An article in Housing Studies, “Assessing anxiety and depression trajectories among single homeless adults receiving rapid rehousing following placement in housing,” examines self-reported anxiety and depression symptoms among a group of 98 single adults experiencing homelessness shortly after receiving rapid rehousing (RRH) services. RRH programs aim to house people as quickly as possible through the Housing First model by providing a range of services such as housing identification, temporary financial assistance for rent and move-in costs, and ongoing case management. The authors find that RRH programs were associated with significant decreases in anxiety and depression symptoms among single adults experiencing homelessness. They emphasize the need for expanding upon these findings through additional research studies focused on the impact of rapid rehousing programs on mental health outcomes.
Prior research on RRH programs has focused mainly on outcomes related to housing stability, with limited or no consideration of the programs’ impact on recipients’ mental health status. Housing is widely considered a key social determinant of health and, in the context of homelessness, has a particularly strong link to mental health. The authors note that studies of other kinds of housing assistance, such as permanent supportive housing, have placed a greater emphasis on examining the mental health outcomes of recipients.
The authors sought to estimate the extent to which the anxiety and depression symptoms of people experiencing homelessness changed over time following placement in housing through an RRH program and to understand how individuals’ demographic and socioeconomic characteristics influenced these changes. They recruited participants from individuals receiving RRH services from a large nonprofit homeless service and housing agency based in a major city in the northeast U.S. Case specialists were given recruitment flyers to share with clients, who could choose to opt into the study. Eligibility was limited to clients who were initially placed into housing between March 2018 and June 2020 and had access to the internet or a phone. Participants took surveys online or by phone at the time of housing placement and every six months thereafter through June 2021; participants received a $15-25 gift card as compensation for each completed survey.
The surveys took approximately 10 minutes to complete and asked a range of questions on housing status, employment, income, health status, and sociodemographic measures. The authors included two well-tested and widely used clinical assessments within each survey to measure participants’ anxiety and depression levels: the Generalized Anxiety Disorder Scale (GAD-7), which has a scale of 0 to 21, and the Patient Health Questionnaire (PHQ-9), which has a scale of 0 to 27. For both assessments, scores closer to zero indicate lower levels of anxiety or depression, and higher scores indicate more severe levels of anxiety or depression. Participants took anywhere between one to six follow-up surveys depending on time of enrollment and availability, with a total of 210 surveys included in the analysis.
The authors found that participants’ anxiety and depression scores decreased over time following placement into stable housing through the RRH program. From the initial surveys taken during the first month of being rehoused, the estimated average anxiety score for participants was 8.3 and the estimated average depression score was 8.8. At one year post move-in, estimated average participant scores for anxiety and depression declined to 7.3 and 7.7, respectively. At two years post move-in, the estimated average scores further declined to 6.4 for anxiety and 6.7 for depression. The authors identified several factors that influence the trajectory of anxiety and depression levels among participants including age, race, and monthly income. Generally, older participants and those with a poor credit history displayed a more dramatic reduction in their symptoms over time than younger participants and those with no history of poor credit scores.
Given the deficit of prior research studies on this subject, as well as the lack of a control group in this study, the authors note that it is hard to place the significance of some of their findings. They emphasize the need for additional studies regarding the relationship between RRH and mental health outcomes to fully examine the impact of these programs. Additionally, the authors suggest that future studies consider factors such as participants’ access to mental health and substance use treatment services, the availability of educational and vocational programs, and the structure of participants’ social networks to understand how RRH services can be modified to meet the unique needs of individuals in the program and support greater improvements in mental health outcomes.
Read the full article here.