The impact of persistent poor housing conditions on mental health: A longitudinal population-based study
Introduction
It is generally accepted that good housing protects health (Shaw, 2004, Thomson and Thomas, 2015). Exposure to poor housing conditions, such as damp, leaks, and inadequate heating, has been shown to increase the risk of developing respiratory infections and asthma, but also more serious conditions such as tuberculosis (Bonnefoy et al., 2003, Shaw, 2004, Walker et al., 2006, Bonnefoy, 2007, Webb et al., 2013). Poor housing conditions also affect mental health. People living in housing with more problems have a greater likelihood of experiencing mental ill health (Pevalin et al., 2008) while physical improvements to housing improves mental health (Curl et al., 2015, Willand et al., 2015). However, the influence of longer-term exposure (persistence) to poor housing on mental health specifically remains unclear (Marsh et al., 2000). This paper aims to address two questions: first, does the persistence of poor housing conditions over the previous four years affect mental health in the present and, second, does a person's experience of poor housing conditions in the past continue to affect their mental health in the present irrespective of whether they are currently experiencing poor housing conditions?
People who are living in poor housing conditions today are far more likely to experience poor housing conditions in the future. Data from the UK shows that among people living with (one or more) housing problems in 2001, 57% had housing problems in 2002 and 56% had housing problems in 2003. Some housing problems may change year to year but others, such as damp, may be especially difficult to rectify. Persistent housing problems affect a relatively small proportion of households, for example, just under 10% of households with housing problems in 2000 reported housing problems each year until 2003.
Persistence of poor housing may, in part, be due to a lack of autonomy or inadequate financial resources (Kemp, 2011, Desmond, 2016). Renters are reliant on their landlords to fix housing problems. In the low-cost end of the housing market landlords have few incentives to make costly repairs and so renters may be forced to choose between poor quality housing and trying to find better quality housing, which may require moving and be less affordable (Kemp, 2011). Similarly, and especially among lower-income homeowners, housing problems may persist because households lack the financial resources to engage tradespeople (Bogdon, 1996).
We argue that, similar to unemployment, the health consequences of housing problems at a particular point-in-time may be quite different from the health effects of housing problems that persist over time (Paul and Moser, 2009). The association between current housing problems and current mental health may overlook the persistence of housing problems and the toll they take on mental health. Further complicating the interpretation of any association between housing problems and health are potential effect lags. Mental health problems may be ‘sticky’; persisting even after the initial trigger has been removed (Clark et al., 2001, Lucas et al., 2004, Davydov et al., 2010, Huijts et al., 2015). Previous housing problems may initiate stress and anxiety that is not immediately alleviated when the problem is fixed (Curl et al., 2015).
Building on the previous literature, we hypothesize that housing problems in the past will affect health in the present and that this relationship will be observable even after accounting for current housing problems. To explore this hypothesis, we develop a new measure of housing problems over time using a longitudinal data set that is better able to disentangle the health effects of current and past housing problems. To our knowledge, few studies have attempted to disentangle the health consequences of current and previous housing conditions. Our study, therefore, provides one of the first examinations of the cumulative impact of housing problems on mental health.
Section snippets
Study sample
The data came from the 13 annual waves (1996 to 2008) of the British Household Panel Survey (BHPS) that included questions about housing conditions. The BHPS is a well-established survey and is extensively documented (Taylor et al., 2010, University of Essex. Institute for Social and Economic Research, 2010). Panel data for analysis was unbalanced as individuals move in and out of the survey according to a set of following rules (Taylor et al., 2010). To be included in the sample for this
Results
Initially we examined whether one year of housing problems was associated with poorer mental health. We followed the same individuals over a five-year period and compared the association between experiencing housing problems in only one of those years and experiencing no housing problems over this same period. We plotted the coefficients in Fig. S1. In all cases the association was positive suggesting that experiencing housing problems, even for only one year, negatively affects mental health
Discussion
Three main conclusions can be drawn. First, living with housing problems in the past is associated with poorer mental health in the present. Second, living in persistently poor housing harms mental health over and above the effect of current housing problems. Mental health effects of persistent housing problems vary by tenure type, harming social renters and outright owners the most. Third, among people who remained in the same residence, but developed new housing problems, there was an
Conflict of interest statement
All authors have no conflict of interests.
Transparency document
Acknowledgments
Emma Baker and Rebecca Bentley's contributions were supported by Australian Research Council Future Fellowships [FT140100872 and FT150100131 respectively].
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