housing and mental health: a review of the evidence and a ... · housing and mental health 477...
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Journal of Social Issues, Vol. 59, No. 3, 2003, pp. 475--500
Housing and Mental Health: A Review of the Evidenceand a Methodological and Conceptual Critique
Gary W. Evans∗Cornell University
Nancy M. Wells∗Cornell University
Annie MochUniversity of Paris
Despite the fact that people invest more financial, temporal, and psychologicalresources in their homes than in any other material entity, research on housingand mental health is remarkably underdeveloped. We critically review existingresearch on housing and mental health, considering housing type (e.g., single-family detached versus multiple dwelling), floor level, and housing quality (e.g.,structural damage). We then discuss methodological and conceptual shortcomingsof this literature and provide a theoretical framework for future research on housingquality and mental health.
∗The first and second author shared equally in the development of this article. Correspondenceconcerning this article should be addressed to either Gary Evans, Departments of Design and Envi-ronmental Analysis and of Human Development, Cornell University, Ithaca, NY 14853-4401 [e-mail:[email protected]] or Nancy Wells, Department of Design and Environmental Analysis, Cornell Uni-versity, Ithaca, NY 14853-4401 [e-mail: [email protected]].
Preparation of this article was partially supported by Hatch Grants from the U.S. Department ofAgriculture (NY 327407 and 327416), the National Institute of Child Health and Human Development(I F33 HD08473-01), the John D. and Catherine T. MacArthur Foundation Network on SocioeconomicStatus and Health, the W. T. Grant Foundation, the Bronfenbrenner Life Course Center at CornellUniversity, the Rackham Graduate School Regents’ and the Seabury Foundation Fellowship at theUniversity of Michigan, the Society for the Psychological Study of Social Issues, and the NationalInstitute of Mental Health (T32MH19958-05). We thank Sherry Bartlett and Frank Becker for feedbackon earlier drafts.
475
C© 2003 The Society for the Psychological Study of Social Issues
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476 Evans, Wells, and Moch
The home environment is of tremendous significance to human beings. Theresidential setting is where people typically spend most of their time (Robinson &Godbey, 1997); is the venue for contact with the most important members of one’ssocial network (Bronfenbrenner & Evans, 2000); and for most people, representstheir major financial and personal investment (Freeman, 1984, 1993). Given thesignificance of the residential environment to human beings, it is appropriate toask whether housing influences humans’ mental health.
This article explores the relationship between housing and mental health.We first provide a review of the literature, restricting our focus to the immediateresidential space and omitting neighborhood characteristics as well as researchon noise and crowding that has been previously reviewed (Evans, 2001). We thenaddress conceptual issues relevant to housing and mental health research, with aparticular focus on moderators and mediators that may enhance our understandingof the processes underlying linkages between housing and mental health. Lastly,we briefly address the policy implications of this area of research.
Research on Housing and Mental Health: A Review of the Literature
Poor mental health encompasses negative affect, psychological distress, andpsychiatric disorder. A variety of housing characteristics may influence mentalhealth. Our literature review is organized by four categories: housing type (e.g.,single-family detached versus multiple dwelling units, low-rise versus high-risebuildings); floor level of dwelling; housing quality, housing type, and floor levelwith respect to children’s well-being; and overall housing quality (e.g., structuralquality, maintenance, and upkeep). The research related to each of these categoriesis summarized within a table. The studies listed within each table are organizedchronologically. For each study we briefly describe the design of the study andthe sample. We characterize the housing variable under examination and describethe mental health outcome measure(s) used. We indicate whenever reliability andvalidity data are available for the mental health measure. Finally, we describe anymain and interactive effects. In our descriptions corresponding to the tables, webriefly summarize the general findings or trends among the studies, mention possi-ble explanatory mechanisms (mediators), and highlight the salient methodologicalissues.
Housing Type: Effects of Single-Family Detached Versus Multiple DwellingUnits and Low-Rise Versus High-Rise Buildings
The studies presented in Table 1 examine mental health differences among res-idents of various housing types. Nearly all the studies suggest that multi-dwellinghousing is associated with adverse psychological health. In general, people livingin high-rises seem to have more mental health problems than those living in low-rises or houses. With the exception of Ineichen and Hooper (1974), the research
-
Housing and Mental Health 477Ta
ble
1.H
ousi
ngTy
pe:E
ffec
tsof
Sing
le-F
amily
Det
ache
dV
ersu
sM
ultip
leD
wel
ling
Uni
tsan
dL
ow-R
ise
Ver
sus
Hig
h-R
ise
Bui
ldin
gson
Men
talH
ealth
Aut
hor(
s)D
esig
n/N
otes
Part
icip
ants
Hou
sing
Out
com
eB
asic
Res
ult
Fann
ing,
1967
Ran
dom
assi
gnm
ent
1500
wom
en(B
ritis
h&
Can
adia
nse
rvic
emen
’sw
ives
)(G
erm
any)
Det
ache
dho
mes
&m
ultiu
nit3
–4st
ory
blgs
M.D
.vis
itsfo
rps
ycho
logi
cal
sym
ptom
s
Mul
tiuni
tdw
elle
rsha
dhi
gher
rate
sof
visi
tsto
M.D
.for
psyc
holo
gica
lsy
mpt
oms
Am
ick
&K
viz,
1974
915
adul
tpub
lichs
gre
side
nts
(U.S
.)H
igh-
rise
v.lo
w-r
ise
Alie
natio
nSi
gnif
ican
tlyhi
gher
leve
lsof
alie
natio
nin
high
rise
blgs
than
inlo
w-r
ises
Bag
ley,
1974
Mat
ched
onag
e,cl
ass,
no.o
fch
ildre
n,le
ngth
ofre
side
nce
inci
ty
69w
omen
(hig
h-ri
se),
43w
omen
(hou
ses)
(Eng
land
)
12-s
tory
high
-ris
esv.
2-st
ory
sem
i-de
tach
edhs
g(w
gard
ens)
Neu
rotic
ism
and
M.D
.vi
sits
Hou
sedw
elle
rsha
dlo
wer
neur
otic
ism
scor
esan
dfe
wer
M.D
.vi
sits
for
“ner
vous
illne
ss”
Inei
chen
&H
oope
r,19
74N
om
atch
ing
orst
atis
tical
cont
rols
262
youn
gfa
mili
es(E
ngla
nd)
Hig
h-ri
sev.
low
-ris
eho
uses
Psyc
holo
gica
lsy
mpt
oms
Poor
men
talh
ealth
amon
ghi
gh-r
ise
resi
dent
s,bu
twor
seam
ong
hous
ere
side
nts
Hoo
per
&In
eich
en,1
979
18m
o.la
ter–
follo
w-u
pof
Inei
chen
&H
oope
r(1
974)
262
youn
gfa
mili
es(E
ngla
nd)
Hig
h-ri
sev.
low
-ris
eho
uses
Psyc
holo
gica
lsy
mpt
oms
Foun
dan
iron
ing-
outo
fpr
ior
(197
4)m
enta
lhea
lthdi
ffer
ence
s
Ric
hman
,197
4C
ontr
olle
dfo
rSE
S75
wom
en(E
ngla
nd)
Hig
h-ri
sev.
low
-ris
ev.
hous
esPs
ycho
logi
cal
prob
lem
sW
omen
livin
gin
high
-ris
eor
low
-ris
efl
ats
com
plai
ned
mor
eab
out
lone
lines
san
dde
pres
sion
than
wom
enliv
ing
inho
uses
Ric
hman
,197
7C
ontr
olle
dfo
rSE
S19
8w
omen
(Eng
land
)H
ouse
sv.
flat
sv.
mai
sone
ttes
Dep
ress
ion
[RV
]W
omen
livin
gin
hous
esha
dle
ssde
pres
sion
than
wom
enin
flat
san
dm
aiso
nette
sM
oore
,197
4M
atch
edon
rank
,ag
e,fa
mily
size
,du
ratio
nof
tena
ncy
169
Bri
tish
&C
anad
ian
serv
icem
en’s
wiv
es(G
erm
any)
Flat
dwel
lers
v.ho
use
dwel
lers
Psyc
hiat
ric
illne
ss[R
V],
M.D
.vis
itsfo
rps
ycho
logi
cal
sym
ptom
s
No
sign
ific
antd
iffe
renc
ein
psyc
hiat
ric
illne
ss,t
houg
htr
ends
wer
ein
expe
cted
dire
ctio
n.Si
mila
rtr
ends
for
visi
tsto
M.D
.for
psyc
hiat
ric
illne
ss
(con
tinu
ed)
-
478 Evans, Wells, and Moch
Tabl
e1.
(Con
tinu
ed)
Aut
hor(
s)D
esig
n/N
otes
Part
icip
ants
Hou
sing
Out
com
eB
asic
Res
ult
Moo
re,1
975
Mat
ched
onra
nk,
age,
fam
ilysi
ze,
dura
tion
ofte
nanc
y
688
Bri
tish
&C
anad
ian
serv
icem
en’s
wiv
es(G
erm
any)
Flat
dwel
lers
v.ho
use
dwel
lers
Neg
ativ
eaf
fect
soci
alin
tera
ctio
nFl
atdw
elle
rsle
ssha
ppy,
less
heal
thy,
liked
area
less
,&co
mpl
aine
dm
ore
abou
tiso
latio
n&
lone
lines
s
Moo
re,1
976
Mat
ched
onra
nk,
age,
fam
ilysi
ze,
dura
tion
ofte
nanc
y
167
hous
edw
elle
rs,
167
flat
dwel
lers
—B
ritis
h&
Can
adia
nse
rvic
emen
’sw
ives
(Ger
man
y)
Flat
dwel
lers
v.ho
use
dwel
lers
Psyc
hiat
ric
illne
ss[R
V],
neur
otic
ism
,M
.D.v
isits
for
psyc
hiat
ric
illne
ss
Neu
rotic
pers
onal
ities
dwel
ling
infl
ats
mor
elik
ely
toha
veps
ych.
illne
ssth
anst
able
pers
onal
ities
infl
ats.
No
sim
ilar
diff
eren
ceam
ong
hous
edw
elle
rs
Wilc
ox&
Hol
ahan
,197
6M
atch
edon
greg
ario
usne
ss,
self
-est
eem
,siz
eof
hom
etow
n,ra
ce
110
2nd
sem
este
rfr
eshm
en(U
.S.)
Hig
h-ri
sev.
low
-ris
edo
rmito
ries
Soci
alin
tera
ctio
n,so
cial
supp
ort[
RV
]H
igh-
rise
resi
dent
sfo
und
toha
vele
ssso
cial
supp
orta
ndw
ere
less
soci
ally
invo
lved
with
othe
rre
side
nts
Zal
ot&
Web
ber,
1977
No
mat
chin
g87
adul
ts(C
anad
a)H
igh-
rise
v.si
ngle
-fam
ilyde
tach
edho
mes
Soci
alco
ntac
twne
ighb
ors
&co
mpl
exity
ofde
scri
ptio
nsof
neig
hbor
s[R
V]
Res
iden
tsof
sing
le-f
amily
deta
ched
hsg
had
mor
ein
tera
ctio
nw
ithne
ighb
ors
and
gave
mor
eco
gniti
vely
com
plex
desc
ript
ions
ofne
ighb
ors
McC
arth
y&
Saeg
ert,
1979
Ran
dom
assi
gnm
entt
obl
gs
60ad
ults
—m
ostly
Afr
ican
Am
eric
an&
Puer
toR
ican
Am
eric
an(U
.S.)
3-st
ory
low
-ris
ev.
14-s
tory
high
-ris
ePs
ycho
logi
cal
dist
ress
,soc
ial
supp
ort
Hig
h-ri
sere
side
nts:
grea
ter
soci
alov
erlo
ad,l
ess
sens
eof
cont
rola
ndsa
fety
,les
sso
cial
supp
ort/s
ocia
lre
latio
ns,&
less
atta
chm
entt
oco
mm
unity
(but
grea
ter
atta
chm
ent
toro
om)
-
Housing and Mental Health 479E
dwar
ds,B
ooth
,&
Edw
ards
,19
82
Stat
istic
ally
cont
rolle
dfo
rag
e,ed
ucat
ion,
occu
patio
nal
stat
us
560
whi
tefa
mili
esw
depe
nden
tchi
ldre
n(C
anad
a)
Sing
le-f
amily
deta
ched
v.m
ultif
amily
hsg
Psyc
hiat
ric
prob
lem
s[R
V],
pare
ntin
gpr
actic
es,m
arita
lre
latio
ns
Mor
eps
ychi
atri
cpr
oble
ms
amon
gm
enin
mul
tifam
ilyhs
g.N
odi
ffer
ence
sam
ong
wom
en.F
athe
rsre
port
mor
eph
ysic
alpu
nish
men
t.N
odi
ffer
ence
amon
gm
othe
rs.
Bot
hm
enan
dw
omen
repo
rtm
ore
mar
italp
robl
ems
inap
artm
ent(
i.e.,
argu
men
ts,m
embe
rth
reat
sto
leav
e)C
hurc
hman
&G
insb
erg,
1984
Mat
ched
oned
ucat
ion,
ethn
icity
,em
ploy
men
tst
atus
,no.
ofch
ildre
n,du
ratio
nof
resi
denc
e
344
wom
en(I
srae
l)H
igh-
rise
v.lo
w-r
ise
apar
tmen
ts(o
wne
d)So
cial
inte
ract
ion
[R]
Hig
h-ri
sere
side
nts
enco
unte
red
mor
epe
ople
and
mor
ew
how
ere
stra
nger
s;ho
wev
er,n
odi
ffer
ence
sin
perc
eive
dso
cial
supp
ort
McC
arth
y,B
yrne
,H
arri
son,
&K
eith
ley,
1985
Mat
ched
onSE
S67
4ad
ults
(Eng
land
)H
igh-
rise
v.fl
ats
v.ho
uses
Psyc
holo
gica
ldis
tres
s[R
V]
Inte
ract
ion
ofhs
gty
pean
dar
ea.
Psyc
holo
gica
ldis
tres
sw
asw
orst
for
resi
dent
sof
high
-ris
ehs
gw
ithin
low
SES
neig
hbor
hood
s.In
wel
l-of
fne
ighb
orho
ods,
hsg
type
n.s.
Hus
aini
,Moo
re,
&C
asto
r,19
91N
om
atch
ing
600
Afr
ican
Am
eric
anel
derl
y(U
.S.)
Hig
h-ri
sese
nior
hsg
v.de
tach
edho
mes
inco
mm
unity
Dep
ress
ion
[RV
],ps
ychi
atri
cdi
sord
er[R
V]
Hig
h-ri
sedw
ellin
gel
derl
yw
ere
mor
ede
pres
sed,
had
high
erra
tes
ofps
ychi
atri
cdi
sord
er,a
ndw
ere
mor
eso
cial
lyis
olat
edL
evi,
Ekb
lad,
Cha
nghu
i,&
Yue
qin,
1991
No
mat
chin
g50
3ad
ults
,chi
ldre
n,&
elde
rly
in12
5ho
useh
olds
(Chi
na)
Tra
ditio
nal1
-sto
ryho
me
wco
urty
ard
v.m
id-r
ise
v.hi
gh-r
ise
Men
talh
ealth
[RV
]M
ore
soci
alco
ntac
twith
neig
hbor
sin
trad
ition
al(7
4%)
v.m
id-r
ise
(69%
)or
high
-ris
e(5
4%)
Not
e.bl
g=
build
ing;
hsg
=ho
usin
g;R
=re
liabi
lity;
V=
valid
ity;n
.s.=
nots
igni
fica
nt.
-
480 Evans, Wells, and Moch
suggests that residents of single-family detached homes typically fare the best interms of mental health.
Findings on mental health correlates of housing type raise important questionsabout what underlying mechanisms might explain these linkages. For example,adverse impacts of high-rise dwellings may be due to social isolation and lack ofaccess to play spaces for young children. A potential mediating variable that mightaccount for some of the relation between multiple dwelling units and well-being isstigmatization related to building appearance and/or fear of crime. In a later section,Mediating Processes, we discuss these and other possible underlying psychosocialprocesses that may explain how and why housing can impact psychological well-being in adults and children.
Unfortunately, many of the studies in Table 1 are marred by weak researchdesigns, often lacking controls for confounding variables. For example, socio-economic status (SES) is correlated with both housing quality and mental health. Itmay relate also to housing tenure (e.g., owning versus renting) and neighborhoodquality. Substandard housing occurs more often in low-income neighborhoods.Recent work on neighborhood quality and mental health (Leventhal & Brooks-Gunn, 2000) illustrates neighborhood quality effects on mental health in children.Only Fanning (1967), McCarthy and Saegert (1979), and Wilcox and Holahan(1976) employ random assignment to building types, thereby avoiding potentialconfounds.
A more subtle problem that plagues many studies of high-rise versus low-risehousing is that samples of high-rise apartment dwellers often include some peoplewho live on lower floors, thus potentially diluting the impacts of building height.This issue is addressed more directly in studies that compare residents living ondifferent floors as shown in Table 2.
Floor Level of Dwelling
Table 2 summarizes research examining mental health differences betweenpeople living on higher versus lower floors. Of the eight studies, six provideevidence of poorer mental health among residents of higher floor levels. Possibleexplanations for the adverse impacts of living on a higher floor include anxietyabout accidents and falls and difficulties with the development and maintenanceof social networks. These are discussed further below under Mediating Processes.
Of the studies presented in Table 2, only Fanning (1967) employs randomassignment. Thus, the findings of most of the studies are threatened by a majorconfound—the self-selection bias. In other words, perhaps people with poor mentalhealth tend to choose to live on higher floors.
Studies on floor level effects also ignore within-floor heterogeneity that couldcontribute to unexplained variance and lead to low effect estimates. For example,people may reside longer on some floors than on others. The duration of exposureto a particular housing characteristic such as floor level might contribute to the
-
Housing and Mental Health 481Ta
ble
2.E
ffec
tsof
Floo
rL
evel
ofD
wel
ling
onM
enta
lHea
lth
Aut
hor(
s)D
esig
n/N
otes
Part
icip
ants
Hou
sing
Out
com
eB
asic
Res
ult
Fann
ing,
1967
Ran
dom
assi
gnm
ent
1500
wom
en(B
ritis
h&
Can
adia
nse
rvic
emen
’sw
ives
)(G
erm
any)
3-an
d4-
stor
yhs
gM
.D.c
onsu
ltatio
nfo
rps
ycho
logi
cal
sym
ptom
s
Sign
ific
ant,
posi
tive
rela
tions
hip
betw
een
floo
rle
vela
ndps
ych.
dist
ress
(Inc
iden
ts2
×gr
eate
ram
ong
wom
enw
holiv
edon
4th
floo
rv.
wom
enon
grou
ndfl
oor)
Mitc
hell,
1971
No
mat
chin
g30
00+
adul
ts(H
ong
Kon
g)U
rban
dwel
lings
Em
otio
nali
llnes
s&
host
ility
[R]
Floo
rle
vela
ffec
tsem
otio
nali
llnes
s&
host
ility
,but
only
for
peop
leliv
ing
with
nonr
elat
edpe
ople
inon
edw
ellin
gB
agle
y,19
74N
om
atch
ing
69w
omen
(Eng
land
)12
-sto
rybu
ildin
gN
euro
ticis
m[R
V]
&M
.D.v
isits
re:
nerv
ousn
ess
Neg
ativ
eco
rrel
atio
nbe
twee
nne
urot
icis
man
dfl
oor
leve
l.(N
ote:
olde
rch
ildle
ssre
side
nts
lived
onhi
gher
floo
rs)
Wilc
ox&
Hol
ahan
,19
76M
atch
edon
greg
ario
usne
ss,
self
-est
eem
,siz
eof
hom
etow
n,ra
ce
552n
dse
mes
ter
fres
hmen
(U.S
.)1–
5v.
7–10
floo
rsin
high
-ris
edo
rmito
rySo
cial
supp
ort,
soci
alin
volv
emen
t[R
V]
Les
sso
cial
supp
orta
ndle
ssso
cial
invo
lvem
entw
ere
foun
don
high
erfl
oors
Ric
hman
,197
7C
ontr
olle
dfo
rSE
S19
8w
omen
(Eng
land
)H
igh-
rise
hsg
Dep
ress
ion
[RV
]W
omen
livin
gab
ove
3rd
floo
rha
dgr
eate
rin
cide
nts
ofde
pres
sion
than
wom
enon
low
erfl
oors
Gill
is,1
977
No
mat
chin
g44
2pu
blic
hous
ing
resi
dent
s(C
anad
a)E
ight
type
sof
publ
ichs
g(e
.g.,
sing
lede
tach
ed,r
ow,
high
-ris
e)
Psyc
holo
gica
lstr
ain
[RV
]G
ende
rx
floo
rle
veli
nter
actio
n.Fo
rw
omen
,flo
orle
velp
redi
cts
psyc
holo
gica
lstr
ain.
For
men
,re
latio
nshi
pis
wea
ker
&ot
her
dire
ctio
nH
anna
y,19
81N
om
atch
ing
964
adul
ts(S
cotla
nd)
Det
ache
d,te
rrac
ed,
low
-ris
e,1s
t4fl
oors
ofhi
gh-r
ise,
5th
floo
r+of
high
-ris
e
Men
tals
ympt
oms
[RV
]Pe
ople
on5t
hfl
oor
orab
ove
had
twic
eth
enu
mbe
rof
men
tals
ympt
oms
asth
ose
onlo
wer
floo
rs(o
rin
othe
rty
pes
ofhs
g)Sa
ito,I
wat
a,H
osok
awa,
&O
hi,1
993
Con
trol
led
for
age
and
empl
oym
ent
stat
usof
wom
en
444
wom
en(J
apan
)A
com
mun
ityof
12bl
gs.F
loor
s1–
2v.
3–4
v.5–
8v.
9–14
v.15
–23
Psyc
holo
gica
lhea
lth[R
V]
No
mai
nef
fect
offl
oor
leve
lon
psyc
holo
gica
lhea
lth
Not
e.bl
g=
build
ing;
hsg
=ho
usin
g;R
=re
liabi
lity;
V=
valid
ity.
-
482 Evans, Wells, and Moch
strength of mental health sequelae. As an illustration, Marsh, Gordon, Pantazis, andHeslop (1999) found that the strength of the negative association between housingquality and children’s well-being depended on years of exposure. Heterogeneity inpersonal characteristics with known mental health correlates such as gender or age(Caspi, 1998; Cohen, Kessler, & Gordon, 1995) are often unexamined in studiesof floor level and mental health.
Housing Quality, Housing Type, and Floor Level: Children’s Well-Being
The studies presented in Table 3 examine the impact of housing quality, hous-ing type, and floor level on children. Overall, these studies suggest more behavioralproblems and restricted play opportunities among high-rise-dwelling children.Richman (1974) is anomalous in her finding of no significant differences amongthe behavior of high-rise-, low-rise-, and house-dwelling children. In addition,Homel and Burns (1989) diverge from the other studies of floor level with theirfinding of no main effect. This study is unusual, however, in its operationalizationof higher floor level. While most floor level studies compare the first few floorsto several higher floors (e.g., see Table 2—Hannay, 1981 [1−4 v. 5+]; Richman,1977 [1−3 v. 4+]; Wilcox & Holahan, 1976 [1−5 v. 7−10]), Homel and Burnscompare the ground floor to the above-ground floors.
Several mediating processes have been discussed with respect to housing andchildren’s psychological distress. These include parent–child interaction, child andadolescent monitoring and supervision, restricted play opportunities for youngerchildren, lack of contact with the natural environment, and safety concerns (seeMediating Processes, below, for more details).
Gillis (1974) found that building type may be linked with juvenile delinquency.Since this study was conducted on the aggregate (census tract) level, caution iswarranted in assuming those living in multiple dwellings are the same individualsexhibiting juvenile delinquency. Furthermore, as with most of these studies, thedirection of causality is unclear. If the juvenile delinquents are living in multiunitdwellings, their families may have self-selected into housing type. Only Saegert(1982) avoids self-selection through random assignment to low-rise or high-risebuildings. Furthermore, several significant findings listed in Table 3 occur withcontrols for SES.
Overall Quality of the Housing Environment
Table 4 summarizes research examining the relationship between overall hous-ing quality and mental health. Operationalizations of housing quality include struc-tural deficiencies, cockroach and rodent infestation, dampness, and mold, as wellas housing dissatisfaction, neighborhood comparisons, and comparisons of “dif-ficult to rent” versus low-vacancy housing. All the studies summarized in Table 4suggest that housing quality is positively correlated with psychological well-being.
-
Housing and Mental Health 483Ta
ble
3.E
ffec
tsof
Hou
sing
Qua
lity,
Hou
sing
Type
,and
Floo
rL
evel
onC
hild
ren’
sW
ell-
Bei
ngA
utho
r(s)
Des
ign/
Not
esPa
rtic
ipan
tsH
ousi
ngO
utco
me
Bas
icR
esul
t
Dav
ie,B
utle
r,&
Gol
dste
in,1
972
Con
trol
led
for
soci
alcl
ass
10,0
00+
kids
from
birt
hto
age
7(U
.K.)
Bas
icam
eniti
es(h
otw
ater
,ba
thro
om,i
ndoo
rba
th)
Soci
alad
apta
tion
atsc
hool
[RV
]H
ousi
ngam
eniti
essi
gnif
ican
tlyco
rrel
ated
with
soci
alad
apta
tion
atsc
hool
Gill
is,1
974
Agg
rega
tele
vel;
cont
rolle
dfo
ret
hnic
ity&
SES
30ce
nsus
trac
ts(C
anad
a)M
ultip
ledw
ellin
gv.
sing
lede
tach
edhs
gJu
veni
lede
linqu
ency
[V]
Les
sju
veni
lede
linqu
ency
inar
eas
ofde
tach
edhs
g
Inei
chen
&H
oope
r,19
74N
om
atch
ing
262
mar
ried
wom
en(E
ngla
nd)
Hig
h-ri
sev.
non-
high
-ris
eB
ehav
iora
lpro
blem
sTw
ice
asm
any
child
ren
livin
gin
high
-ris
esex
hibi
ted
beha
vior
alpr
oble
ms
asth
ose
inno
n-hi
gh-r
ises
Gitt
us,1
976
No
mat
chin
g34
6w
orki
ng-c
lass
fam
ilies
wch
ildre
n<
5ye
ars
(Eng
land
)
Hig
h-ri
ses,
low
-ris
es,
sing
ledw
ellin
gsPl
aybe
havi
orC
hild
ren
inhi
gh-r
ises
had
mor
ere
stri
cted
play
;wer
em
ore
likel
yto
play
alon
e;m
othe
rsle
sssa
tisfi
edw
play
faci
litie
sR
ichm
an,1
974
Con
trol
led
for
SES
75pr
esch
oolc
hild
ren
(Eng
land
)H
igh-
rise
sv.
low
-ris
esv.
hous
esB
ehav
iora
lpro
blem
s[R
V]
No
sign
ific
antd
iffe
renc
esin
beha
vior
prob
lem
sam
ong
the
thre
egr
oups
ofch
ildre
n(r
esid
ing
inhi
gh-r
ises
,low
-ris
es,o
rho
uses
)R
ichm
an,1
977
Mat
ched
onge
nder
&SE
S70
5pr
esch
oolc
hild
ren
(Eng
land
)H
igh-
rise
sv.
othe
rhs
gty
pes
Beh
avio
ralp
robl
ems
[RV
]C
hild
ren
resi
ding
inhi
gh-r
ises
exhi
bite
dm
ore
beha
vior
alpr
oble
ms
Saeg
ert,
1982
Ran
dom
assi
gnm
ent
tobl
gs31
2el
emen
tary
scho
olch
ildre
n(U
.S.)
3-st
ory
v.14
-sto
rypu
blic
hsg
blgs
Beh
avio
rald
istu
rban
ces
insc
hool
[RV
]Fo
rbo
ys,t
each
ers’
ratin
gsof
beha
vior
aldi
stur
banc
e(i
.e.,
host
ility
,anx
iety
,hy
pera
ctiv
ity/d
istr
actib
ility
)w
ere
high
erfo
r14
-sto
rybl
gre
side
nts.
For
girl
s,no
diff
eren
ceC
hurc
hman
&G
insb
erg,
1984
Pare
nts
mat
ched
oned
ucat
ion,
ethn
icity
,em
ploy
men
tsta
tus,
no.o
fch
ildre
n,du
ratio
nof
resi
denc
e
168
child
ren
age
2–13
(Isr
ael)
Hig
h-ri
sev.
low
-ris
eap
artm
ents
(ow
ned)
Play
beha
vior
The
outd
oor
play
ofch
ildre
nin
high
-ris
esw
asm
ore
rest
rict
edth
anth
ose
inlo
w-r
ises
−for
4-to
5-ye
ar-o
lds
only
Hom
el&
Bur
ns,1
989
No
mat
chin
g32
1ch
ildre
nag
es9–
11(A
ustr
alia
)G
roun
dle
velv
.abo
vegr
ound
Em
otio
nala
djus
tmen
t,so
cial
adju
stm
ent
No
effe
ctof
floo
rle
velo
nem
otio
nalo
rso
cial
adju
stm
ent
Oda
,Tan
iguc
hi,W
en,
&H
igur
ashi
,198
9N
om
atch
ing
169
infa
nts,
876
kind
erga
rtne
rs(J
apan
)L
owfl
oors
(1–5
)v.
high
floo
rs(1
4–23
)In
depe
nden
ce—
“Fun
dam
enta
lDai
lyC
usto
ms”
(FD
Cs)
Chi
ldre
nliv
ing
onhi
ghfl
oors
show
edde
laye
din
depe
nden
ceof
FDC
ssu
chas
gree
ting,
potty
trai
ning
,sho
eing
,com
pare
dto
infa
nts
onlo
wfl
oors
.Dif
fere
nce
inin
depe
nden
cedi
min
ishe
dw
ithag
e–n.
s.di
ffer
ence
amon
gki
nder
gart
ners
Not
e.bl
g=
build
ing;
hsg
=ho
usin
g;R
=re
liabi
lity;
V=
valid
ity;n
.s.=
nots
igni
fica
nt.
-
484 Evans, Wells, and MochTa
ble
4.E
ffec
tsof
Ove
rall
Hou
sing
Qua
lity
onM
enta
lHea
lth
Aut
hor(
s)D
esig
n/N
otes
Part
icip
ants
Inde
pend
entV
aria
ble
Out
com
eB
asic
Res
ult
Bag
ley,
Jaco
bson
,&
Palm
er,1
973
Agg
rega
tele
vel/e
colo
gica
lst
udy
19w
ards
ofth
eci
ty(9
000
peop
le/w
ard)
(Eng
land
)
War
dsof
the
city
“Beh
avio
ral
path
olog
ies,
”e.
g.,
psyc
holo
gica
lill
ness
,sen
ility
,al
coho
lism
,ad
dict
ion,
suic
ide
Beh
avio
ralp
atho
logi
eses
peci
ally
loca
ted
ince
ntra
lurb
anar
eas
char
acte
rize
dby
over
crow
ding
,si
ngle
-per
son
hous
ehol
ds,
in-m
igra
nts,
&po
orhs
gco
nditi
ons
Bag
ley,
1974
Mat
ched
onag
e,se
x,so
cial
clas
s10
0ps
ychi
atri
cin
patie
nts
v.10
0co
ntro
ls(E
ngla
nd)
Hsg
cond
ition
s(s
elf-
repo
rt)
Neu
rotic
cond
ition
s[R
V]
Hsg
stre
ss(f
urni
shed
rent
edac
com
mod
atio
ns,s
hare
dto
ilet&
bath
,no
pipe
dho
twat
er,a
ndde
nsity
>1.
5/ro
om)
was
rela
ted
tone
urot
icis
mev
enfo
rpe
ople
who
rece
ived
nom
enta
lhea
lthtr
eatm
ent
Car
p,19
75M
over
san
dno
nmov
ers
gene
rally
equi
vale
ntpr
e-m
ove
400+
low
-inc
ome
elde
rly
Mov
ers
(to
new
apar
tmen
tbui
ldin
gfo
rel
derl
y)v.
nonm
over
s:pr
e-m
ove,
1ye
arpo
st-m
ove,
8ye
ars
post
-mov
e
Hap
pine
ss,w
orry
,op
timis
m,m
oral
eM
over
sre
port
edm
ore
happ
ines
s,le
ssw
orry
,gre
ater
sens
eof
optim
ism
,and
high
erm
oral
eth
anno
nmov
ers,
1ye
aran
d8
year
sfo
llow
ing
the
mov
e
Duv
all&
Boo
th,
1978
Tra
ined
rate
rsas
sess
edin
teri
or&
exte
rior
stru
ctur
alde
fici
enci
es.
Con
trol
led
for
educ
atio
n,ag
e,et
hnic
ity&
husb
and’
soc
cupa
tion
522
mar
ried
wom
en<
45ye
ars
wat
leas
t1
child
(Can
ada)
Perc
eive
dad
equa
cyof
spac
e&
priv
acy;
stru
ctur
alde
fici
enci
es;
nons
truc
tura
lde
fici
enci
es(n
oise
,co
ld,p
ests
)
Em
otio
nalw
ell-
bein
g:(1
)tr
anqu
ilize
rus
e&
(2)
psyc
holo
gica
lsy
mpt
oms
[RV
]
Maj
orst
ruct
ural
defi
cien
cies
(sag
ging
,cra
cked
,or
brok
enst
ruct
ural
elem
ents
),la
ckof
priv
acy,
and
spac
epr
oble
ms
pred
icte
dm
enta
lhea
lth
-
Housing and Mental Health 485
Bro
wn,
Bro
lchá
in,
and
Har
ris,
1975
Con
trol
led
for
SES
Wom
enag
e18
–65:
114
bein
gtr
eate
dfo
rde
pres
sion
;220
rand
omsa
mpl
e(E
ngla
nd)
Hsg
prob
lem
s(s
elf-
repo
rt)–
over
crow
ding
,ph
ysic
alsh
ortc
omin
gs,
nois
e,in
secu
rete
nure
,etc
.
“Psy
chia
tric
scre
enin
g”de
velo
ped
atIn
stitu
teof
Psyc
hiat
ry,i
nL
ondo
n[R
V]
Hig
her
rate
sof
depr
essi
onam
ong
wor
king
-cla
ssw
omen
are
rela
ted
tohs
gpr
oble
ms
such
asov
ercr
owdi
ng,p
hysi
cal
shor
tcom
ings
,noi
se,i
nsec
ure
tenu
re
Kas
l,W
ill,W
hite
,&
Mar
cuse
,19
82
Mat
ched
onSE
San
dot
her
fact
ors
337
min
ority
,lo
w-i
ncom
ew
omen
wch
ildre
nin
publ
ichs
g(U
.S.)
Hsg
qual
ity(m
ixof
self
-rep
ort&
rate
rite
ms)
Men
talh
ealth
[RV
]H
sgqu
ality
xne
ighb
orho
odqu
ality
inte
ract
ion:
wom
enliv
ing
inpo
orhs
gw
ithin
dete
rior
ated
neig
hbor
hood
had
poor
erm
enta
lhe
alth
.Chi
ldre
n’s
men
tal
heal
th–n
.s.
Wiln
er,W
alkl
ey,
Pink
erto
n,&
Tayb
ack,
1962
Mat
ched
onm
any
fact
ors
incl
udin
gag
e,re
nt,
occu
patio
nal
stat
us,a
ndle
ngth
ofre
side
nce
600
blac
kfa
mili
es—
half
mov
eto
publ
ichs
g;ha
lfst
ayin
slum
s(U
.S.)
Hsg
qual
ity:b
ased
onA
m.P
ublic
Hea
lthA
ssoc
.in
stru
men
ts—
self
-re
port
&ra
ter
item
s
Psyc
holo
gica
ldis
tres
s[R
V];
scho
olpe
rfor
man
ce(c
hild
)[R
V]
Smal
lim
prov
emen
tsin
optim
ism
,pe
rson
allif
esa
tisfa
ctio
n.L
ess
aggr
essi
onto
war
dsau
thor
ity.
(Moo
d&
nerv
ousn
ess
n.s.
)C
hild
ren’
ssc
hool
perf
orm
ance
impr
oved
Zah
ner,
Kas
l,W
hite
,&W
ill,
1985
Lon
gitu
dina
l;co
ntro
lled
for
inco
me,
etc.
337
Bla
ck&
Lat
ino
wom
en(U
.S.)
Roa
ch&
rode
ntin
fest
atio
nPs
ycho
logi
cal
sym
ptom
s[R
V]
Rat
infe
stat
ion
was
cons
iste
ntly
asso
ciat
edw
ithpo
ores
tmen
tal
heal
thB
yrne
,Har
riso
n,K
eith
ley,
&M
cCar
thy,
1986
Mat
ched
onSE
S38
3ho
useh
olds
inco
unci
lhsg
(Eng
land
)
“Dif
ficu
ltto
let”
(i.e
.,hi
gher
vaca
ncy
rate
s,lo
nger
tofi
ndte
nant
s,m
ore
tran
sfer
requ
ests
)v.
othe
rco
unci
lhsg
Psyc
holo
gica
ldis
tres
s[R
V]—
(e.g
.,an
xiet
y,de
pres
sion
,ye
s/no
ques
tions
)
“Dif
ficu
ltto
let”
hsg
asso
ciat
edw
ithm
ore
psyc
holo
gica
ldis
tres
s(e
xcep
tfor
adul
tsov
erag
e65
)
(con
tinu
ed)
-
486 Evans, Wells, and Moch
Tabl
e4.
(Con
tinu
ed)
Aut
hor(
s)D
esig
n/N
otes
Part
icip
ants
Inde
pend
entV
aria
ble
Out
com
eB
asic
Res
ult
Elto
n&
Pack
er,
1986
Ran
dom
lyas
sign
edto
mov
eor
stay
.N
osi
gnif
ican
tbe
twee
n-gr
oups
diff
eren
cein
sym
ptom
spr
ior
tom
ove
56re
ques
ted
relo
catio
nfr
omco
unci
lhsg
due
tom
enta
lhea
lth:2
8st
ay,2
8m
ove
(Eng
land
)
Poor
hsg
v.be
tter
hsg.
(Hsg
qual
ityno
tac
tual
lym
easu
red.
Subj
ects
attr
ibut
edm
enta
lhea
lthdi
ffic
ultie
sto
nois
e,st
ruct
ural
prob
lem
s,cr
owdi
ng,e
tc.)
Anx
iety
&de
pres
sion
[RV
]H
ighl
ysi
gnif
ican
tim
prov
emen
tin
depr
essi
onan
dan
xiet
ysy
mpt
oms
1–3
mon
ths
follo
win
gm
ove,
and
stab
lech
ange
s1
year
late
r
Elto
n&
Pack
er,
1987
Mat
ched
onse
x,ag
e,an
dSE
S41
who
mov
edfr
omco
unci
lhsg
due
tom
enta
lhea
lthv.
11w
hom
oved
for
othe
rre
ason
s(E
ngla
nd)
Poor
hsg
v.be
tter
hsg
(with
diff
eren
tre
ason
sfo
rre
loca
tion)
Anx
iety
&de
pres
sion
[RV
]Im
prov
emen
tsin
sym
ptom
sof
anxi
ety
and
depr
essi
onfo
rbo
thpe
ople
who
mov
edfr
omco
unci
lhs
gdu
eto
men
talh
ealth
and
peop
lew
hom
oved
for
othe
rre
ason
s
Bir
tchn
ell,
Mas
ters
,&D
eahl
,198
8
No
cont
rols
for
SES
(alth
ough
mor
ede
pres
sed
wom
enw
ere
poor
)
408
wom
en(E
ngla
nd)
Inte
rior
hsg
qual
ityD
epre
ssio
nR
esid
entia
lqua
lity
was
sign
ific
antly
low
erfo
rde
pres
sed
than
for
nond
epre
ssed
peop
le
Bla
ckm
an,
Eva
son,
Mel
augh
,&W
oods
,198
9
Stat
istic
ally
cont
rolle
dfo
rpr
opor
tion
ofch
ildre
n<
age
5an
dpr
opor
tion
ofsi
ngle
pare
nts
(SE
Sno
tco
ntro
lled)
1317
adul
ts,8
74ch
ildre
nin
two
hsg
area
s(N
orth
ern
Irel
and)
Com
pare
dtw
oar
eas
ofpu
blic
hsg:
poor
erqu
ality
v.be
tter
Men
talh
ealth
—se
lf-r
epor
tG
reat
erin
cide
nce
ofm
enta
lhea
lthpr
oble
ms
inpo
orhs
gfo
rbo
thad
ults
and
child
ren
-
Housing and Mental Health 487H
unt,
1990
599
hous
ehol
dsw
child
unde
rag
e16
—ad
ults
(80%
fem
ale)
and
child
ren
(Eng
land
&Sc
otla
nd)
Hsg
cond
ition
sas
sess
edby
two
surv
eyor
s:da
mpn
ess,
mol
d,co
ld,n
oisy
,poo
rre
pair
,ove
rcro
wde
d
Em
otio
nald
istr
ess
(Adu
lts:b
adne
rves
,fe
elin
glo
w,
head
ache
s,G
HQ
scor
e.C
hild
ren:
irri
tabi
lity,
tem
per
tant
rum
s,un
happ
ines
s,be
d-w
ettin
g)
Am
ong
both
adul
tsan
dch
ildre
n,pe
rcen
tage
ofpe
ople
repo
rtin
gsy
mpt
oms
ofps
ycho
logi
cal
dist
ress
ispo
sitiv
ely
corr
elat
edw
ithth
enu
mbe
rof
hsg
prob
lem
s
Hun
t&M
cKen
na,
1992
Con
trol
led
for
age
752
adul
tsin
thre
ear
eas
ofhs
g(E
ngla
nd)
Com
pare
dth
ree
area
sof
publ
ichs
gw
ithva
ryin
gde
gree
ofph
ysic
alim
prov
emen
ts
Anx
iety
&de
pres
sion
[RV
]Fo
rpe
ople
over
age
64,g
reat
erin
cide
nce
ofde
pres
sion
and
anxi
ety
amon
gth
ose
who
lived
inun
impr
oved
hsg
vers
usbe
tter
hsg
Saito
,Iw
ata,
Hos
okaw
a,&
Ohi
,199
3
Con
trol
led
for
inte
rnal
dens
ity,
floo
rle
vel,
age,
empl
oym
ent
stat
us
444
wom
en(J
apan
)D
issa
tisfa
ctio
nor
perc
eive
dhs
gpr
oble
ms
Psyc
holo
gica
lhea
lth[R
V]
Poor
erps
ycho
logi
calh
ealth
foun
dam
ong
thos
ew
ho(a
)w
ere
diss
atis
fied
with
hous
eor
room
arra
ngem
ent,
(b)
perc
eive
dho
use
asin
adeq
uate
for
child
ren,
etc.
Smith
,Sm
ith,
Kea
rns,
&A
bbot
t,19
93
Stat
istic
ally
cont
rolle
dfo
rso
cial
clas
s,lo
catio
n,et
hnic
ity
279
hous
ehol
dsin
inad
equa
tehs
g(A
ustr
alia
)
Two
hsg
stre
ssor
(sel
f-re
port
)sc
ales
:di
scom
fort
and
phys
ical
cond
ition
[R]
Psyc
holo
gica
ldis
tres
s[R
V]
Perc
eive
dhs
gdi
scom
fort
pred
icts
psyc
holo
gica
ldis
tres
s.So
cial
supp
ortm
oder
ates
inlo
wor
med
ium
hsg
disc
omfo
rt,b
utno
tin
high
Hal
pern
,199
5N
osi
gnif
ican
tbe
twee
n-gr
oups
diff
eren
ces
insy
mpt
oms
prio
rto
rem
odel
ing
117
low
-inc
ome,
fem
ale
head
sof
hous
ehol
d.H
alf
rem
odel
edto
impr
ove
hsg,
half
did
not(
Eng
land
)
Pre–
post
hsg
impr
ovem
ents
(e.g
.,re
plac
edfr
ontp
orch
&do
or,m
oder
nize
dki
tche
n&
bath
,pr
ovid
edce
ntra
lhe
atin
g)
Anx
iety
&de
pres
sion
[RV
]Sy
mpt
oms
ofbo
than
xiet
yan
dde
pres
sion
decr
ease
din
inte
rven
tion
grou
p.N
och
ange
inco
ntro
lgro
up
(con
tinu
ed)
-
488 Evans, Wells, and Moch
Tabl
e4.
(Con
tinu
ed)
Aut
hor(
s)D
esig
n/N
otes
Part
icip
ants
Inde
pend
entV
aria
ble
Out
com
eB
asic
Res
ult
Hop
ton
&H
unt,
1996
Con
trol
led
for
SES
451
hous
ehol
ds(S
cotla
nd)
Dam
pnes
s(c
heck
list
of6
prob
lem
sas
soci
ated
wda
mpn
ess)
Em
otio
nald
istr
ess
[RV
]D
ampn
ess
was
sign
ific
antly
asso
ciat
edw
ithpo
orer
men
tal
heal
th
LeC
lair
&In
nes,
1997
Agg
rega
tele
vel/
ecol
ogic
alst
udy
Chi
ldre
nan
dad
oles
cent
s(C
anad
a)
Hsg
qual
ity(p
erce
ntof
dwel
ling
units
inba
dre
pair
with
ince
nsus
trac
t)
Ref
erra
lsto
child
ren’
sce
nter
for
moo
d/co
nduc
t/str
ess-
rela
ted
diso
rder
s[V
]
Hsg
qual
itybe
stpr
edic
tsm
ood/
cond
uct/s
tres
sre
ferr
als
(onl
yot
her
sign
ific
antp
redi
ctor
was
soci
alcl
ass)
Payn
e,19
97N
oco
ntro
lfor
SES
orin
com
e12
66ad
ults
(U.K
.)H
sgqu
ality
(goo
d,ad
equa
te,o
rpo
or)
Isol
atio
n,de
pres
sion
,w
orri
esT
hose
livin
gin
hsg
ina
“poo
rst
ate
ofre
pair
”ar
efo
urtim
esas
likel
yto
expe
rien
ceis
olat
ion,
depr
essi
on,&
wor
ries
than
thos
ein
good
hsg
Wei
ch&
Lew
is,
1998
Con
trol
led
for
six
othe
rin
dice
sof
mat
eria
lde
priv
atio
n,se
x,ag
e,so
cial
clas
s,m
arita
lsta
tus,
educ
atio
n,et
hnic
ity,
num
ber
ofhe
alth
prob
lem
s,an
dre
gion
ofre
side
nce
9064
adul
tsag
e16
–75
(U.K
.)H
sgpr
oble
ms
(esp
.da
mpn
ess,
leak
yro
of,r
otin
woo
d)
Com
mon
men
tal
diso
rder
s[R
V]
Tho
sew
ithst
ruct
ural
hsg
prob
lem
are
(1.4
0od
dsra
tio)
likel
yto
have
men
tald
isor
der
Oba
sanj
o,19
98C
ontr
olle
dfo
rSE
S,ra
ce,a
ge,
gend
er
63in
ner-
city
Afr
ican
Am
eric
an&
His
pani
cad
oles
cent
s,ag
e15
–19
(U.S
.)
Hsg
qual
ity—
base
don
17se
lf-r
epor
tite
ms,
emph
asis
onsp
ace/
crow
ding
and
nois
eis
sues
(onl
y3/
17ite
ms
re:m
ain-
tena
nce/
upke
ep)
Psyc
hoso
mat
icill
ness
[R],
cogn
itive
cont
rol[
R],
cogn
itive
failu
re[R
V],
dire
cted
atte
ntio
nfa
tigue
[R]
Hsg
qual
ityw
asa
stro
ngpr
edic
tor
ofal
ldep
ende
ntva
riab
les
-
Housing and Mental Health 489O
basa
njo,
1998
Con
trol
led
for
SES,
race
,age
,ge
nder
680
inne
r-ci
tym
ostly
Afr
ican
Am
eric
anad
oles
cent
s,ag
e13
–19
(U.S
.)
Hsg
qual
ity—
base
don
8se
lf-r
epor
tite
ms
(em
phas
ison
mai
nten
ance
−4/8
item
s)
Perc
eive
dso
cial
supp
ort[
RV
],ps
ycho
som
atic
illne
ss[R
],di
rect
edat
tent
ion
fatig
ue[R
]
Hsg
qual
ityw
aspr
edic
tive
ofso
cial
supp
ort,
dire
cted
atte
ntio
nfa
tigue
,an
dps
ycho
som
atic
illne
sses
.The
effe
ctof
hsg
qual
ityon
the
latte
rtw
ode
pend
entv
aria
bles
was
mod
erat
edby
age.
Dun
n&
Hay
es,
2000
528
hous
ehol
dsin
two
neig
hbor
hood
s(C
anad
a)
Ove
rall
satis
fact
ion
wdw
ellin
g,an
dre
spon
seto
“Ica
n’t
stan
dto
beat
hom
eso
met
imes
.”
Men
talh
ealth
[RV
]T
hose
who
repo
rted
poor
erov
eral
lsa
tisfa
ctio
nw
ithdw
ellin
gw
ere
(2.4
6tim
es)
mor
elik
ely
tore
port
poor
erm
enta
lhea
lth,a
ndth
ose
who
disa
gree
dw
ith“I
can’
tsta
ndto
beat
hom
e...
”w
ere
(2.2
6tim
es)
less
likel
yto
repo
rtpo
orm
enta
lhe
alth
(onl
yw
hen
“con
stan
tlyun
der
stre
ss”
rem
oved
from
poss
ible
inde
pend
entv
aria
bles
)E
vans
,Wel
ls,
Cha
n,&
Saltz
man
,200
0
(a)
Con
trol
led
for
inco
me
(b)
Lon
gitu
dina
lde
sign
,co
ntro
lled
for
pre-
mov
eps
ycho
logi
cal
dist
ress
(a)
207
low
-&
mid
dle-
inco
me
rura
lw
omen
(U.S
.)(b
)31
low
-inc
ome
urba
nw
omen
(U.S
.)
(a)
Hsg
qual
ity—
eval
uate
dby
trai
ned
rate
rus
ing
quan
titat
ive
inst
rum
ent
(b)
(Sam
eH
Qsc
ale
asab
ove)
Pre-
/pos
t-m
ove
long
itudi
nal
com
pari
son
ofpo
orve
rsus
new
hsg
(a)
Psyc
holo
gica
ldi
stre
ss[R
V]
(b)
(Sam
eas
abov
e)
(a)
Hsg
qual
itypr
edic
tsps
ycho
logi
cald
istr
ess
(b)
Cha
nges
inhs
gqu
ality
wer
epr
edic
tive
ofpo
st-m
ove
psyc
holo
gica
ldis
tres
s
Eva
ns,S
altz
man
,&
Coo
perm
an,
2001
Con
trol
led
for
SES
and
mot
hers
’m
enta
lhe
alth
277
child
ren,
grad
es3–
5,m
ean
age
9.12
,lo
wto
high
inco
me
(U.S
.)
Hsg
qual
ityev
alua
ted
bytr
aine
dra
ter
Psyc
holo
gica
lhea
lth[R
V],
task
pers
iste
nce
[RV
]
Hsg
qual
itypr
edic
tsch
ildre
n’s
men
talh
ealth
and
task
pers
iste
nce
Not
e.bl
g=
build
ing;
hsg
=ho
usin
g;R
=re
liabi
lity;
V=
valid
ity;n
.s.=
nots
igni
fica
nt.
-
490 Evans, Wells, and Moch
Various characteristics of housing quality may influence psychosocial pro-cesses that in turn can affect mental health. Some of these mediating processesare identity and self-esteem, anxiety about structural hazards, worry and lack ofcontrol over maintenance and management practices, and fear of crime. These arediscussed in detail under Mediating Processes.
Unfortunately, a variety of factors render the majority of results on housingquality and mental health inconclusive. First, the independent variables are oftensubjectively defined or based on self-report. For instance, in Hopton and Hunt(1996), dampness is subjectively assessed; in Brown, Brolcháin, and Harris (1975),Duvall and Booth (1978), Smith, Smith, Kearns, and Abbott (1993), and Obasanjo(1998), housing problems are based on self-report. This is particularly problematicwhen the dependent variable is also based on self-report (which psychologicalwell-being often is) because some of the covariance between housing quality andmental health may be created by the overlap in method.
In several studies, differences between housing conditions are presumed, butnot explicitly measured. As an example, in Elton and Packer’s (1986, 1987) studiesof relocation, housing quality is not actually measured. While it seems reasonable toaccept that housing quality improved following the move to new housing, measuredchanges in housing conditions would provide stronger evidence. A recent studyemployed a more detailed, quantitative measurement of housing quality completedby trained raters before and after people moved (Evans, Wells, Chan, & Saltzman,2000).
Many housing scales consist of dichotomous items (e.g., present/absent) and/ora small number of items. Both of these features attenuate estimates of associa-tion (Ghiselli, Campbell, & Zedeck, 1981). Christenson, Carp, Cranz, and Wiley(1992), in a reanalysis of housing quality and residential satisfaction data, demon-strated significantly larger correlations when multiitem scales were employed in-stead of single-item indicators. Furthermore, as documented in Tables 1−4, manystudies have used mental health measures of unknown reliability. This too attenu-ates estimates of covariation (Ghiselli et al., 1981).
Insufficient variability in housing quality underestimates covariation withmental health outcomes (Ghiselli et al., 1981). Variability in housing quality isrestricted when public housing samples or institutional housing (e.g., college dor-mitories, military housing, prison housing) samples are relied on (cf. Marsh et al.,1999).
Conceptual Issues
Two conceptual issues permeate research on housing and mental health: mod-eration and mediation. Nearly all studies have examined the main effects of housingcharacteristics on mental health without taking into account other variables thatmight moderate the relation between housing and mental health. Secondly, few
-
Housing and Mental Health 491
studies examine what underlying psychosocial processes (i.e., mediators) mightexplain how and why housing can affect mental health.
Moderating/Processes
Housing researchers have generally not incorporated moderating constructs(interaction effects) that may amplify or attenuate the impacts of housing onmental health (Freeman, 1993; Gifford, in press; Lawrence, 1993). A few ofthe studies on high-rise living (see Tables 1 and 2) reveal that women stayingat home with young children may be particularly susceptible to the ill effects ofhigh-rise living. This subgroup may be especially vulnerable because of socialisolation caused in part by their inability to let their children play outside. Re-search from China provides anecdotal reports of parental anxiety among high-risedwellers due to a lack of play spaces for children that parents can easily monitor(Levi, Ekblad, Changhui, & Yueqin, 1991). In Hong Kong, high-rise housing wasfound to be associated with psychological distress but only among apartmentsshared by multiple family units (Mitchell, 1971). Boys may be more vulnerableto suboptimal housing than girls (Saegert, 1982), and the age of children maymake a difference as well. Young adolescents may be more sensitive to hous-ing quality than their older counterparts. Obasanjo (1998) attributed this to thegreater opportunities available to older adolescents to escape from their immediateresidence.
In addition to personal variables, the social and physical context in whichhousing is located may alter its impacts on human beings. Multiple-story build-ings located in low-income neighborhoods might affect people differently thansimilarly designed houses located in a different place (Gifford, in press). Poorerquality housing is more strongly related to psychological symptoms in adults whenthe housing is located in more deteriorated neighborhoods (Kasl, Will, White, &Marcuse, 1982; McCarthy, Byrne, Harrison, & Keithley, 1985). Public housingfamilies randomly relocated to scattered site public housing in middle-class subur-ban neighborhoods showed more improvements in mental health relative to similarfamilies with improved housing quality who relocated to low-income neighbor-hoods (Katz, Kling, & Liebman, 2000; Leventhal & Brooks-Gunn, in press). Also,there is evidence that young boys in these families engaged in less antisocial be-havior (Katz et al., 2000; Ludwig, Duncan, & Hirschfield, 2001). The effects ofcrowding on psychological distress after controlling for SES are elevated by in-adequate housing (Evans, Lercher, & Kofler, 2002). The negative psychologicalimpacts of residential crowding are amplified among families living on upper floorlevels (Hassan, 1976; Mitchell, 1971). Children living in more crowded or noisierhomes suffer fewer ill effects if they have a room where they can spend time alone(Evans, Kliewer, & Martin, 1991; Wachs & Gruen, 1982).
-
492 Evans, Wells, and Moch
Mediating Processes
An important avenue for understanding housing and mental health is devel-opment of a preliminary taxonomy of psychosocial processes that might accountfor linkages between housing and psychological well-being.
Identity. Symbolically, both structural quality and maintenance of the homeprovide feedback to residents about quality in their environment and are oftenprimary factors in how others view the residents (Kearns, Hiscock, Ellaway, &Macintyre, 2000). Residents of public housing, for example, feel stigmatized bythe larger community and may internalize others’ negative perceptions of them(Halpern, 1995). Others such as prospective employers, the police, and schoolauthorities may react negatively, as well, to the stigma attached to living in housingprojects, bad neighborhoods, and so on (Rosenbaum, Reynolds, & Deluca, 2002).Failure to reside in a place consonant with one’s ideals might influence self-esteem.The house is a symbol of self, reflecting both inwardly and outwardly who we are,what we have accomplished, and what we stand for (Becker, 1977; Cooper-Marcus,1995; Freeman, 1984; Halpern, 1995).
Insecurity. Poor housing quality often means more hassles with maintenance andin some cases dependence upon people in bureaucratic organizations (e.g., publichousing authority) who can be quite difficult to interact with. For low-incomepeople, not only is substandard housing more likely, but high rates of involuntaryrelocation frequently occur (Evans & Kantrowitz, 2002). Bartlett (1998) providesqualitative evidence for the potentially psychologically injurious impacts of highmobility among children. Mobility is also a principal component of instability,which has been linked to poorer socioemotional development in young children(Bronfenbrenner & Evans, 2000). In addition, less secure housing tenure is asso-ciated with poor health. For example, Macintyre, Ellaway, Der, Ford, and Hunt(1988) found that renters had worse physical health than owners even after statis-tically controlling for income.
Concerns about safety and hygiene (falls, burns, infestation, garbage, waste),especially if children are present, could reasonably engender considerable anxietyand worry (Wells & Evans, 2003b). Housing research on the elderly suggests thatphysical hazards related to falls in particular (step design, flooring materials, light-ing) are of major concern (Wells & Evans, 1996). Several hazards are potentiallymore dangerous in high-rise buildings including fires, earthquakes, structural de-fects, and falls (especially for children) from windows/balconies (Freeman, 1993).Residences may be sited on land unsuitable for housing where landslides, flooding,fires, and major storms are more likely to occur (Bartlett, 1999).
The physical environment can affect actual rates of crime as well as fearof crime. Spaces that are hard to visually survey (low visual access), insecure
-
Housing and Mental Health 493
entryways, lighting, level of incivilities, or an ambiance of lack of caring (vandal-ism, graffiti, disrepair), plus streets and entryways that are easily and anonymouslypassable all contribute to crime (Newman, 1972; Taylor & Harrell, 1996).
Social support. Fanning (1967) proposed that women staying at home and re-siding in high-rise buildings experienced a high degree of isolation and lonelinessdue to the high-rise buildings’ verticality and lack of garden/play space—bothcharacteristics that could deter social interaction. Several of the studies summa-rized in Tables 1 and 2 indicate that women in high-rise housing report moreloneliness and less social contact with their neighbors partly due to a lack ofproximity to communal gathering places. Physical proximity to other living unitsas well as doorway orientation to high-use pathways and interaction nodes (e.g.,mailboxes) affect social interaction patterns as well (Festinger, Schacter, & Back,1950). Porches, balconies, outdoor gardens, terraces, and patios increase visualexposure and access to neighbors and thus elevate social contact.
In a series of studies, Baum and his colleagues (Baum, Gatchel, Aiello, &Thompson, 1981; Baum & Valins, 1977; Baum & Valins, 1979) demonstratedthat the design of multi-dwelling housing influenced social support. Residents ofdouble-loaded corridors experience less social support in comparison to those insuite-designed college dormitories. Manifesting not only in questionnaires but alsoin actual behaviors outside the dormitory environment and at two different sites, theresults are quite robust. Residents of long corridors, for example, sat farther awayand interacted less with a confederate in a waiting room in comparison to studentswho lived in suites. They also acted less cooperatively in a group gaming situationand manifested more helplessness in their game-playing strategies. The resultsof these studies are particularly persuasive because the residents were randomlyassigned to their dormitories.
More instrumental forms of social support may be influenced by housingconditions as well. Housing location can affect access to neighbors with moreknowledge about jobs, school teachers with information about college, and asso-ciations with youth actively planning to attend college (Rosenbaum et al., 2002).
Parenting. Parenting is a key link in understanding housing quality and chil-dren’s well-being (Bartlett, 1997; Freeman, 1993). Parental practices in responseto inadequate housing might include more restrictive, rigid control over chil-dren’s activities. Stewart (1970) documented widespread restrictions on play ac-tivities plus inadequate play spaces for children among families living in high-riseapartment complexes (see also Table 3). Bartlett (1998) uncovered qualitative ev-idence that inaccessibility to outdoor play was an important contributor to a pre-school child’s distress. Furthermore, in an intensive analysis of 20 urban families,Huttenmoser (1995) documented that 4-year-olds who could not play indepen-dently outdoors, primarily because of traffic-related safety, had more strained
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494 Evans, Wells, and Moch
relations with their parents, had fewer playmates, and manifested poorer socio-emotional development (see also Oda, Taniguchi, Wen, & Higurashi, 1989). Lackof access to green, outdoor spaces can undermine the support of both children’splay and their access to adults (Taylor, Wiley, Kuo, & Sullivan, 1998). Inability tospend time in natural areas may also be associated with poor cognitive function-ing (Kaplan & Kaplan, 1989; Wells, 2000) or psychological well-being (Wells &Evans, 2003a).
Parental self-esteem and confidence as well as feelings of self-efficacy mightbe impacted by chronic, intractable housing problems. Social withdrawal in re-sponse to uncontrollable social interaction is a typical coping strategy. Parents withinadequate privacy may be less able or willing to socially engage their children.Both crowding (Bradley & Caldwell, 1987; Evans, Maxwell, & Hart, 1999) andnoise (Wachs & Camli, 1991) are negatively associated with parental responsive-ness to young children.
Control. Home is a place that reflects identity and provides security andmaximum control. Good housing offers protection not only from the elements butalso from negative social conditions. It is a primary territory where we can regulateinterpersonal contact (Altman, 1975). Poor housing quality reduces behavioraloptions, diminishes mastery, and contributes to a general sense of helplessness.Evans, Saltzman, and Cooperman (2001) found that housing quality was inverselyrelated to learned helplessness among third through fifth graders, independentof income. Residents of public housing who relocated to middle-class suburbanneighborhoods with federal financial assistance reported marked elevations infeelings of self-efficacy and mastery in comparison to other public housing tenantswho relocated to low-income neighborhoods (Rosenbaum et al., 2002).
Size and quality of space can restrict flexibility, disallowing multiple usesof space, particularly important when amount of space is limited. Difficulties inregulating social interaction, inability to control and regulate access to space, andlack of jurisdiction over the immediate public environment might all contributeto feelings of low self-efficacy. Yancey (1971) and Newman (1972) both pro-vide valuable insight with respect to the design of public housing complexes andcrime. According to Yancey’s (1971) research, the provision of transition spacesfrom public to private areas reduces residents’ feelings of isolation and their fearof public spaces. Newman’s (1972) work suggests that building height, complexsize, the number of occupants sharing an entrance, and the building footprint canbe influential in the incidence of crime. Larger, high-rise buildings with manypeople sharing entrances and designs that make it difficult to monitor entrywaysare associated across multiple sites with higher levels of crime.
The arrangement of rooms within a home can influence occupants’ ability tocontrol social interaction. Depth (number of interconnecting spaces) and perme-ability (number of interconnecting routes) influence social stimulation (Hillier &Hanson, 1984). Adults in crowded homes, for example, suffer less psychological
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distress when the housing unit has greater depth (Evans, Lepore, & Schroeder,1996).
The duration of residency as well as frequency of moves can both affect mas-tery (Fried, 1972; Hiscock, Macintyre, Kearns, & Ellaway, this issue; Smith, 1990).Personalization opportunities contribute to a sense of control (Vinsel, Brown,Altman, & Foss, 1980). Appropriate size and scale of the environment affordthe ability to reach, maneuver, and manipulate various residential spaces and el-ements. Children, the elderly, and individuals with physical disabilities may beespecially sensitive to size and scale. As an example, consider the height of doorhandles, dexterity requirements for their use, and the necessary force to operate adoor once unlatched.
Policy Implications
Some preliminary policy implications can be drawn from our review of thehousing and mental health literature. Foremost, sufficient evidence exists to claimthat housing does matter for psychological health. This is particularly true for low-income families with young children. Second, high-rise, multiple-family dwellingsare inimical to families with preschool children. This appears to occur because oftwo factors: (a) social isolation of mothers and (b) inadequate play opportunitiesfor children. When economic policies require construction of such housing, effortsshould be made to reduce the height and overall size of such structures. Particularattention should be paid to spaces to support neighboring and informal contactwith other residents and for adequate play spaces for children. As we discussedabove under Social support, several lines of evidence converge on characteristicsof housing design that can facilitate or inhibit the formation and maintenance ofsocial ties.
Within the home, the provision of spaces where children can escape from over-crowding and other chaotic living conditions may attenuate impacts of suboptimalhousing conditions. Noise, unwanted social interaction, and constant interrup-tion all contribute to instability and unpredictability in young children’s lives(Bronfenbrenner & Evans, 2000). The role of housing and neighborhood quality incumulative risk exposure among low-income children is not adequately appreci-ated (Evans & Kantrowitz, 2002). Given current demographic trends, much moreattention is called for on mental health of the elderly in relation to housing andneighborhood characteristics as well (Administration on Aging, 2000; Markham& Gilderbloom, 1998).
Research funds should be focused on more rigorous evaluations of housingimprovements for low-income families. Random clinical trials, prospective lon-gitudinal designs, and consideration of multiple levels of analysis (neighborhood,building, housing unit) with hierarchical linear modeling (HLM) and other suit-able analytic techniques are needed (Bryk & Raudenbush, 1992). Such researchneeds to incorporate better instruments to assess housing quality to measure salient,
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underlying psychosocial processes (e.g., parenting) that may convey housing ef-fects on mental health (e.g., Evans et al., 2000). Use of standardized mental healthscales, appropriate for nonclinical populations, is recommended.
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