Housing Disadvantage and Poor Mental Health: A Systematic Review.

CONTEXT: This study reviews collective evidence on the longitudinal impact of housing disadvantage (based on tenure, precarity, and physical characteristics) on mental health. It is focused on temporally ordered studies where exposures preceded outcomes, a key criterion to establishing causal evidence.

EVIDENCE ACQUISITION: A systematic review of evidence on housing disadvantage and mental health was performed. The literature search used six electronic databases including MEDLINE (PubMed and Ovid platform), Embase, PsycINFO, Web of Science, SciELO, and Sociological Abstracts. Population-based longitudinal studies where exposure to housing disadvantage (excluding exposure to homelessness) preceded mental health were included. Methodologic quality of selected studies was examined using the Newcastle-Ottawa Quality Assessment Scale. Because of definitional and methodologic heterogeneity among studies, narrative synthesis rather than meta-analysis was used to summarize research findings.

EVIDENCE SYNTHESIS: Of the 1,804 unique titles identified in the literature search, 12 met the selection criteria for inclusion in the systematic review. Housing disadvantage was measured by overcrowding, mortgage delinquency, housing mobility, housing tenure, subjective perceptions of inadequate housing, eviction, and physical housing conditions. Mental health was measured as depression, psychological impairment, anxiety, allostatic load, mental strain, and psychological health. Study sample sizes ranged from 205 to 16,234 people, and the follow-up period ranged from within 1 year to 34 years. Each study indicated a positive association between housing disadvantage and mental health for at least one housing disadvantage measure and mental health outcome.

CONCLUSIONS

This systematic review confirms that prior exposure to housing disadvantage may impact mental health later in life.