Housing Affordability as a Social Determinant of Mental Health: Longitudinal Evidence from China

Background: Housing affordability is one of the most pressing social and political challenges in urban China, yet empirical evidence on its impact on residents' mental health remains limited. Methods: Guided by the Social Determinants of Health (SDOH) framework, this study examines its relationship with mental health using nationally representative longitudinal data from the China Family Panel Studies (CFPS) across the 2016, 2018, and 2020 waves. We employ two-way fixed effects models and further incorporate an instrumental variable strategy to address potential endogeneity. Results: There is a significant association between housing affordability and mental health; greater affordability is associated with a lower likelihood of experiencing depressive symptoms. Heterogeneity analyses further reveal that these benefits vary by housing asset status and educational attainment. Conclusions: From an SDOH perspective, this study provides empirical evidence on how housing affordability contributes to mental health inequities in the Chinese context. Housing affordability should be recognized as a public health concern requiring coordinated policy responses. Targeted interventions are necessary to protect vulnerable populations that are most exposed to affordability shocks.