Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Center on the Developing Child, Harvard University, Boston, Massachusetts.
JAMA Pediatr. 2023 Aug 1;177(8):818-826. doi: 10.1001/jamapediatrics.2023.1733.
Childhood housing insecurity has dramatically increased in the US in recent decades, but whether an association with adverse mental health outcomes exists after adjusting for repeated measures of childhood poverty is unclear.
To test whether childhood housing insecurity is associated with later anxiety and depression symptoms after adjusting for time-varying measures of childhood poverty.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included individuals aged 9, 11, and 13 years at baseline from the Great Smoky Mountains Study in western North Carolina. Participants were assessed up to 11 times from January 1993 to December 2015. Data were analyzed from October 2021 to October 2022.
Participants and their parents reported social factors annually when participants were 9 to 16 years of age. A comprehensive measure of childhood housing insecurity was constructed based on frequent residential moves, reduced standard of living, forced separation from home, and foster care status.
Between ages 9 and 16 years, the Child and Adolescent Psychiatric Assessment was used up to 7 times to evaluate childhood anxiety and depression symptoms. Adult anxiety and depression symptoms were assessed at ages 19, 21, 26, and 30 years using the Young Adult Psychiatric Assessment.
Of the 1339 participants (mean [SD] age, 11.3 [1.63] years), 739 (55.2%; 51.1% weighted) were male; 1203 individuals assessed up to 30 years of age were included in the adulthood outcome analyses. Standardized mean (SD) baseline anxiety and depression symptom scores were higher among children who experienced housing insecurity than among those who never experienced housing insecurity (anxiety: 0.49 [1.15] vs 0.22 [1.02]; depression: 0.20 [1.08] vs -0.06 [0.82]). Individuals who experienced childhood housing insecurity had higher anxiety symptom scores (fixed effects: standardized mean difference [SMD], 0.21; 95% CI, 0.12-0.30; random effects: SMD, 0.25; 95% CI, 0.15-0.35) and higher depression symptom scores (fixed effects: SMD, 0.18; 95% CI, 0.09-0.28; random effects: SMD, 0.26; 95% CI, 0.14-0.37) during childhood. In adulthood, childhood housing insecurity was associated with higher depression symptom scores (SMD, 0.11; 95% CI, 0.00-0.21).
In this cohort study, housing insecurity was associated with anxiety and depression during childhood and with depression during adulthood. Because housing insecurity is a modifiable, policy-relevant factor associated with psychopathology, these results suggest that social policies that support secure housing may be an important prevention strategy.
近几十年来，美国儿童住房无保障问题急剧增加，但在调整了多次儿童贫困的衡量标准后，住房无保障与不良心理健康结果之间是否存在关联尚不清楚。
检验在调整了儿童贫困的时变衡量标准后，儿童住房无保障是否与日后的焦虑和抑郁症状有关。
设计、地点和参与者：本前瞻性队列研究纳入了来自美国北卡罗来纳州西部大烟山研究中基线年龄为 9、11 和 13 岁的个体。参与者从 1993 年 1 月至 2015 年 12 月接受了多达 11 次评估。数据分析于 2021 年 10 月至 2022 年 10 月进行。
当参与者 9 至 16 岁时，参与者及其父母每年报告社会因素。根据频繁的住所搬迁、生活水平降低、被迫离家和寄养状态，构建了一个全面的儿童住房无保障衡量标准。
在 9 至 16 岁之间，使用儿童和青少年心理评估量表多达 7 次评估儿童的焦虑和抑郁症状。在 19、21、26 和 30 岁时，使用青年心理评估量表评估成年期的焦虑和抑郁症状。
在 1339 名参与者中（平均[标准差]年龄为 11.3[1.63]岁），739 名（55.2%；加权 51.1%）为男性；1203 名评估至 30 岁的个体被纳入成年期结局分析。经历过住房无保障的儿童的标准化平均（SD）基线焦虑和抑郁症状评分高于从未经历过住房无保障的儿童（焦虑：0.49[1.15]与 0.22[1.02]；抑郁：0.20[1.08]与-0.06[0.82]）。经历过儿童住房无保障的个体焦虑症状评分更高（固定效应：标准化平均差异[SMD]，0.21；95%置信区间[CI]，0.12-0.30；随机效应：SMD，0.25；95%CI，0.15-0.35）和抑郁症状评分更高（固定效应：SMD，0.18；95%CI，0.09-0.28；随机效应：SMD，0.26；95%CI，0.14-0.37）。在成年期，儿童住房无保障与较高的抑郁症状评分相关（SMD，0.11；95%CI，0.00-0.21）。
在这项队列研究中，住房无保障与儿童期的焦虑和抑郁以及成年期的抑郁有关。由于住房无保障是一个可以改变的、与政策相关的与精神病理学有关的因素，这些结果表明，支持安全住房的社会政策可能是一项重要的预防策略。
