Kavanagh Anne M, Aitken Zoe, Baker Emma, LaMontagne Anthony D, Milner Allison, Bentley Rebecca
Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
Soc Sci Med. 2016 Feb;151:225-32. doi: 10.1016/j.socscimed.2016.01.010. Epub 2016 Jan 9.
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.
成年后出现残疾与心理健康状况下降有关，而获得安全且负担得起的住房与更好的心理健康状况有关。我们假设住房保有 tenure 和可负担性会改变残疾的获得与心理健康之间的关联。我们使用了来自澳大利亚家庭、收入和劳动力动态调查的十二次年度数据浪潮（2001 - 2012 年）（1913 名参与者，13037 次观测）。符合条件的参与者报告在至少连续两次无残疾浪潮之后出现至少连续两次残疾浪潮。在三个固定效应线性回归模型（去除时间不变的混杂因素）中，以加法尺度检验效应量修正，这些模型包括残疾与先前住房状况之间的交叉乘积项：残疾与住房保有 tenure；残疾与住房可负担性，并且在一个有住房成本的子样本（896 名参与者，5913 次观测）中，检验残疾与保有 tenure/可负担性。结果是 SF - 36 的连续心理成分总结（MCS）。模型针对随时间变化的混杂因素进行了调整。有统计证据表明先前的住房状况改变了残疾获得对心理健康的影响。我们的研究结果表明，获得残疾后，居住在经济适用房中的人的 MCS 下降了 1.7 分（95%置信区间 -2.1，-1.3），而居住在负担不起的住房中的人的 MCS 下降了 4.2 分（95%置信区间 -5.2，-1.4）。在有住房成本的人群中，MCS 下降最大的是那些背负负担不起的抵押贷款的人（-5.3，95%置信区间 -8.8，-1.9）以及居住在负担不起的住房中的私人租户（-4.0，95%置信区间 -6.3，-1.6），相比之下，居住在经济适用房中的抵押贷款者的 MCS 下降了 1.4 分（95%置信区间 -2.1，-0.7）。总之，我们使用了因果关系稳健的固定效应回归，并表明残疾获得后心理健康的恶化会因先前的住房状况而改变，对于居住在负担不起的住房中的人，发现了最大的负相关。未来的研究应该检验当人们出现残疾时提供安全、负担得起的住房是否能防止心理健康恶化。
