Do financial hardship and social support mediate the effect of unaffordable housing on mental health?

  • Ankur SinghEmail author
  • Zoe Aitken
  • Emma Baker
  • Rebecca Bentley
Original Paper



Unaffordable housing has a negative impact on mental health; however, little is known about the causal pathways through which it transmits this effect. We examine the role of financial hardship and social support as mediators of this relationship.


We identified households where housing costs changed from affordable to unaffordable across two waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (2014–2015). The sequential causal mediation analysis was used to decompose the total effect of unaffordable housing on mental health into the portion attributable to financial hardship and social support [natural indirect effect (NIE)] and the portion not occurring through measured pathways [natural direct effect (NDE)]. Mental health was measured using the Mental Health Inventory (MHI) and Kessler psychological distress (KPD) scale. Baseline covariates included age, sex, household income, financial hardship, social support, marital status and employment status. Bootstrapping with 1000 replications was used to calculate 95% confidence intervals (CIs). Multiple imputations using chained equations were applied to account for missing data.


Unaffordable housing led to a change in mean mental health score on the MHI scale (− 1.3, 95% CI: − 2.1, − 0.6) and KPDS scale (0.9, 95% CI: 0.4, 1.4). Financial hardship accounted for 54% of the total effect on MHI scale and 53% on KPD scale. Collectively, financial hardship and social support explained 68% of the total effect on MHI scale and 67% on KPD scale, respectively.


In conclusion, the negative mental health effect of unaffordable housing is largely mediated through increased financial hardship.


Causal mediation Housing Mental health Theories 



Rebecca Bentley and Emma Baker are supported by Australian Research Council’s Future Fellowship program (FT150100131 and FT1401100872, respectively). We are grateful to Dr Koen Simons for his statistical guidance on combining estimates from multiple imputation and bootstraps.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

127_2019_1773_MOESM1_ESM.docx (37 kb)
Supplementary material 1 (DOCX 36 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Centre for Health Equity, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia
  2. 2.School of Architecture and Built EnvironmentThe University of AdelaideAdelaideAustralia
  3. 3.Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneAustralia

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