Housing Assistance and Mental Health: Testing the Direct Association

Roughly five million households receive federal housing assistance in the United States. Studies conducted in the 1990s found widespread poor mental health among residents of public housing projects, one of the two main types of federal housing assistance. Subsequent studies often lacked a valid comparison group to determine whether residents entered the program with poor mental health or if the program led to poorer mental health.

In "Is Housing Assistance Associated with Mental Health" (Journal of American Planning Association, Vol. 90, No. 1), Atticus Jaramillo and William Rohe tested for a direct association between housing assistance and two mental health outcomes: depression and anxiety.

Testing Mental Health Outcomes

This study addressed calls for more theoretically and conceptually focused research. Jaramillo and Rohe tested major hypotheses regarding the psychological pathways linking housing assistance and mental health.

To achieve this, the authors compared a sample of assisted housing residents to a matched group of non-assisted adults. Depression and anxiety were selected as two measures of mental health due to their known reliability.

The authors also examined mediated pathways, including psychological stress, mastery, and exposure to discrimination. Path analysis extends traditional regression models by enabling researchers to specify the direct and mediated pathways that could elucidate the relationship between treatment, mediational, outcome, and control variables.

The study controlled for known predictors of mental health, including race, sex, presence of children in the household, and education. Additionally, the authors controlled for life experiences, such as recent exposure to trauma, receipt of mental health services, and mental health issues during adolescence. Furthermore, they accounted for neighborhood socioeconomic disadvantage measured at the census tract level.

Figure 1: Housing reliability compared to mental health.

Is There a Direct Association?

Housing assistance alone was only modestly associated with anxiety, and there was no association found for depression. The authors emphasize that these findings do not negate other important benefits of housing assistance, such as protection from eviction and increased housing stability.

Because housing assistance alone may not promote better mental health, the authors recommend that mental health services be made available to program participants. To accomplish this, planners and policymakers must develop new areas of expertise and redefine their strategic priorities. Interagency collaboration is essential to ensure that all individuals living in assisted housing have access to mental health services.

Limitations of Research

The study utilizes point-in-time data, which should not be interpreted as causal. Another limitation of this analysis was the small size of the treatment group. This constraint meant the researchers could not separately analyze the associations between the Housing Choice Voucher program and conventional public housing. Lastly, influential attributes of the housing market may have been overlooked in assessing neighborhood disadvantage.

Top image: iStock / Getty Images Plus - U.S. Dept. of Housing and Urban Development via Flickr, 2019