Half of women without stable or any housing during pandemic report depression, anxiety

Approximately 50% of women experiencing homelessness or unstable housing during the COVID-19 pandemic had depression or anxiety symptoms, according to study results in a research letter published in JAMA Network Open.

“We know the pandemic caused big mental health challenges in the general population, but there’s been almost no research focused on homeless and unstably housed women, who are some of the most vulnerable members of our community,” Elise D. Riley, PhD, MPH, of the department of medicine at the University of California, San Francisco, told Healio Psychiatry. “Even before the pandemic, they faced more physical and mental health problems than most people, with far fewer financial and social resources to deal with them. Unfortunately, public health threats like pandemics, wildfires, and hurricanes will likely become even more common in the years to come, so it’s critical that we learn how to best adapt services for extremely vulnerable people during these ‘big events.’”

Riley and colleagues sought to obtain data on how to adapt services for socioeconomically marginalized people via a survey of mental health symptoms and social challenges experienced during the COVID-19 pandemic among women experiencing homelessness or unstable housing, of whom there were approximately 440,000 in the U.S. They conducted a cross-sectional study between July 2020 and December 2020 among 128 women (40% Black; median age, 56 years) in San Francisco, whom they recruited from homeless shelters, street encampments, free meal programs and low-income hotels. Participants were female sex at birth, aged 18 years or older and had a lifetime history of sleeping in public, a shelter or temporarily with friends or acquaintances. Symptoms of depression measured via the Patient Health Questionnaire-9 and symptoms of anxiety measured via the Generalized Anxiety Disorder Assessment-7 served as outcome variables. The researchers assessed associations between depression and anxiety symptoms and challenges experienced since the pandemic began. As covariates, they included factors previously linked to depression and anxiety, such as race/ethnicity, recent homelessness, unmet subsistence needs, social isolation, increased difficulty managing symptoms of a chronic medical condition and increased difficulty getting treatment for mental health, substance use or a chronic medical condition.

Results showed 66% of participants had at least one unmet subsistence need, 38% were homeless and 53% were socially isolated. A total of 55% had depression and 42% had anxiety during the pandemic, which was similar to the prevalence before the pandemic of symptom scores that indicated depression (49%) and anxiety (36%) among this population. Riley and colleagues noted a significant association between depression and anxiety and recent homelessness ([anxiety OR = 4.61; 95% CI, 1.91- 12.72]; [depression OR = 5.2; 95% CI, 2.37-12.19]), unmet subsistence needs ([anxiety OR = 2.18; 95% CI, 1-4.74]; [depression OR = 4.81; 95% CI, 2.23-10.81]) and social isolation ([anxiety OR = 5.22; 95% CI, 2.34-12.38]; [depression OR = 3.29; 95% CI, 1.62-6.88]).

Women with increased difficulties receiving care for a chronic medical condition during the pandemic had Patient Health Questionnaire-9 scores that were 3.92 points higher compared with those without difficulties, and their likelihood of screening positive for depression was six times higher (OR = 6.26; 95% CI, 2.31-20.93). The researchers observed worse mental health outcomes among women with increased difficulties receiving mental health care and managing symptoms of a chronic medical condition.

“It’s important to provide medical care specific to a crisis like COVID-19,” Riley said. “At the same time, we need to continue taking care of the whole person because the chronic medical conditions that people lived with before the crisis will have a significant influence on their overall health, including their mental health, during and after the crisis.”