Variation in State-Level Eviction Moratorium Protections and Mental Health Among US Adults During the COVID-19 Pandemic

Abstract

IMPORTANCEAlthough 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. OBJECTIVETo 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. DESIGN, SETTING, AND PARTICIPANTS This cohort study used individual-level, nationallyrepresentative 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.EXPOSURES 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). MAIN OUTCOMES AND MEASURESModerate 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. RESULTSThe 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 statelevel 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). CONCLUSIONS AND RELEVANCE This analysis of the Understanding Coronavirus in AmericaSurvey 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 (continued)

Association of Promoting Housing Affordability and Stability With Improved Health Outcomes

“…After screening 2294 titles, 243 abstracts, and 81 full texts, 26 articles met criteria for inclusion ( Figure 2 ), comprising 3 RCTs described in 6 articles 32 , 33 , 34 , 35 , 36 , 37 and 20 observational studies (16 longitudinal designs 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 and 4 cross-sectional quasi–waiting list control designs comparing current vs future recipients of an intervention 54 , 55 , 56 , 57 ) ( Figure 3 ; eTable 1 in the Supplement ). Most studies selected participants based on medical or social vulnerability.…”

“…especially for the Hispanic subgroup, 42 whereas another found that eviction moratoriums were associated with reduced anxiety and depression symptoms for Black subpopulations only. 41…”

“…A measurable association with health outcomes might require targeting existing long-term rent subsidy programs (which often require burdensome waiting periods 66 and impose restrictions based on criminal records, immigration status, substance use, or eviction history 67 ) to tenants with more modest levels of need while dedicating more comprehensive and flexible supports to people with greater needs. 68 A fourth possibility, supported by the 3 studies that explored moderation by race and ethnicity, 41,42,54 is that some interventions had heterogeneous associations with health outcomes. If a housing intervention's association with outcomes is influenced by structural racism, such as through housing discrimination and segregation of neighborhood opportunities, failure to disaggregate associations of treatment with outcomes could produce ambiguous results and obscure insights into opportunities to combat structural racism through housing policy.…”

A longitudinal analysis of the relationship between housing insecurity and physical health among midlife and aging adults in the United States

“…Further research into the health impacts and racial/ethnic disparities of COVID-19-related housing insecurity and the formulation of effective interventions and countermeasures to reduce housing insecurity effects on health outcomes, therefore, becomes critical. Research by Fenelon et al (2017) and Keene et al (2020) has indicated housing assistance is associated with improved reported health among low-income adults ( Lawler, 2001 ); and eviction moratoriums instated during the COVID-19 pandemic were also associated with better health among U.S. adults ( Leifheit et al, 2021 ). However, our research signals that, in the aftermath of acute economic events such as the current pandemic or economic recessions, these housing supports and benefits (i.e., more affordable housing, preventing insecurity in the first place) should be extended to midlife adults, particularly in Black communities, rather than only the elderly population to protect/preserve population health.…”

A database of US state policies to mitigate COVID-19 and its economic consequences

“…Our database documents the dates that forty-three US states and DC instituted and lifted eviction moratoria. These data were analyzed to demonstrate the associations between eviction moratoria and COVID-19 incidence and mortality [ 23 ], mental health outcomes [ 24 ], and eviction filing rates [ 25 ].…”