In January 2020, the RealChild project was started by researchers at the Perinatal, Obstetric & Pediatric Epidemiology (POPE) group at the Section of Epidemiology of the University of Copenhagen. The RealChild project set out to explore the relations between housing conditions, indoor environment, and infectious, mental, and respiratory health of children, using data from the Danish National Birth Cohort (DNBC). A little more than two months after the start of the project, the first COVID-19 lockdown was implemented in Denmark to mitigate the spread of the SARS-CoV-2. At the beginning of the first national lockdown, the project Standing together at a distance: how Danes are living with the Corona crisis was initiated by our Section. The aim of the “Standing together” project was to explore how the COVID-19 pandemic and nationally implemented preventative measures in Denmark affected people’s mental health and daily lives. Meanwhile, research groups across the world also set up studies assessing the mental health of populations during the COVID-19 pandemic. To efficiently pool and summarize mental health-related research during the pandemic, the international COVID-MINDS network was created.
Housing conditions as well as access to green spaces affect people’s physical and mental health; and inadequate housing is known to associate with a plethora of preventable diseases. Before the COVID-19 pandemic, European citizens already spent most of their time indoors1, but the time spent at home increased to a great extent during the lockdowns. Consequently, residences became the place for most private, work-related, and leisure activities.
Inspired by prior research on the topic, we were interested to investigate which aspects of housing conditions influence people’s mental health when mandated to stay at home. In addition, we wanted to investigate whether country-specific patterns would emerge. To do so, we identified cohorts from the COVID-MINDS network that were already part of a previous project of ours. Eventually, we included data from four European studies from Denmark (DNBC), England (UCL Covid-19 Social Study), and France (TEMPO and Constances), comprising about 70,000 individuals. First, data on housing conditions and mental health were harmonized to enable comparisons. Then, data was analyzed from each cohort separately; finally, results from the cohorts for each exposure-outcome combination were pooled together.
Now that we have shed some light about what happened behind the scenes, let’s talk about our findings!
We found that the housing environment matters for one’s mental health. Maybe not so surprisingly – we found that people living alone were at higher risk of feeling lonely and were less satisfied with their life than people living with others. These results are consistent with other studies. As both social isolation and loneliness have been shown to be associated with increased mortality, impaired quality of life, and wellbeing2, implementing additional support for those living alone should be considered.
We also found that women’s mental health seemed to be more strongly associated with household composition than men’s. Indeed, women living with children reported higher levels of anxiety. The association between living with children and anxiety was the most apparent in France. This result might be explained by a salient aspect of the COVID-19 crisis affecting women in particular: namely, the large-scale closures of daycare centers and schools, resulting in children staying at home and needing to be cared for, and home-schooled3.
Living in urban vs. rural settings did not influence people’s mental health in our study. Likewise, living in a house vs. an apartment did not seem to matter for mental health. However, living in dwellings offering more rooms for a given household was related to better mental health, albeit with some differences by country and age groups. Similarly, having access to outdoor spaces, such as a balcony or a garden, appeared to be associated with lower levels of anxiety, especially in France. Other studies have reported that having access to (or even just having a view of) natural green and blue spaces is associated with better mental health during lockdowns4–6. Although having access to natural green spaces might be the most beneficial for mental health, we found that having access to any type of outdoor space (e.g. balcony, garden, or yard) compared to none, may lower levels of anxiety during a lockdown. These findings speak in favor of incorporating private and public outdoor spaces into urban planning interventions and housing design.
So why does all of this matter?
Housing environment is a key determinant of individuals’ physical and mental health. In times of epidemic outbreaks, crowding and some other housing conditions are important factors for disease spread7,8. However, people’s homes may affect them in more ways than their risk of infection and household transmission. Indeed, our study shows that housing may determine who fares well and who does not - at least in the initial COVID-19 lockdowns in Denmark, the UK, and France. Housing environment is also a modifiable determinant of health, which means that it can be changed. As such, it can be controlled to a certain extent by the individuals, but mostly at a societal level. In the short-term, local and national policy-makers and public health professionals need to understand that individuals in certain housing environments may experience poorer mental health compared to others in the same situation. Communicating, supporting, and intervening accordingly should be considered when lockdowns are implemented. For the long-term, investments and research into implementing better housing and urban planning, i.e. by incorporating private and public outdoor spaces, could create home environments that benefit citizen’s mental health during and outside of a pandemic.
- European Commission. Indoor air pollution: new EU research reveals higher risks than previously thought. (2003).
- Steptoe, A., Shankar, A., Demakakos, P. & Wardle, J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc. Natl. Acad. Sci. U. S. A. 110, 5797–5801 (2013).
- Alon, T. Doepke, M., Olmstead-Rumsey, J., Tertilt, M. The Impact of COVID-19 on Gender Equality. National Bureau of economic research https://ideas.repec.org/p/bon/boncrc/crctr224_2020_163.html (2022).
- Pouso, S. et al. Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial for mental health. Sci. Total Environ. 756, (2021).
- Dzhambov, A. M. et al. Does greenery experienced indoors and outdoors provide an escape and support mental health during the COVID-19 quarantine? Environ. Res. 196, (2021).
- Ribeiro, A. I. et al. Exposure to nature and mental health outcomes during COVID-19 lockdown. A comparison between Portugal and Spain. Environ. Int. 154, 106664 (2021).
- UN-Habitat Housing and COVID-19.
- Ismail, M., Warsame, A. & Wilhelmsson, M. An Exploratory Analysis of Housing and the Distribution of COVID-19 in Sweden. Build. 2022, Vol. 12, Page 71 12, 71 (2022).
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