Abstract
Although evictions have been associated with adverse mental health outcomes, it remains unclear which stages of the eviction process are associated with mental distress among renters. Variation in COVID-19 pandemic eviction protections across US states enables identification of intervention targets within the eviction process to improve renters' mental health. To measure the association between the strength of eviction protections (ie, stages blocked by eviction moratoriums) and mental distress among renters during the COVID-19 pandemic. This cohort study used individual-level, nationally representative data from the Understanding Coronavirus in America Survey to measure associations between state eviction moratorium protections and mental distress. The sample of 2317 respondents included renters with annual household incomes less than $75 000 who reported a state of residence and completed surveys between March 10 and September 3, 2020, prior to the federal eviction moratorium order by the Centers for Disease Control and Prevention. Time-varying strength of state moratorium protections as a categorical variable: none, weak (blocking court hearings, judgments, or enforcement without blocking notice or filing), or strong (blocking all stages of the eviction process beginning with notice and filing). Moderate to severe mental distress was measured using the 4-item Patient Health Questionnaire. Linear regression models were adjusted for time-varying state COVID-19 incidence and mortality, public health restrictions, and unemployment rates. Models included individual and time fixed effects as well as clustered standard errors. The sample consisted of 2317 individuals (20 853 total observations) composed largely (1788 [78%] weighted) of middle-aged adults (25-64 years of age) and women (1538 [60%]); 640 respondents (23%) self-reported as Hispanic or Latinx, 314 respondents (20%) as non-Hispanic Black, and 1071 respondents (48%) as non-Hispanic White race and ethnicity. Relative to no state-level eviction moratorium protections, strong protections were associated with a 12.6% relative reduction (risk ratio, 0.87; 95% CI, 0.76-0.99) in the probability of mental distress, whereas weak protections were not associated with a statistically significant reduction (risk ratio, 0.96; 95% CI, 0.86-1.06). This analysis of the Understanding Coronavirus in America Survey data found that strong eviction moratoriums were associated with protection against mental distress, suggesting that distress begins early in the eviction process with notice and filing. This finding is consistent with the idea that to reduce mental distress among renters, policy makers should focus on primary prevention of evictions.
Highlights
IntroductionA factor know to be associated with mental distress,[1] has been widespread in the US
Housing insecurity, a factor know to be associated with mental distress,[1] has been widespread in the US
Relative to no statelevel eviction moratorium protections, strong protections were associated with a 12.6% relative reduction in the probability of mental distress, whereas weak protections were not associated with a statistically significant reduction
Summary
A factor know to be associated with mental distress,[1] has been widespread in the US. Following decades of increasing housing costs, the median household income in the US is no longer adequate to pay for basic needs.[2] In 2019, 1 in 3 renter households earning less than $75 000 lived in unaffordable housing, putting more than 30% of their income toward rent and utilities.[3] Stretched thin, renters face eviction with troubling frequency. There are 6 eviction filings annually for every 100 renter households[4]; the rate is higher among female-headed households, families with children, and Black and Latinx people.[5,6,7] During the last decade, a growing body of evidence has linked eviction and the threat of eviction to poor mental health outcomes, such as depressive symptoms, anxiety, and suicide.[8,9,10,11,12,13]
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