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The Relative Impact of Risk Factors for Homelessness, Housing Barriers, and Health Care Barriers on Mental Health
Lorelle Sun1, Mary Meyers1, Anjna Nair1
1Medical College of Wisconsin, Milwaukee, Wisconsin.
Background:
Housing and health care both play crucial roles in overall health. Though housing and health care barriers negatively impact affect health, little is known about the relative influence of each. This study sought to understand the relationship between housing circumstance, barriers to care, and mental health outcomes among low-income, uninsured patients seen at a free clinic in Milwaukee, Wisconsin. This includes investigating the relative impact of risk factors for homelessness, housing barriers, and health care barriers on mental health.
Methods:
Surveys were administered to clinic patients (n = 94) from June to December 2023. Surveys assessed patient demographics, housing and health care barriers, and mental health outcomes, primarily measured by the Patient Health Questionnaire-2 (PHQ-2), General Anxiety Disorder-2 (GAD-2) questionnaire, modified loneliness scale, and individuals' subjective mental health rating.
Results:
Increased health care barriers and socioenvironmental risk factors for homelessness significantly predicted worse PHQ-2 score, GAD-2 score, loneliness, and mental health rating. Despite significant associations, increased housing barriers did not significantly predict any of the 4 mental health metrics. Furthermore, neither housing barriers nor health care barriers significantly predicted recreational drug use, whereas socioenvironmental risk factors for homelessness were both a significant predictor and response of increased recreational drug use. The most frequently reported mental health care barriers were insurance coverage, financial barriers, and transportation issues. In addition, there was significantly lower patient trust in mental health care providers than in general medical providers, which may reflect increased stigma.
Conclusions:
Compared to housing barriers, increased health care barriers significantly predicted worse mental health outcomes. This study emphasizes the importance of addressing health care barriers to improve mental health.
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