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标题：The Onset of Depression During the Great Recession: Foreclosure and Older Adult Mental Health
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作者：Kathleen A. Cagney ; Christopher R. Browning ; James Iveniuk 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：3
页码：498-505
DOI：10.2105/AJPH.2013.301566
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined neighborhood-level foreclosure rates and their association with onset of depressive symptoms in older adults. Methods. We linked data from the National Social Life, Health, and Aging Project (2005–2006 and 2010–2011 waves), a longitudinal, nationally representative survey, to data on zip code–level foreclosure rates, and predicted the onset of depressive symptoms using logit-linked regression. Results. Multiple stages of the foreclosure process predicted the onset of depressive symptoms, with adjustment for demographic characteristics and changes in household assets, neighborhood poverty, and visible neighborhood disorder. A large increase in the number of notices of default (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.14, 2.67) and properties returning to ownership by the bank (OR = 1.62; 95% CI = 1.06, 2.47) were associated with depressive symptoms. A large increase in properties going to auction was suggestive of such an association (OR = 1.45; 95% CI = 0.96, 2.19). Age, fewer years of education, and functional limitations also were predictive. Conclusions. Increases in neighborhood-level foreclosure represent an important risk factor for depression in older adults. These results accord with previous studies suggesting that the effects of economic crises are typically first experienced through deficits in emotional well-being. Recent evidence suggests that the foreclosure crisis, emerging in full force in 2007, has had devastating effects on the housing market and on the condition of housing units in neighborhoods with high rates of foreclosure. Economic models point to significant neighborhood externalities associated with increases in foreclosure rates, 1,2 and extant research suggests that the impact of an economic downturn may first be felt through depression. 3 Depression, in turn, has important implications for physical health, quality of life, and the cost of medical care. 4 Research on the association between neighborhood social context and depression suggests that the surrounding neighborhood environment may have independent effects on depression, over and above individual influences. 5 Research on foreclosure and health is limited, but ecological analyses suggest an association between a spike in foreclosures and use of health services, such as unscheduled hospital visits. 6 To our knowledge, no research has examined the role of the economic downturn, or the “Great Recession,” in the onset of depression with a focus on the residential context in which individuals observe economic decline. 6 We therefore explored the onset of depression over the interval of the economic downturn with a unique data source, the National Social Life, Health, and Aging Project (NSHAP), and with attention to one visible sign of economic decline—household foreclosures. Fortuitously, NSHAP wave 1 (W1) was collected in 2005 and 2006 and wave 2 (W2) in 2010 and 2011, thus bounding the economic downturn and foreclosure crisis. We linked these data with national foreclosure data to examine the effect of neighborhood foreclosure rates on the onset of depressive symptoms. NSHAP is a study of older adults (≥ 57 years), a group for whom the experience of foreclosure in the residential environment may be particularly relevant. 7 More than 1.5 million older adults lost their homes between 2007 and 2011; by 2011, the foreclosure rate for this age group was more than 8 times what it had been at the inception of the crisis. The Federal Reserve reports that nearly one half of households whose head is aged 65 to 74 years have no retirement account savings, 8 making the value of one’s home, and the fear of its loss, of even greater concern. Although the absolute risk of foreclosure may still be relatively low for older adults, the experience of an increase in that risk in the immediate neighborhood environment may nevertheless have consequences. Furthermore, the effects of foreclosure at the neighborhood level may be borne most heavily by older residents. Retirement and mobility limitations may diminish the radius of routine activity; the immediate neighborhood environment may then become more important because the greater share of one’s day is spent in neighborhood space. 9 Drawing on physical and social disorder approaches in urban sociology and research on neighborhoods and mental health in social epidemiology, 10–14 we hypothesized that increased foreclosure rates in the immediate environment and the corresponding decline in the condition of housing may affect onset of depression and reports of depressive symptoms. A key component of our model was that foreclosure and deteriorated housing, the increased presence of vacant or abandoned buildings, and the associated potential for increased criminal activity 15 may have significant consequences for mental health. Physical disorder (e.g., boarded-up buildings, infrastructure deterioration) may combine with indicators of social decline (e.g., crime, loitering), leading to a depressed mood, fear, and social withdrawal. 16,17 Mental health states such as these may discourage contact among residents 18,19 and lead to lower levels of street activity, 20 further disconnecting older adults from potentially important sources of local social support and interaction. Thus the erosion of neighborhood life that accompanies high rates of foreclosure may have a significant impact on the mental health of its residents.