Housing Instability Is as Strong a Predictor of Poor Health Outcomes as Level of Danger in an Abusive Relationship

Abstract

Advocates, clinicians, policy makers, and survivors frequently cite intimate partner violence (IPV) as an immediate cause of or precursor to housing problems. Research has indicated an association between homelessness and IPV, yet few studies examine IPV and housing instability. Housing instability differs from homelessness, in that someone experiencing housing instability may currently have a place to live but faces difficulties with maintaining the residence. We present baseline findings from a longitudinal cohort study of 278 female IPV survivors with housing as a primary concern. Our analysis indicates the greater the number of housing instability risk factors (e.g., eviction notice, problems with landlord, moving multiple times), the more likely the abused woman reported symptoms consistent with PTSD (p < .001), depression (p < .001), reduced quality of life (p < .001), increased work/school absence (OR = 1.28, p < .004), and increased hospital/emergency department use (OR = 1.22, p < .001). These outcomes persist even when controlling for the level of danger in the abusive relationship and for survivors' drug and alcohol use. Importantly, both housing instability and danger level had stronger associations with negative health outcomes than other factors such as age, alcohol, and drug use; both make unique contributions to negative health outcomes and could contribute in different ways. Housing instability is an important and understudied social determinant of health for IPV survivors. These findings begin to address the literature gap on the relationship between housing instability, IPV, and survivors' health, employment, and utilization of medical care services.

Conceptualizing Housing Instability: Experiences with Material and Psychological Instability Among Women Living with Partner Violence

“…Most studies examining the links between housing and IPV focus on financial aspects of housing (e.g., late rent or mortgage, evictions, affordability of housing), and mobility (e.g., frequency of moves, related issues) (Pavao et al, 2007;Ponic et al, 2011;Rollins et al, 2012). Future studies measuring or defining housing instability cannot continue to ignore the importance of the psychological components of housing.…”

“…Yet, many studies of housing and IPV fail to consider these simultaneous challenges (Pavao et al, 2007) or may do so in a manner that insufficiently portrays the extent and severity of the co-occurring issues. Rollins et al (2012), in their longitudinal study of housing instability among survivors of IPV, also examined employment difficulties but did so by measuring whether any days were missed from work in the six months prior to the interview. Women in our Conceptualizing Housing Instability 15 15 study reported fear of safety at work, violence spilling over into the workplace, as additional concerns that should be considered in research examining employment issues.…”

“…There are not even agreed-upon definitions of housing instability, as reflected by the myriad measures used by studies within the IPV literature. Measures of housing instability are sometimes limited to the housing itself, such as difficulty paying rent or mortgages, inability to secure housing due to credit problems, paying 50 per cent or more of income to meet housing costs, eviction threats or notices, frequent moves, crowding, or doubling up with family or friends (Pavao et al, 2007;Rollins et al, 2012). Other definitions encompass related determinants that limit access to stable housing, including difficulty paying bills or moving because of partner harassment, or greater discrimination by landlords (e.g., refusing to rent to women known to be fleeing abuse) (Barata & Stewart, 2010).…”

“…Other definitions encompass related determinants that limit access to stable housing, including difficulty paying bills or moving because of partner harassment, or greater discrimination by landlords (e.g., refusing to rent to women known to be fleeing abuse) (Barata & Stewart, 2010). Sometimes, information on housing instability is lost as data on housing problems are combined into a single dichotomous or count variable, thereby precluding a nuanced understanding of how each of the instability factors may be uniquely related to IPV or well-being (Pavao et al, 2007;Rollins et al, 2012).…”

Foreclosure and Health in Southern Europe: Results from the Platform for People Affected by Mortgages

“…Cross-sectional studies, conducted mainly in the USA, have reported poorer mental health and well-being among individuals subject to foreclosure than those in stable housing. [2][3][4] In two successive studies, Pollack et al found that people who were more than 2 months behind on their mortgage payments or who were involved in a foreclosure judgment had a higher prevalence of psychiatric disorders such as depression, anxiety, or dysphoria compared to people without housing instability. 5,6 Houle 7 recently reported that an increase in the rate of mortgage foreclosures at county level was associated with poorer mental health after adjusting for individual and contextual variables, while Fowler et al suggested that housing loss is associated with increased suicide risk.…”