Housing environment and mental health of Europeans during the COVID-19 pandemic: a cross-country comparison

Abstract

Many studies have investigated the impact of the COVID-19 pandemic on mental health. Throughout the pandemic, time spent at home increased to a great extent due to restrictive measures. Here we set out to investigate the relationship between housing conditions and the mental health of populations across European countries. We analyzed survey data collected during spring 2020 from 69,136 individuals from four cohorts from Denmark, France, and the UK. The investigated housing conditions included household density, composition, and crowding, access to outdoor facilities, dwelling type, and urbanicity. The outcomes were loneliness, anxiety, and life satisfaction. Logistic regression models were used, and results were pooled using random-effects meta-analysis. In the meta-analysis, living alone was associated with higher levels of loneliness (OR = 3.08, 95% CI 1.87-5.07), and lower life satisfaction (OR = 1.27, 95% CI 1.05-0.55), compared to living with others. Not having access to an outdoor space and household crowding were suggestively associated with worse outcomes. Living in crowded households, living alone, or lacking access to outdoor facilities may be particularly important in contributing to poor mental health during a lockdown. Addressing the observed fundamental issues related to housing conditions within society will likely have positive effects in reducing social inequalities, as well as improving preparedness for future pandemics.

Figure 1

Data collection in the four participating cohorts.

Figure 2

Association between access to outdoor space (yes vs. no) and high levels of anxiety (N = 68,712). The cohort-specific estimates and 95% confidence intervals were obtained using binary logistic regression models. Age, educational attainment, gender, previously diagnosed chronic disease status and presence of previously diagnosed mental illness were used a covariates. In addition, the models included mutual adjustment for the other housing exposures. 95% CI 95% confidence interval, OR odds ratio.

Figure 3

Association between household crowding and low life satisfaction (N = 18,652). The cohort-specific estimates and 95% confidence intervals were obtained using binary logistic regression models. Age, educational attainment, gender, previously diagnosed chronic disease status and presence of previously diagnosed mental illness were used a covariates. In addition, the models included mutual adjustment for the other housing exposures. 95% CI 95% confidence interval, OR odds ratio.

Figure 4

Association between living alone (vs. living with others) and high levels of loneliness (N = 69,136). The cohort-specific estimates and 95% confidence intervals were obtained using binary logistic regression models. Age, educational attainment, gender, previously diagnosed chronic disease status and presence of previously diagnosed mental illness were used a covariates. In addition, the models included mutual adjustment for the other housing exposures. 95% CI 95% confidence interval, OR odds ratio.

Figure 5

Association between living alone (vs. living with others) and low life satisfaction (N = 40,965). The cohort-specific estimates and 95% confidence intervals were obtained using binary logistic regression models. Age, educational attainment, gender, previously diagnosed chronic disease status and presence of previously diagnosed mental illness were used a covariates. In addition, the models included mutual adjustment for the other housing exposures. 95% CI 95% confidence interval, OR odds ratio.