Housing environment and mental health outcomes: A levels of analysis perspective

Abstract

This study examines the effects of perceived housing environment on selected well-being outcomes of a seriously mentally ill population in supported housing programs. Individuals live independently in their own apartments and use supportive mental health services as needed. The study conceptualizes one's housing environment as existing at the apartment, neighborhood and the surrounding community levels of analysis that, taken together, form a multi-dimensional construct of housing environment. Self-report data from interviews with a sample of seriously mentally ill adults is paired with (a) observer ratings of housing environments, (b) census profiles of the surrounding community and (c) case manager ratings of clients' functioning in order to explore the effects of supported housing environments on well-being outcomes. Well-being is operationalized here as levels of psychiatric distress, recovery orientation, residential satisfaction, and adaptive functioning. Hierarchical regression models posit that apartment, neighborhood and census tract level variables are unique predictors of these domains of well-being. Results show that neighborhood level variables, especially those relating to the social environment, are the most influential predictors for understanding variance in well-being, with apartment level variables also contributing to understanding of housing environment effects. The census tract level predictors did not contribute a significant amount of explanation of the variance in well-being outcomes. Implications for supported housing programs and the role of ecological levels of analysis in conceptualizing and measuring housing environment influence are discussed.

Investigating the Relationship Between Neighborhood Experiences and Psychiatric Distress for Individuals with Serious Mental Illness

“…Neighborhood experiences were assessed with four measures from the Housing Environment Survey (HES) which inquire about the social environment (social climate of neighborhood, sense of belonging, and perceptions of safety) and interpersonal relationships tied to housing (e.g., neighbor) (Kloos and Shah 2009;Wright and Kloos 2007). The scales primarily used a 5-point response set; participants rated how much they agreed or disagreed with statements about each aspect of their housing environment (Table 1).…”

“…There is evidence that perceptions of environments and neighborhood experiences are better predictors of health-related outcomes than objective measures, such as ratings of the physical appearance of the neighborhood, census information on crowding and SES, etc. (e.g., Stiffman et al 1999;Wright and Kloos 2007). The evaluative process involved in perception may be key to the psychological mechanisms affecting behavior in community settings.…”

“…We found that neighborhood social climate fully mediated the relationship between key neighborhood experiences and psychiatric distress, thus pointing to the important role that psychological integration plays in individuals' adaptation to community life. This speaks to the potential benefit for mental health services to guide interventions aimed at fostering a sense of community among fellow consumers in community-based settings, while also enhancing opportunities for meaningful interactions with non-mentally ill neighbors (Wright and Kloos 2007;). …”

Examining the Psychological Sense of Community for Individuals with Serious Mental Illness Residing in Supported Housing Environments

“…(Wright and Kloos 2007;Townley and Kloos 2009;Kloos and Shah 2009). The majority of interviews were conducted in the participants' living space (i.e.…”

Housing Quality in a Randomized Controlled Trial of Housing First for Homeless Individuals with Mental Illness: Correlates and Associations with Outcomes

“…7 Relationships have been shown between a higher density of alcohol establishments in urban neighborhoods and rates of four types of violent crime, 8 between noise, overcrowding, absence of green space, community facilities, and fear of crime with lower mental health status and vitality scores, 9 and between neighborhoods defined in various ways as being disadvantaged and higher levels of depression and psychiatric distress. [10][11][12] While this accumulation of evidence makes it clear that housing and neighborhood quality are important social and physical ecological variables that may mediate or moderate outcomes in housing intervention research, Bobjective^housing and/or neighborhood quality is rarely measured in studies of housing interventions for homeless individuals including those with mental illness. Studies typically report on the simple provision of housing without elaborating on quality.…”