Do financial hardship and social support mediate the effect of unaffordable housing on mental health?
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.
KeywordsCausal 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.
- 1.WHO (2014) Social determinants of mental health. WHO and the Calouste Gulbenkian Foundation, GenevaGoogle Scholar
- 2.Lund C, Brooke-Sumner C, Baingana F, Baron EC, Breuer E, Chandra P, Haushofer J, Herrman H, Jordans M, Kieling C, Medina-Mora ME, Morgan E, Omigbodun O, Tol W, Patel V, Saxena S (2018) Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. Lancet Psychiatry 5(4):357–369. https://doi.org/10.1016/S2215-0366(18)30060-9 CrossRefGoogle Scholar
- 6.Durand CP, Andalib M, Dunton GF, Wolch J, Pentz MA (2011) A systematic review of built environment factors related to physical activity and obesity risk: implications for smart growth urban planning. Obesity Rev 12(5):e173–e182. https://doi.org/10.1111/j.1467-789X.2010.00826.x CrossRefGoogle Scholar
- 17.Milligan V, Phibbs P, Gurran N, KF (2007) Approaches to evaluation of affordable housing initiatives in Australia. Australian Housing and Urban Research Institute Limited, Melbourne:AHURI Research Paper No. NRV3-7Google Scholar
- 20.Alley DE, Lloyd J, Pagan JA, Pollack CE, Shardell M, Cannuscio C (2011) Mortgage delinquency and changes in access to health resources and depressive symptoms in a nationally representative cohort of Americans older than 50 years. Am J Public Health 101(12):2293–2298. https://doi.org/10.2105/ajph.2011.300245 CrossRefGoogle Scholar
- 22.Bartley M (2004) Health inequality: an introduction to theories, concepts, and methods. Polity Press, CambridgeGoogle Scholar
- 23.Townsend P, Davidson N, Black DS (1982) Inequalities in health: the Black report. Penguin, HarmondsworthGoogle Scholar
- 29.Summerfield M, Freidin S, Hahn M, Ittak P, Li N, Macalalad N, Watson N, Wilkins R, Wooden M (2011) HILDA user manual–release 10. Melbourne Institute of Applied Economic and Social Research, University of Melbourne, MelbourneGoogle Scholar
- 30.Yates J, Milligan V (2007) Housing affordability: a 21st century problem. AHURI Final Report No. 105. Australian Housing and Urban Research Institute Limited, MelbourneGoogle Scholar
- 32.Butterworth P, Crosier T (2004) The validity of the SF-36 in an Australian National Household Survey: demonstrating the applicability of the Household Income and Labour Dynamics in Australia (HILDA) Survey to examination of health inequalities. BMC Public Health 4:44. https://doi.org/10.1186/1471-2458-4-44 CrossRefGoogle Scholar
- 33.Pirkis J, Burgess P, Kirk P, Dodson S, Coombs T (2005) Review of standardised measures used in the National Outcomes and Casemix Collection (NOCC). NSW, SydneyGoogle Scholar
- 38.VanderWeele TJ (2015) Explanation in causal inference: methods for mediation and interaction. Oxford University Press, New YorkGoogle Scholar
- 42.Dunn N, Inskip H, Kendrick T, Oestmann A, Barnett J, Godfrey K, Cooper C (2008) Does perceived financial strain predict depression among young women? Longitudinal findings from the Southampton Women’s Survey. Ment Health Fam Med 5(1):15–21Google Scholar
- 47.COAG (2012) The roadmap for national mental health reform 2012–2022. Council of Australian Governments, CanberraGoogle Scholar