Unstable housing in childhood associated with anxiety in adolescence

Key takeaways:

• Adolescents who experienced housing insecurity reported more anxiety and depressive symptoms compared with their peers.
• Researchers did not find a trajectory of increasing insecurity over time.

Adolescents who experienced housing insecurity beginning in infancy reported worse overall health outcomes, including anxiety and depressive symptoms, according to study results published in Pediatrics.

The findings indicate a need for screening methods that identify housing insecurity at the start, as well as policies to prevent housing insecurity and associated health outcomes in this population, researchers concluded.

It is known that housing insecurity adversely affects child growth and abstract development, but less is known about the cumulative long-term effects, they wrote in the study.

“I have a broad interest in mental health and wanted to further contextualize factors in development that may influence health and psychological wellbeing later in life,” Kristyn A. Pierce, MPH, a researcher in the department of pediatrics at NYU Grossman School of Medicine, told Healio. “There are many people who still believe that ‘they are just a child [and] they will not remember this,’ but there is mounting evidence that that is not true.”

“My clinical practice includes a lot of children experiencing housing insecurity without a lot of context about what the longitudinal impacts might be,” Carol Duh-Leong, MD, MPP, assistant professor in the department of pediatrics at NYU Grossman School of Medicine, told Healio.

Pierce, Duh-Leong and colleagues pooled data from the Future of Families and Child Wellbeing Study and created a composite measure of housing insecurity using five indicators — such as skipping a rent or mortgage payment or eviction — for participants aged 1, 3, 5, 9 and 15 years.

They identified three distinct trajectories of housing insecurity, including no insecurity (“secure”); intermittent-moderate insecurity (“moderately insecure”) and high insecurity in early childhood (“highly insecure”).

Of the 4,714 participants, researchers classified 47.3% into the secure group, 46.4% into the moderately insecure group and 6.3% into the highly insecure group.

Results showed that adolescents who experienced secure housing in childhood reported better overall health compared with those in the moderately insecure (adjusted OR = 0.81;95% CI, 0.69–0.95) and highly insecure groups (aOR =, 0.67; 95% CI, 0.5–0.92).

In addition, adolescents in the highly insecure housing group reported significantly higher anxiety symptoms (adjusted incidence rate ratio [IRR] = 1.06; 95% CI, 1.01–1.11), and more depressive symptoms (adjusted IRR = 1.14; 95% CI, 1.08–1.20).

“Previous studies that investigated longitudinal patterns of housing insecurity in adult samples found a trajectory of increasing insecurity over time. We did not find a trajectory of increasing housing insecurity in our sample of children,” the two authors told Healio in joint email responses.

“This could perhaps be due to certain protective factors for families with young children,” they said. “It’s important to note that the trajectories are not reflective of every individual experience, and therefore, there could have been children who experienced increasing insecurity who were not captured in our model. It was also surprising that even though some children in both insecure housing trajectory groups may have experienced periods of decreasing or no housing insecurity, they still had worse health outcomes as compared to children who had secure housing for the entirety of the study.”

According to the researchers, future research should examine psychiatric symptoms longitudinally with housing insecurity and other material hardships during childhood to better understand how those experiences relate across developmental stages.

“Additionally, we can’t speak to all needs of a specific community without bringing them into the conversation. This emphasizes the need for qualitative research to more thoroughly capture the insights of families experiencing housing insecurity so we can begin to understand the best ways to prevent and address housing insecurity and its consequences,” the two authors told Healio.

“Housing insecurity is not a ‘one size fits all’ experience and therefore may be hard to identify in practice,” they added. “[Physicians] should continue to screen in primary care settings, but it is important to involve other stakeholders — for example, social workers, public health professionals — to develop more creative screening/intervention efforts because families experiencing housing insecurity may not always be consistently engaged within a health system.”