How do Housing Subsidies Improve Quality of Life Among Homeless Adults? A Mediation Analysis

Abstract

Supported housing, combining rent subsidies with intensive case management, is associated with improvements in quality of life of homeless adults, but factors mediating their impact on quality of life have not been studied. Twelve-month outcome data from a randomized trial of the Housing and Urban Development- Veterans Affairs Supported Housing program (HUD-VASH) showed that access to a housing rent subsidy plus intensive case management (ICM) was associated with greater improvement in subjective quality of life than ICM alone. Multiple mediation analyses were applied to identify variables that significantly mediated the relationship between receipt of housing voucher and improvements in quality of life. Significant mediating covariates were those whose 95% bias-corrected confidence intervals, when added to the model predicting improvement in quality of life, did not overlap zero. Increases in the number of days housed, size of social network, and availability of emotional support appear to mediate improvement in quality of life and account for 71% of the benefit attributable to having a rent subsidy. Improvement in subjective quality of life though housing subsidies is mediated by gains in both material and psychosocial factors. Mediating factors deserve special attention in supported housing services.

Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: a systematic review

“…Our search yielded 15 908 citations, of which 249 full-text articles were screened, and 72 met inclusion criteria and were included in our systematic review (figure 1; appendix pp [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. The 72 articles included data from 15 studies (across 41 publications) on permanent supportive housing, 13,15,17, data from ten studies (across 15 publications) on income assistance, 12,24,[75][76][77][78][79][80][81][82][83][84][85][86][87] and data from 21 publications (of which five publications were also included for the analysis of permanent supportive housing and income assistance) with cost-effectiveness data. 12,13,56,62,72,[88][89][90][91][92][93]...…”

Factors That Influence Quality of Life in People Experiencing Homelessness: A Systematic Mixed Studies Review

“…Thirteen of the 55 studies included in this review examined the impact of social relationships on QoL among PEH. Results of these studies showed consistent significant links with QoL and were found to mediate the relationships between independent variables and QoL (M. O'Connell et al, 2018;Rutenfrans-Stupar et al, 2019). Qualitative evidence also supported the importance of social relationships on QoL.…”

“…Experiences with care, mediated by social participation, had a positive relationship with QoL ([χ 2 = 1.668, comparative fit index [CFI] = 0.961, root mean square error of approximation [RMSEA] = 0.055]; Rutenfrans-Stupar et al, 2019). Housing subsidies, mediated by size of social network, also had a positive relationship with increased QoL ([β = 0.047, 95% CI = [0.005, 0.095]; M. O'Connell et al, 2018). Lack of perceived social support, reported in two studies (odds ratio [OR] = 0.95, 95% CI = [0.91, 0.99], Garey et al, 2019; OR = 2.77, 95% CI = [1.70, 4.49], Ito et al, 2014), associated with negative QoL.…”

Latent class mediator for multiple indicators of mediation

“…Examples of mediation analysis include the effect of genetic variants on the incidence of lung cancer, whether directly and/or mediated through smoking behaviors 1 ; the effect of a new mechanism of drug delivery on quality of life through improved medication adherence 2 ; the effect of a job training program on employment outcomes through the development of new vocational skills and/or job search tools 3 ; and the effect of housing subsidies on quality of life of homeless people that may be mediated through reduced days of homelessness or increased social support 4 …”

“…Examples of mediation analysis include the effect of genetic variants on the incidence of lung cancer, whether directly and/or mediated through smoking behaviors 1 ; the effect of a new mechanism of drug delivery on quality of life through improved medication adherence 2 ; the effect of a job training program on employment outcomes through the development of new vocational skills and/or job search tools 3 ; and the effect of housing subsidies on quality of life of homeless people that may be mediated through reduced days of homelessness or increased social support. 4 Traditional mediation analysis estimates the mediation effect through the difference-in-coefficients method 5 or the product-of-coefficients method. 6 In the difference-in-coefficients method, the outcome is regressed on the exposure (with coefficient c) in a first model and on both the exposure (with coefficient c ′ ) and the mediator (with coefficient b) in a second model.…”