Housing insecurity is associated with childhood anxiety and lifelong depression

1. In a prospective cohort study, housing insecurity during childhood was associated with higher anxiety and depression symptom scores during later childhood and higher depression symptom scores during adulthood.

2. These associations held even when accounting for childhood poverty status, indicating that housing insecurity has distinct effects from other forms of material deprivation.

Evidence Rating Level: 2 (Good)

Study Rundown: Housing insecurity has been widely associated with worse physical and mental health outcomes for children and adults in cross-sectional studies. However, limited longitudinal evidence exists to evaluate whether the consequences of housing instability are long-lasting. Using data from a cohort of 1420 children from the Appalachian region of North Carolina, this study aimed to estimate prospective associations between housing insecurity and child and adult mental health outcomes. The authors found that childhood housing insecurity was associated with higher levels of both anxiety and depression during later childhood, and higher levels of depression in adulthood. These associations persisted even when accounting for childhood poverty status. Housing insecurity may thus be an important, modifiable risk factor for poor mental health. Strengths of this study include the careful definition of housing insecurity, which was developed with expert input and modeled in multiple ways for robustness, as well as the prospective design used. The authors conducted a sensitivity analysis to determine if loss-to-follow-up might be associated with housing instability, and were able to demonstrate that it was not. Additionally, the modeling strategy implemented was thorough and technically excellent, with both fixed and random effects models employed to account for time-varying covariates. However, generalizability may be limited, as the sample was largely rural and either white or Native American. More research is needed on the longitudinal impacts of housing insecurity in diverse and metropolitan areas.

Click to read the study in JAMA Pediatrics

Relevant Reading: Unstable housing and caregiver and child health in renter families

In-Depth [prospective cohort]: This study utilized data from the Great Smokey Mountain Study, a cohort of children from the Appalachian region of North Carolina who were followed prospectively from 1993 to 2015. Housing insecurity was defined broadly as a child having experienced one or more of the following possible exposures: (1) frequent moves (4+ times in 5 years); (2) reduced standard of living in the last month (e.g., needing to move or inadequate heat); (3) forced separation from home; and/or (4) current placement in foster care. Over a quarter of the study population (26.5%) was categorized as housing insecure during at least one time point. Anxiety and depression were measured annually using in-person interviews conducted according to the CAPA protocol (for children) and YAPA protocol (for young adults). Both fixed effects and random effects models were run. Fixed effects models were limited to the subset of children whose housing insecurity status changed during the study and capitalized on within-person variation to estimate the impact of a change in housing status on mental health. These models demonstrated a 0.21-point (95% CI: 0.12-0.30) increase in childhood anxiety symptom scores for contemporaneous housing insecurity and a 0.24-point (95% CI: 0.10-0.38) for lagged housing insecurity. Similarly, they showed a 0.18-point (95% CI: 0.09-0.28) increase in childhood depression symptoms scores for contemporaneous housing insecurity and a 0.19-point (95% CI: 0.05-0.33) increase for lagged housing insecurity. Lagged anxiety was also associated with a 0.11-point (95% CI: 0.00-0.21) increase in adult depression symptom scores. Random effects models, which measured the average association of childhood housing insecurity with each outcome after adjustment for both time-invariant and time-varying covariates, closely recapitulated these findings.

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