Mortgage Mess or Mental Health Matter?by Jennifer Gibson, PharmD | March 29, 2012
The last decade has brought record-high home foreclosures as part of the economic crisis that has gripped the United States. It is evident that these mortgage failures have affected more than just the housing market, bringing widespread implications to the job market, education, and national levels of debt. Home foreclosures may also significantly impact mental health — a public health crisis in addition to an economic and financial one.
Recently, the American Journal of Public Health published a study linking mortgage delinquency and depressive symptoms in older Americans. The researchers used data from the Health and Retirement Study, a longitudinal survey of a nationally-representative sample of adults over 50 years old, to assess changes in health and health-related resources associated with mortgage delinquency over a 2-year period at the height of the housing crisis (2006-2008). Changes in health included incidence of depressive symptoms and major declines in self-reported overall health, and changes in health-related resources included access to affordable food and prescription medications.
Overall, individuals who fell behind on their mortgage payments were more than 8 times more likely to develop depressive symptoms, 7.5 times more likely to experience food insecurity, and nearly 9 times more likely to experience cost-related medication nonadherence than those who did not fall behind on payments. Notably, the mortgage-delinquent group of homeowners had worse health status at baseline, but the results accounted for this difference between the groups.
Home ownership is a sign of wealth and material resources and is associated with better health. Alternatively, financial strain is associated with worse health and higher mortality. These associations are due to several mechanisms: psychological stress, disrupted access to resources such as food and health care, and interruption of social ties and support systems. The implications to psychosocial well-being caused by a mortgage default or foreclosure are believed to be more substantial than other types of financial stress.
Previous studies of mortgage failures reported that individuals in foreclosure had higher rates of depression, hypertension, and heart disease and a higher prevalence of cost-related health care and medication nonadherence. Though, it is not clear if foreclosure causes poor health status or poor health is a risk factor for mortgage-related difficulties. In some studies, homeowners with existing health problems reported being forced to choose between paying medical bills, including prescription drug costs, and their mortgage at the height of financial strain.
The health outcomes in the current study have important implications for older adults, since each predicts further health declines and worse overall outcomes to major illnesses and health conditions. The impairments in physical functioning, social functioning, and employability worsen the cycle of financial strain. Not only are millions of Americans without safe and affordable housing now, millions of Americans are also at risk for or experiencing mental and physical health issues — a significant disadvantage to getting the country back on a healthy economic track.
While the study only addressed older Americans, the results are likely applicable to anyone facing mortgage foreclosure. It would be no surprise if losing one’s home resulted in psychosocial and physical stress. Homeowners in default of their mortgages are a group at high-risk for declines in health, and the authors of the current study assert that these homeowners may benefit from coordinated, affordable health services that includes mental health counseling along with financial counseling services.
Alley DE, Lloyd J, Pagán 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. American journal of public health, 101 (12), 2293-8 PMID: 22021301
Cannuscio CC, Alley DE, Pagán JA, Soldo B, Krasny S, Shardell M, Asch DA, & Lipman TH (2011). Housing strain, mortgage foreclosure, and health. Nursing outlook PMID: 22000689
Pollack CE, Kurd SK, Livshits A, Weiner M, & Lynch J (2011). A case-control study of home foreclosure, health conditions, and health care utilization. Journal of urban health : bulletin of the New York Academy of Medicine, 88 (3), 469-78 PMID: 21491152
Pollack, C., & Lynch, J. (2009). Health Status of People Undergoing Foreclosure in the Philadelphia Region American Journal of Public Health, 99 (10), 1833-1839 DOI: 10.2105/AJPH.2009.161380
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