The effect of housing on the mental health of older people: the impact of lifetime housing history in Whitehall II.

Mai Stafford,Michael Marmot,Philippa L Howden-Chapman,Tarani Chandola

doi:10.1186/1471-2458-11-682

Abstract

BackgroundThis study describes differences in trajectories of self-reported mental health in an ageing cohort, according to their housing, while controlling for confounders.MethodsThe General Health Questionnaire was measured on six occasions as part of Whitehall II cohort study of office-based British civil servants (1985-2009); 10,308 men and women aged 35-55 at baseline.ResultsHome-ownership was the predominant tenure at baseline and increased over the life-course, but the social gradient remained. In the bivariate analysis, by phase nine, renters had higher (poorer mental health) GHQ scores (55.48) than owner occupiers (51.98). Those who reported difficulty paying bills or problems with housing had higher GHQ scores at baseline (financial difficulties 57.70 vs 54.34; house problems 58.06 vs 53.99) and this relative difference increased by phase nine (financial difficulties 59.64 vs 51.67; house problems 56.68 vs 51.22). In multivariate models, the relative differences in GHQ scores by tenure increased with age, but were no longer significant after adjusting for confounders. Whereas GHQ scores for those with housing problems and financial difficulties were still significantly higher as participants grew older.ConclusionThe social gradient in the effect of home ownership on mental health, which is evident at baseline, diminishes as people get older, whereas housing quality and financial problems become relatively more important in explaining older people's health. Inequalities in housing quality and ability to deal with household financial problems will become increasingly important mental health issues as the population ages.

Highlights

This study describes differences in trajectories of self-reported mental health in an ageing cohort, according to their housing, while controlling for confounders
We explore the relationship between housing tenure, housing quality and household financial security over the adult life course on the mental health of older people, who are approaching retirement age or retired
Bivariate analyses Housing tenure in the Whitehall II Study is skewed towards home-ownership and became more so over the life-course

Summary

Introduction

This study describes differences in trajectories of self-reported mental health in an ageing cohort, according to their housing, while controlling for confounders. Self-reported mental health generally improves by early old age, but social class differences in anxiety and depression increase with age [1]. In the Whitehall II study, social inequalities in both self-reported mental health and general health increased in early old age, as the rate of improvement in mental health was less for those in the lower employment grades [2]. Housing costs, including fuel use, rent or mortgages, maintenance and repairs, are a significant component of the minimum income for healthy living required by older people [9] and those who are home-owners may be mortgage-free by the time they retire. Time-use surveys consistently show that older people spend more than 90% of their time indoors, mostly in their homes, [10] so that the indoor home environment is their most significant environmental exposure, as well as being the place that they have most contact with their families or friends

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