HOUSING CONSTRAINTS, PSYCHOLOGICAL DISTRESS, AND SUICIDE:DIVERGING OUTCOMES ACROSS U.S. COUNTIES
Author(s)
Chengcheng Zhang, PhD1, Kristin Schuller, PhD2.
1Assistant Professor, Towson University, Towson, MD, USA, 2Towson University, Towson, MD, USA.
1Assistant Professor, Towson University, Towson, MD, USA, 2Towson University, Towson, MD, USA.
OBJECTIVES: Housing inequality is a persistent determinant of health that may impose significant mental and behavioral health burdens on communities. This study investigates the association between structural housing conditions and population mental health outcomes using data from the 2023 to 2025 County Health Rankings & Roadmaps.
METHODS: Using multivariable linear regression models, we estimate associations between multiple housing indicators, including severe housing problems, housing cost burden, severe cost burden, overcrowding, lack of basic household facilities, long commute times, and low homeownership, and each mental health outcome, adjusting for demographic, socioeconomic, and geographic characteristics.
RESULTS: Results show that long commute times and low homeownership are consistently associated with higher average poor mental health days (+0.06 days each, both p < 0.001), while severe cost burden is also positively associated (+0.03 days, p = 0.004). In contrast, suicide rates are significantly lower in counties with high overcrowding (-1.88 per 100,000, p < 0.001), lack of household necessities (-0.29, p = 0.035), and, unexpectedly, severe cost burden (-0.59, p = 0.012).
CONCLUSIONS: These findings reveal a divergence between psychological distress and suicide mortality: while structural housing burdens are associated with increased poor mental health days, they are often linked to lower suicide rates. This contrast may reflect urban protective factors or unmeasured community-level supports. The results highlight the need for policies that integrate housing conditions with both preventive mental health care and targeted suicide prevention strategies.
METHODS: Using multivariable linear regression models, we estimate associations between multiple housing indicators, including severe housing problems, housing cost burden, severe cost burden, overcrowding, lack of basic household facilities, long commute times, and low homeownership, and each mental health outcome, adjusting for demographic, socioeconomic, and geographic characteristics.
RESULTS: Results show that long commute times and low homeownership are consistently associated with higher average poor mental health days (+0.06 days each, both p < 0.001), while severe cost burden is also positively associated (+0.03 days, p = 0.004). In contrast, suicide rates are significantly lower in counties with high overcrowding (-1.88 per 100,000, p < 0.001), lack of household necessities (-0.29, p = 0.035), and, unexpectedly, severe cost burden (-0.59, p = 0.012).
CONCLUSIONS: These findings reveal a divergence between psychological distress and suicide mortality: while structural housing burdens are associated with increased poor mental health days, they are often linked to lower suicide rates. This contrast may reflect urban protective factors or unmeasured community-level supports. The results highlight the need for policies that integrate housing conditions with both preventive mental health care and targeted suicide prevention strategies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE23
Topic
Economic Evaluation