By Kristi Eaton
The high number of foreclosures as a result of the collapse of the housing market has become not only a financial problem, but a mental health one as well. A new University of Pennsylvania School of Medicine study shows that nearly half of the people studied undergoing foreclosure reported symptoms of depression, and 37 percent met the criteria for major depression. Many also reported an inability to afford prescription drugs and skipping meals.
“The foreclosure crisis is also a health crisis,” says lead author Craig Pollack, who conducted the research while working as an internist at Penn. "We need to do more to ensure that if people lose their homes, they don't also lose their health."
The research, published in the American Journal of Public Health, found that compared to residents in the general public, those in foreclosure were more likely to be uninsured — 22 percent compared to 8 percent — though similar health problems were seen among both the insured and uninsured. Nearly 60 percent reported that they had skipped or delayed meals because they couldn't afford food, while 48 percent of people undergoing foreclosure opted not to fill a prescription because of the expense during the preceding year, compared to 15 percent of the general public.
For some, health issues were the cause of the foreclosure problems. The study revealed that a medical condition in their family was the primary reason for 9 percent of respondents to undergo a home foreclosure. Also, more than a quarter of those surveyed said they had significant unpaid medical bills.
Pollack says the prolonged period of time that most homeowners spend in foreclosure could have a serious effect on health because the financial hardships of foreclosure may lead homeowners to cut back on healthcare spending that they consider discretionary, such as preventive care visits, healthy foods, or drugs for chronic conditions such as hypertension. Moreover, the stress of undergoing foreclosure may exacerbate unhealthy behaviors. For instance, among the participants who smoke, 65 percent said they had been smoking more since they received notice of foreclosure.
The exceptionally high rate of depressive symptoms found in the study is especially concerning, Pollack says. Previous research showed that only about 12.8 percent of people living in poverty met criteria for major depression.
"When people purchase homes, they are buying a piece of the American Dream," says co-author Julia Lynch, the Janice and Julian Bers assistant professor in the Social Sciences in Penn's Department of Political Science. "Losing a home can be especially devastating because it means the loss of this dream. When this happens, there is reason to worry not only about the health of the homeowner but also that of family members and the broader community they live in."
The authors say that the data collected in Philadelphia may be modest when compared to other cities that have experienced a sharp spike in housing foreclosures. Although foreclosure filings nearly doubled between 2007 and 2008 in Philadelphia, other large cities have higher unemployment and foreclosure rates.
To combat the health problems revealed in the study, Pollack and Lynch suggest that healthcare workers and mortgage counseling agencies coordinate their efforts to help people at risk of foreclosure access both medical and housing help. Doctors, they suggest, should ask their patients about their housing situation and steer them toward mortgage relief resources. Mortgage counselors, meanwhile, can provide information about how to access safety net healthcare, enroll in public insurance programs like State Children's Health Insurance Program or Medicaid, or apply for nutritional assistance programs for pregnant and nursing mothers and their children.
“This study raises the stakes of the housing crisis,” Pollack says. “The policy push to get people into mortgage counseling should be combined with health outreach in order to fully help people during this tremendously difficult period in their lives.”
The authors studied 250 Philadelphia homeowners undergoing foreclosure. The participants were recruited with the Consumer Credit Counseling Service of Delaware Valley, a non-profit, U.S. Housing and Urban Development-approved mortgage counselor.