1998)
  • S. Nettleton et al.

    When a capital investment becomes an emotional loss: the health and consequences of the experience of mortgage possession in England

    Housing Studies

    (2000)
  • Gottschalck AO. Net worth and asset ownership of households: 2002. US Census Bureau; 2008. p....
  • W.M. Rohe et al.

    Social Benefits and Costs of Homeownership: A Critical Assessment of the Research

    (2001)
  • L.J. Simmons et al.

    Confronting the contours of economic crisis in community practice

    Journal of Community Practice

    (2009)
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