Californians experiencing housing insecurity face higher rates of psychological distress

As California struggles with providing affordable housing, a new study from the UCLA Center for Health Policy Research shows that people who experience housing insecurity have much higher rates of psychological distress.

The study on disparities in housing insecurity and mental health, which uses data from the 2022 California Health Interview Survey (CHIS) also demonstrated that people of color were more likely to report their housing as unstable. While 18%, or 5.2 million, of California adults said their housing situation felt unstable, the rates were significantly higher for marginalized racial and ethnic populations:

• 29% of American Indians or Alaska Natives, which is 61% higher than the average
• 26% of Black or African Americans, which is 44% higher than the average
• 24% of Latinx, which is 33% higher than the average

People who reported they frequently worried about being able to pay their rent or mortgage experienced psychological distress at nearly twice the proportion of those who did not, 39% versus 21%, which has implications for mental health policies and programs in the state, the authors said.  

“Our study reinforces what research has demonstrated for years: Access to affordable housing affects a person’s health,” said Sean Tan, one of the study’s authors and senior public administration analyst at the UCLA Center for Health Policy Research (CHPR). “It also spotlights the critical need for more affordable housing in California.”

The report defined housing insecurity as either having unstable housing or frequently worrying about keeping up with rent or mortgage payments.

The report notes how the history of housing in the United States has been plagued by racial discrimination and segregation through “redlining,” which has resulted in unequal access to housing opportunities and inequitable health outcomes, particularly for African Americans and people of color.

In California, housing challenges are especially pronounced because of high costs of living, soaring housing prices, and a lack of affordable housing options, which have worsened because of the COVID-19 pandemic, the report states. Data from the 2022 CHIS show that about 10% of adults (more than 2.8 million Californians) had difficulty paying their rent or mortgage because of the pandemic. Three quarters of adults burdened by housing costs — paying more than one-third of their income for housing — are renters.

The 2022 California Health Interview Survey, which includes responses from 21,463 adults, 985 teens and 3,395 children, covers a wide range of health topics and topics that influence health, including access to and use of health care, health insurance, mental health, housing, discrimination, climate change, gun violence, community engagement, and much more.

Key data from the report show:

• 49% of adults ages 18–29 frequently worried about paying their rent or mortgage compared with 22% of adults 65 and older.
• 53% of households with incomes less than twice that of the 2022 federal poverty level, which was about $55,000 for a family of four, frequently worried about paying their rent or mortgage compared with 31% of households earning at least four times the poverty level.
• Nearly twice the proportion of noncitizens experienced housing instability compared with U.S. citizens (30% versus 16%).

While 41% of those surveyed said they frequently worried about being able to pay their mortgage or rent, the percentages were higher for Native Hawaiians and Pacific Islanders (62%), Latinx (51%) and Black or African American (43%) adults in California. More than half (52%) of noncitizens frequently worried about struggling to keep up with their rent or mortgage compared with 39% of U.S. citizens.

“Housing is the largest regular expense for the vast majority of people, so it follows that people who typically have lower wages and fewer assets would have more unstable housing and worry more about paying their bills,” said Joelle Wolstein, one of the study’s authors and a CHPR research scientist. “However, the effects of this disparity ripple beyond people’s financial health.”

The report states that 45% of adults with unstable housing had experienced moderate to serious psychological distress — a measure of mental or behavioral health, including symptoms of anxiety or depression — in the year prior to being surveyed compared with 25% of adults with stable housing.

Despite having nearly twice the rate of psychological distress, only 22% of adults with unstable housing utilized mental health care compared with 18% of adults with stable housing in the past year.

The report recommends that California:

• Invest in programs that create or preserve affordable housing opportunities.
• Connect mental health services with housing resources. Integrative care models such as Medicaid Health Homes, California Department of Healthcare Services’ Whole Person Care, patient-centered medical home models and Community Behavioral Health Clinics have shown promise.
• Enact inclusive housing assistance policies. Governments may consider eliminating citizenship requirements in public housing and rental assistance programs. In recent years, California expanded Medi-Cal benefits to cover all income-qualified individuals, regardless of citizenship status. Removing citizenship barriers to housing assistance would enable noncitizen Californians and their families to have more access to stable and affordable housing and potentially improve health outcomes, including mental health.

“We know lawmakers faced difficult budgeting decisions this year, but this study shows the importance of investing in programs that stabilize and make housing affordable, which is a crucial factor for good mental health,” Tan said. “California leaders should not make cuts without due consideration of the potential adverse impacts of reducing or eliminating funding for affordable housing programs.”

Terms used in this study

Housing stability

Respondents were asked: “How do you feel about your current housing situation?” The response categories were: “very stable,” “fairly stable,” “somewhat stable,” “fairly unstable” or “very unstable”. Respondents who answered “very stable” or “fairly stable” were categorized as having stable housing and “somewhat stable,” “fairly unstable” and “very unstable” as having unstable housing.

Frequently worrying about housing 

Respondents were asked: “Please tell me how often you personally worry about struggling to keep up with your mortgage or rent payments.” The response categories were: “very often,” “somewhat often,” “from time to time” or “almost never.” Respondents who answered “very often,” “somewhat often” or “from time to time” were categorized as worrying about housing and “almost never” as not worrying about housing.