title: Housing tenure and affordability and mental health following disability acquisition in adulthood.
abstract: Acquiring a disability in adulthood is associated with a reduction in mental health and access to secure and affordable housing is associated with better mental health. We hypothesised that the association between acquisition of disability and mental health is modified by housing tenure and affordability. We used twelve annual waves of data (2001-2012) (1913 participants, 13,037 observations) from the Household, Income and Labour Dynamics in Australia survey. Eligible participants reported at least two consecutive waves of disability preceded by two consecutive waves without disability. Effect measure modification, on the additive scale, was tested in three fixed-effects linear regression models (which remove time-invariant confounding) which included a cross-product term between disability and prior housing circumstances: housing tenure by disability; housing affordability by disability and, in a sub-sample (896 participants 5913 observations) with housing costs, tenure/affordability by disability. The outcome was the continuous mental component summary (MCS) of SF-36. Models adjusted for time-varying confounders. There was statistical evidence that prior housing modified the effect of disability acquisition on mental health. Our findings suggested that those in affordable housing had a -1.7 point deterioration in MCS (95% CI -2.1, -1.3) following disability acquisition and those in unaffordable housing had a -4.2 point reduction (95% CI -5.2, -1.4). Among people with housing costs, the largest declines in MCS were for people with unaffordable mortgages (-5.3, 95% CI -8.8, -1.9) and private renters in unaffordable housing (-4.0, 95% CI -6.3, -1.6), compared to a -1.4 reduction (95% CI -2.1, -0.7) for mortgagors in affordable housing. In sum, we used causally-robust fixed-effects regression and showed that deterioration in mental health following disability acquisition is modified by prior housing circumstance with the largest negative associations found for those in unaffordable housing. Future research should test whether providing secure, affordable housing when people acquire a disability prevents deterioration in mental health.
authors.affiliation: Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia. Electronic address: a.kavanagh@unimelb.edu.au.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Kavanagh
authors.affiliation: Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Aitken
authors.affiliation: School of Architecture & Built Environment, The University of Adelaide, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Baker
authors.affiliation: Population Health Strategic Research Centre, School of Health & Social Development, Deakin University, Australia; McCaughey VicHealth Centre for Community Wellbeing, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: Anthony D
authors.initials: AD
authors.lastname: LaMontagne
authors.affiliation: Population Health Strategic Research Centre, School of Health & Social Development, Deakin University, Australia; McCaughey VicHealth Centre for Community Wellbeing, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Milner
authors.affiliation: Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bentley
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health / Q000592:standards*; D008875:Middle Aged; D011638:Public Housing / Q000592:standards*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
keywords: Disability; Effect measure modification; Fixed-effects regression; Housing affordability; Housing tenure; Longitudinal study; Mental health