Anxiety, mood, and substance use disorders in United States African-American public housing residents

Rental Housing Type and Self-Reported General Health and Mental Health Status: Evidence from the Canadian Housing Survey 2018-2019

Using the Canadian Housing Survey, 2018-2019, we examined self-reported general and mental health among tenants residing in various housing types, including cooperative, non-profit, government, and private housing. Adjusting for confounders, we discovered that tenants in not-for-profit housing reported the highest odds, over four and half times (odds ratio 4.63), of poor general health compared to tenants in privately owned housing in Canada. On the other hand, the odds were reversed for tenants in cooperative housing and government housing, with 24% and 33% lower odds of poor general health, respectively, compared to tenants in privately owned housing. Moreover, we found that tenants in not-for-profit (1.26) and government housing (1.43) reported higher odds of poor mental health. On the other hand, tenants in cooperative housing reported 42% lower odds of poor mental health than tenants in privately owned housing. Furthermore, we observed variations in the odds of poor general and poor mental health among tenants from different equity-seeking groups across different housing types. These findings highlight the importance of considering housing type and equity factors in understanding health outcomes among tenants.

Factors associated with mental health of internal migrants (Kayayei) in Agbogbloshie-Ghana

BACKGROUND

The United Nations (UN) Sustainable Development Goal (SDG) Eight (8) advocates for decent work and improved economic outcomes for all. However, internal migrant workers in Ghana, especially female head porters, commonly known as "Kayayei", work in exploitative and hazardous conditions exposing them to physical and mental health risks. Yet, mental health among this vulnerable group of migrants has not been given the needed attention it deserves in the country. We, therefore, examined the factors associated with mental health challenges among internal migrants (Kayayei) in Ghana.

METHODS

A cross-sectional study among a systematic random sample of 352 Kayayei was conducted in Agbogbloshie-Accra, Ghana. An interviewer-administered questionnaire was used to collect data on the factors impacting the mental health of Kayayei. The study used binary logistic regression in predicting factors impacting mental health distress at a 0.05 level of significance and 95% confidence interval.

RESULTS

The prevalence of depression, anxiety, and stress were, 305 (86.6%), 332 (94.4), and 149 (42.4), respectively, with 147(41.1%) of respondents having all three mental health issues. The difficult nature of work significantly predicted depression, anxiety, and stress. Respondents who perceived their work as very difficult were 4.3 times, (aOR = 4.36, 95% CI = 2.17, 8.76, p =  < 0.001), 3.66 times (aOR = 3.66, 95% CI = 1.37, 9.76, p = 0.009), and 1.73 times (aOR, = 1.73, 95% CI = 1.04, 2.85, p =  < 0.009) more likely to be depressed, anxious, and stressed respectfully as compared to those who rate their work as just difficult.

CONCLUSION

The majority of the Kayayei suffered from mental health distress (depression, anxiety, and Stress) due to their work circumstances. This study suggests that the Ghana Labour Commission must extend the Labour Act 2003(Act 651) to cover the informal sector and create awareness among the Kayayei community to know their rights and report any abuse to law enforcement agencies. It is also suggested that the government, NGOs, and other benevolent organisations train the Kayayei to attain alternative and sustained livelihoods that will not negatively impact their mental health as has been found in the current study. Finally, the government should fully implement the 2012 Mental Health Act to increase awareness and access to quality mental health care.

Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil

INTRODUCTION

Housing-related factors can be predictors of health, including of diabetes outcomes. We analysed the association between subsidised housing residency and diabetes mortality among a large cohort of low-income adults in Brazil.

RESEARCH DESIGN AND METHODS

A cohort of 9 961 271 low-income adults, observed from January 2010 to December 2015, was created from Brazilian administrative records of social programmes and death certificates. We analysed the association between subsidised housing residency and time to diabetes mortality using a Cox model with inverse probability of treatment weighting and regression adjustment. We assessed inequalities in this association by groups of municipality Human Development Index. Diabetes mortality included diabetes both as the underlying or a contributory cause of death.

RESULTS

At baseline, the mean age of the cohort was 40.3 years (SD 15.6 years), with a majority of women (58.4%). During 29 238 920 person-years of follow-up, there were 18 775 deaths with diabetes as the underlying or a contributory cause. 340 683 participants (3.4% of the cohort) received subsidised housing. Subsidised housing residents had a higher hazard of diabetes mortality compared with non-residents (HR 1.17; 95% CI 1.05 to 1.31). The magnitude of this association was more pronounced among participants living in municipalities with lower Human Development Index (HR 1.30; 95% CI 1.04 to 1.62).

CONCLUSIONS

Subsidised housing residents had a greater risk of diabetes mortality, particularly those living in low socioeconomic status municipalities. This finding suggests the need to intensify diabetes prevention and control actions and prompt treatment of the diabetes complications among subsidised housing residents, particularly among those living in low socioeconomic status municipalities.

Changes in health and health care utilization following eviction from public housing

OBJECTIVES

This study sought to (1) determine the number of persons evicted from the Durham Housing Authority (DHA) over a 5-year period, (2) explore changes in the number of persons with various medical diagnoses and health care utilization patterns before and after eviction, and (3) examine how many persons evicted from DHA became literally homeless.

DESIGN

This was a pre/post cross-sectional quantitative study.

SAMPLE

Heads of households evicted from DHA properties from January 1, 2013 through December 31, 2017 were included in the study.

MEASUREMENTS

We matched people evicted by the DHA in a university health system electronic health record system to determine changes in diagnoses and health care utilization before and after eviction. We also matched the cohort in the homeless management information system to determine how many persons evicted became literally homeless.

RESULTS

Findings indicate statistically significant increases in persons with medical diagnoses in five of ten categories, total hospital admissions, and emergency department visits after eviction. Of the 152 people included in the study, 34 (22%) became literally homeless.

CONCLUSIONS

Health and health care utilization patterns were different before and after eviction. Implications for clinicians are explored.

Factors Influencing Gateway Providers' Confidence in Helping People with Mental Illness

Low mental health service utilization among vulnerable groups with mental health needs has been an ongoing public health concern. Guided by the Gateway Provider Model, this study focuses on public housing employees, a unique gateway provider group, who are within close proximity with public housing residents, a vulnerable group who may experience more psychological distress and mental illness. The present study examined the relationships of mental health literacy, stigma, attitude toward mental health treatment, exposure to mental health treatment, and training to confidence among public housing employees (N = 193) in helping someone with mental illness. Findings show that confidence is associated with mental health literacy and training, yet no relationship between confidence and stigma, and confidence and previous exposure to mental health treatment were found. The findings emphasize the importance of mental health literacy and training of gateway providers as a possible way to promote mental health in the community.

The Role of Individual and Small-Area Social and Environmental Factors on Heat Vulnerability to Mortality Within and Outside of the Home in Boston, MA

Climate change is resulting in heatwaves that are more frequent, severe, and longer lasting, which is projected to double-to-triple the heat-related mortality in Boston, MA if adequate climate change mitigation and adaptation strategies are not implemented. A case-only analysis was used to examine subject and small-area neighborhood characteristics that modified the association between hot days and mortality. Deaths of Boston, Massachusetts residents that occurred from 2000–2015 were analyzed in relation to the daily temperature and heat index during the warm season as part of the case-only analysis. The modification by small-area (census tract, CT) social, and environmental (natural and built) factors was assessed. At-home mortality on hot days was driven by both social and environmental factors, differentially across the City of Boston census tracts, with a greater proportion of low-to-no income individuals or those with limited English proficiency being more highly represented among those who died during the study period; but small-area built environment features, like street trees and enhanced energy efficiency, were able to reduce the relative odds of death within and outside the home. At temperatures below current local thresholds used for heat warnings and advisories, there was increased relative odds of death from substance abuse and assault-related altercations. Geographic weighted regression analyses were used to examine these relationships spatially within a subset of at-home deaths with high-resolution temperature and humidity data. This revealed spatially heterogeneous associations between at-home mortality and social and environmental vulnerability factors.

Psychiatric Disorders and Alcohol Consumption Among Low-Income African Americans:Gender Differences

Background: Although cooccurrence of nonsubstance use disorders (non-SUDs) and substance use is well-established in the literature, most of what we know in this regard is derived from studies that have recruited predominantly White sample populations. As a result, there is a gap in knowledge on this link among low-income African Americans (AAs). There is also a need to understand how low-income AA men and women differ in these associations. Objective: To study whether there is an association between number of non-SUDs and amount of alcohol consumption by AA adults, and whether this association varies between AA men and women. Methods: This cross-sectional study recruited a nonrandom sample of 150 AA adults with non-SUDs (i.e., major depression, bipolar disorders, obsessive–compulsive disorder, paranoid disorder, panic disorder, posttraumatic stress disorder (PTSD), and schizoaffective disorder). The independent variable was the number of non-SUDs. The dependent variable was the amount of alcohol consumption. Age, socioeconomic status (educational attainment and household income), and self-rated health were covariates. Gender was the moderator. Linear regression models were used to analyze the data. Results: A higher number of non-SUDs was not associated with a higher amount of alcohol use in the pooled sample of AA adults. We, however, found a significant interaction between gender and number of non-SUDs on the amount of alcohol use, suggesting a stronger effect of non-SUDs on alcohol consumption in AA men than in AA women. Gender-stratified linear regression models showed a positive association between number of non-SUDs and amount of alcohol consumption in AA men but not in AA women. Conclusion: Non-SUDs impact alcohol use of AA men but not women. Future research should test whether AA men may have a higher tendency to turn to alcohol to regulate their emotions and cope with psychological pain due to multiple non-SUDs. The results also suggest that integration of services for SUDs and non-SUDs may be more relevant to provision of mental health services for AA men than AA women.

Public housing and healthcare use: an investigation using linked administrative data

OBJECTIVE

This study investigated whether a move to public housing affects people's use of healthcare services.

METHOD

Using administrative data from Manitoba, the number of hospitalizations, general practitioner (GP), specialist and emergency department (ED) visits, and prescription drugs dispensed in the years before and after the housing move-in date (2012/2013) were measured for a public housing and matched cohort. Generalized linear models with generalized estimating equations tested for differences between the cohorts in utilization trends. The data were modeled using Poisson (rate ratio, RR), negative binomial (incident rate ratio, IRR), and binomial (odds ratio, OR) distributions.

RESULTS

GP visits (IRR = 1.04, 95% CI 1.01-1.06) and prescriptions (IRR = 1.04, 95% CI 1.02-1.05) increased, while ED visits (RR = 0.90, 95% CI 0.82-1.00) and hospitalizations (OR = 0.95, 95% CI 0.93-0.96) decreased over time. The public housing cohort had a significantly higher rate of GP visits (IRR = 1.08, 95% CI 1.04-1.13), ED visits (RR = 1.18, 95% CI 1.01-1.37), and prescriptions (IRR = 1.09, 95% CI 1.05-1.13), and was more likely to be hospitalized (OR = 1.39, 95% CI 1.21-1.61) compared to the matched cohort. The rate of inpatient days significantly decreased for the public housing cohort, but did not change for the matched cohort.

CONCLUSION

Healthcare use changed similarly over time (except inpatient days) for the two cohorts. Public housing provides a basic need to a population who has a high burden of disease and who may not be able to obtain and maintain housing in the private market.

Changes in healthcare use among individuals who move into public housing: a population-based investigation

Background

Residence in public housing, a subsidized and managed government program, may affect health and healthcare utilization. We compared healthcare use in the year before individuals moved into public housing with usage during their first year of tenancy. We also described trends in use.

Methods

We used linked population-based administrative data housed in the Population Research Data Repository at the Manitoba Centre for Health Policy. The cohort consisted of individuals who moved into public housing in 2009 and 2010. We counted the number of hospitalizations, general practitioner (GP) visits, specialist visits, emergency department visits, and prescriptions drugs dispensed in the twelve 30-day intervals (i.e., months) immediately preceding and following the public housing move-in date. Generalized linear models with generalized estimating equations tested for a period (pre/post-move-in) by month interaction. Odds ratios (ORs), incident rate ratios (IRRs), and means are reported along with 95% confidence intervals (95% CIs).

Results

The cohort included 1942 individuals; the majority were female (73.4%) who lived in low income areas and received government assistance (68.1%). On average, the cohort had more than four health conditions. Over the 24 30-day intervals, the percentage of the cohort that visited a GP, specialist, and an emergency department ranged between 37.0% and 43.0%, 10.0% and 14.0%, and 6.0% and 10.0%, respectively, while the percentage of the cohort hospitalized ranged from 1.0% to 5.0%. Generally, these percentages were highest in the few months before the move-in date and lowest in the few months after the move-in date. The period by month interaction was statistically significant for hospitalizations, GP visits, and prescription drug use. The average change in the odds, rate, or mean was smaller in the post-move-in period than in the pre-move-in period.

Conclusions

Use of some healthcare services declined after people moved into public housing; however, the decrease was only observed in the first few months and utilization rebounded. Knowledge of healthcare trends before individuals move in are informative for ensuring the appropriate supports are available to new public housing residents. Further study is needed to determine if decreased healthcare utilization following a move is attributable to decreased access.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3109-7) contains supplementary material, which is available to authorized users.

Expanding a measure of mental health literacy: Development and validation of a multicomponent mental health literacy measure

Mental health literacy (MHL) is an important factor in mental health care. However, few measures are available that assess multiple components of MHL and that are applicable to lay community people. A valid, comprehensive measure is needed to adequately identify the level of MHL and need for mental health education. This study presents the development of a multicomponent MHL measure and its psychometric properties. Participants (n=211) were recruited from a local public housing authority in Texas. A series of an exploratory factor analysis, a confirmatory factor analysis, an independent sample t-test, and a correlation analysis were used to assess construct, known-groups, and concurrent validity. Internal consistency reliability was examined by Kuder-Richardson Formula 20. The result suggested a second-order factor model by three first-order factors: knowledge-oriented MHL; beliefs-oriented MHL; resource-oriented MHL. This measure was a valid tool to assess MHL among public housing staff. This measure can be useful in examining lay community members' levels of MHL.

Health and social predictors of applications to public housing: a population-based analysis

BACKGROUND

Residents of public housing are often in poor health. However, it is unclear whether poor health precedes residency in public housing. We compared the health of people who applied to public housing to people who did not apply and had similar socioeconomic characteristics.

METHODS

Population-based administrative databases from Manitoba, Canada, containing health, housing and income assistance information were used to identify a cohort of individuals who applied to public housing and a matched cohort from the general population. Conditional logistic regression was used to test the association between a public housing application and health status and health service use, after controlling for income.

RESULTS

There were 10 324 individuals in each of the public housing applicant and matched cohorts; the majority were women, young, urban residents, and received income assistance. A higher per cent of the public housing cohort had physician-diagnosed physical and mental health conditions compared to the matched cohort. Physical health, mental health and health service use were significantly associated with applying to public housing, after controlling for individual and area-level income.

CONCLUSIONS

Applicants to public housing were in poorer health compared to people of the same income level who did not apply to public housing. These health issues may affect the long-term stability of their tenancy if appropriate services and supports are not provided. Additionally, preventing ill health, better management of mental health and additional supports may reduce the need for public housing, which, in turn, would alleviate the pressure on governments to provide this form of housing.

Prevalence of depressive symptoms and associated factors in older adult public housing residents

The purpose of this pilot study was to identify the prevalence of and risk factors associated with depressive symptoms among older adult residents of a public housing apartment. Self-reported depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D) 8. A self-report questionnaire was used to collect data on risk factors of sociodemographic information, cardiovascular health history, and history of depression. Fifty-eight of 171 residents responded, and 31% of residents met the CES-D 8 criterion for depression (total score ≥7). Sequential multiple regression models identified age, loss of loved ones in the past year, and financial worries as significant predictors of CES-D 8 scores. These study results have implications for future studies of depressive symptoms in older adults, suggesting that grief and financial assistance programs may help reduce risks associated with depressive symptoms among community-dwelling older adults living in public housing.

Cognitive impairment in public housing residents living in Western New York

PURPOSE

Many older adults in the USA live in public housing facilities and have characteristics that may place them at risk for cognitive impairment. Cognitive impairment has been largely unexamined in this socioeconomically disadvantaged population, however. We therefore aim to characterize its prevalence and correlates, which may help determine which residents could benefit from additional assistance to optimize their ability to function independently.

METHODS

We interviewed 190 English-speaking public housing residents aged 60 years and older in Rochester, a city in Western New York, to assess socio-demographics, mental health, physical health and disability, coping strategies and social support, and service utilization. The Mini-Cog dementia screen evaluated cognitive status.

RESULTS

Twenty-seven percent of residents screened positive for cognitive impairment. In bivariate analyses, older age, less education, greater duration of residence, worse health, less reliance on adaptive coping strategies, and greater utilization of health services were associated with cognitive impairment; age and worse health remained correlated with cognitive impairment in multivariable analyses. Anxiety, depression, and history of substance misuse were not associated with cognitive impairment.

CONCLUSIONS

The high level of cognitive impairment in public housing could threaten residents' continued ability to live independently. Further examination is needed on how such threats to their independence are best accommodated so that public housing residents at risk for needing higher levels of care can successfully age in place.

Alcohol misuse among older adult public housing residents

Low-income older adults living in public housing are at heightened risk for substance misuse. This study identified the prevalence of alcohol misuse among older public housing residents (n = 187) and explored predictors of problem drinking. Including weekly drinking levels and binge drinking, 23% of the sample engaged in problem drinking behaviors. Logistic regression analysis revealed that race, gender, employment status, years smoking, and illegal drug use were significant predictors of problem drinking. No residents were receiving substance abuse treatment. As the number of older adults increase, training social workers to assess and treat alcohol misuse in older adults is critical.

Understanding tobacco use among urban African American adolescents living in public housing communities: a test of problem behavior theory

This study was guided by Jessor and Jessor's problem behavior theory (PBT) to test the relative effects of personality, perceived environment and behavior system variables on urban teen tobacco use. A sample of 518 urban African American youth residing in public housing communities in three large U.S. cities was utilized. Our results provide partial support for PBT in this study. Personality system variables (i.e., positive attitudes toward tobacco use, and depressive affect, cause and outcome indicators) and behavior system variables (i.e., delinquent behaviors) significantly predicted adolescent tobacco use. Depressive effect and cause indicators were stronger than depressive outcome indicators in predicting the extent of tobacco use. Additionally, age positively moderated the impact of positive attitudes about tobacco use on the extent of adolescent tobacco use. However, perceived environment system variables (e.g., exposure to delinquent peers) did not predict such use. This study suggests that PBT may aid in understanding adolescent tobacco use. Implications for practice and future inquiry are discussed.

Mental healthcare need and service utilization in older adults living in public housing

OBJECTIVES

Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have many risk factors for anxiety and depression.

DESIGN

Cross-sectional study.

SETTING

Public housing high-rises in Rochester, New York.

PARTICIPANTS

One hundred ninety residents aged 60 years and older.

MEASUREMENTS

Anxiety and depression were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, GAD-7, and Patient Health Questionnaire. We obtained information on mental healthcare from medication review and self-report.

RESULTS

Participants had a median age of 66 years, 58% were women, 80% were black, and 92% lived alone. Many participants (31%) were in need of mental healthcare: 21% had syndromal and 11% had subsyndromal anxiety or depression. Mental healthcare need was associated with younger age; intact cognitive functioning; impairments in instrumental activities of daily living (IADL); more medical illness; decreased mobility; smaller social network size; more severe life events; and increased utilization of medical, human, and informal services. Of those with mental healthcare need, most were not receiving it. Compared with residents receiving mental healthcare, residents with untreated need were more likely to be men and have less IADL impairment, medical illness, severe life events, onsite social worker use, and human services utilization.

CONCLUSIONS

Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification, treatment, and ultimately prevention of late-life mental illness in this community setting.

The characteristics of anxiety and depression symptom severity in older adults living in public housing

BACKGROUND

Anxiety and depression are common in older adult public housing residents and frequently co-occur. To understand anxiety and depression more fully in this socioeconomically disadvantaged population, this study relies on the Social Antecedent Model of Psychopathology to characterize anxiety and depression symptoms concurrently.

METHODS

190 public housing residents aged 60 years and older in Rochester, New York, participated in a research interview during which they reported on variables across the six stages of the Social Antecedent Model. GAD-7 and PHQ-9 assessed anxiety and depression symptoms, respectively.

RESULTS

In these older adult residents, anxiety and depression symptom severity scores were correlated (r = 0.61; p < 0.001). Correlates of anxiety and depression symptom severity were similar for both outcomes and spanned the six stages of the Social Antecedent Model. Multivariate linear regression models identified age, medical comorbidity, mobility, social support, maladaptive coping, and recent life events severity as statistically significant correlates. The regression models accounted for 43% of anxiety and 48% of depression symptom variability.

CONCLUSIONS

In public housing residents, late-life anxiety and depression symptoms were moderately correlated. Anxiety symptom severity correlates were largely consistent with those found for depression symptom severity. The broad distribution of correlates across demographic, social, medical, and behavioral domains suggests that the context of late-life anxiety and depression symptomatology in public housing is complex and that multidisciplinary collaborative care approaches may be warranted in future interventions.

Income-related inequalities in common mental disorders among ethnic minorities in England

PURPOSE

The relative prevalence of common mental health problems among different ethnic groups in Britain is one of the least researched topics in health variations research. We calculate and compare income-related inequalities in common mental disorders among ethnic groups in Britain.

METHOD

Data from a nationally representative survey of ethnic minorities (the EMPIRIC survey) were used to calculate concentration index values to indicate the extent of income-related inequalities within and across ethnic groups.

RESULTS

Looking at income-related inequalities in common mental disorders within each of the ethnic groups, it was found that the burden of these disorders were greater for the lower income groups among the Irish, White and African Caribbean communities. Within-group inequality was less clearly defined for each of the three Asian communities: Indian, Bangladeshi and Pakistani. However, when the data were pooled and individuals were assigned income ranks in the pooled set (not within their own ethnic group), the relative position of those in lower income groups among the different groups was striking. The poor among the Bangladeshi, Pakistani and the African Caribbean groups clearly suffered both from low income and a greater burden of mental health morbidity than the other three groups. The effect of lower income is thus worse for the mental health of populations if they are African Caribbean, Pakistani or Bangladeshi than if they are White, Irish or Indian.

CONCLUSION

Inequality in mental health morbidity between and within ethnic groups is at least partly linked to income, and thus to employment and education. Tackling disadvantage and discrimination in these areas could help to tackle the challenge of mental ill-health.

The relationship between socioeconomic position and depression among a US nationally representative sample of African Americans

PURPOSE

Findings from previous studies have not revealed significant, inverse relationships between socioeconomic position (SEP) and depression among African Americans. This study examined the relationship between multiple indicators of SEP and Major Depressive Episode (MDE) among African Americans.

METHODS

Data were drawn from the National Survey of American Life main interview and re-interview. MDE, at both 12 month and lifetime intervals, was assessed using the World Mental Health version of the Composite International Diagnostic Interview. Logistic regression models were adjusted for demographics.

RESULTS

For 12-month MDE, household income and unemployment predicted greater odds of MDE among African American men, while there was an inverse relationship between education and 12-month MDE. Only unemployment was significantly associated with lifetime MDE among African American men. For African American women, a significant inverse relationship between household income and 12-month MDE was observed.

CONCLUSIONS

Findings garnered from this study indicate that it is important to consider multiple measures of SEP in the prediction of depression among African Americans, and that the pattern of association between SEP and depression varies according to sex. Considering the paucity of studies that have explored the relationship between SEP and depression, additional research is needed to more firmly establish the relationship between SEP and depression. It is also important to consider stressors that may affect the relationship between SEP and depression among African Americans.