In this study, we examined the potential association between substandard housing and depression. The main findings suggest that living in substandard housing is related to depression. Participants who live without disabled members in their household have association with depression when they live in substandard housing. Among the three criteria for substandard housing, living in a situation that fails to meet construction and environmental standards is most likely to be associated with depression.
Previous studies regarding substandard housing and mental health problems suggest similar associations. One study suggests that damp, moldy, and cold indoor conditions may be associated with anxiety and depression21. Another study indicates that living in neighborhoods where noise impedes sleep is associated with poor mental health22. Similarly, in our study indicates that participants who live in house that does not meet construction and environmental standards such as noise, vibration, odor, air pollution, ventilation have higher depression score. Further, living in substandard housing may be related to behavioral problems among children23. Similar results were found in this study that living in substandard housing that does not meet the minimum residential area and number of rooms are associated with mental health problem. Although the targeted population were different. Pragmatic concerns and fear may explain these results; living in substandard housing is a psychosocial stressor that can lead to mental health problems10. There is strong accumulated evidence that episodic stressors play a causal role in many instances of depression24.
A key finding of this study was that the results of our subgroup analysis of substandard housing in association with depression stratified by household type. Regardless of whether the participant or a member of their household was disabled, if that participant lives in substandard housing, they are likely to have a higher depression score than a participant living in standard housing. However, the results were only statistically significant in participants without disabled household members. This result may be explained by the cash benefits offered by a disability pension, which is an income support for people with severe disabilities25. Moreover, in South Korea, disabled people benefit from the National Basic Livelihood Security System (NBLSS). The NBLSS is an integrated benefit system comprising four areas: Livelihood Benefit, Medical Benefit, Housing Benefit, and Education Benefit26. The housing benefit includes a discount to one’s electricity and heating bills. As economic burdens elevate the risk of depression27, financial support may act as a buffer, lowering the risk of depression.
Another key finding was that among the three minimum housing standards criteria, construction and environmental standards are most likely to be associated with depression. Construction and Environmental standards include noise, vibration, odor, air pollution, ventilation, and so on. It is well known that prolonged exposure to damp, mold, noise, and odor in one’s living environment are associated with mental health issues21,22,28,29. However, an interesting result of this study was that essential facilities, including water and sewage, a single standing kitchen, single flush toilet, and single bath facilities, do not appear to be associated with depression. One possible explanation for this result is that most participants may meet the essential facility criteria; however, further research is needed in this area.
Evaluations of housing renewal programs for people living in poor conditions, as well as research regarding early educational interventions, show that improving social conditions can contribute to improved mental health status30. Korea officially works to support people living in substandard housing via several programs4. The Public Rental Housing Programs comprise the main low-income housing policies in Korea. Those enrolled in these programs receive favorable treatments in terms of land acquisition, long-term financing below market rates, and tax deductions and exemptions. To assist with housing acquisition and expenses, there are two types of Demand-Side Programs: the deposit loan program and the housing benefits program. The deposit loan program lends some portion of the required deposit at a below-market interest rate, whereas the housing benefits program offers a cash subsidy support based on household size.
Despite these efforts, a UN report 31 revealed that in Korea, the number of people who live in substandard housing is increasing. This poses a serious threat to wellbeing: those who live in substandard housing are easily exposed to greater risks of fire and crime as well as the risks inherent to the poor living environment. The report also indicates that women, young people, the elderly, migrant workers, people with disabilities, and sexual minorities living in substandard housing are more often subject to discrimination and social exclusion from residential welfare.
This study has several limitations. First, measures of substandard housing are based on self-report; therefore, under- or overestimation of behaviors and conditions may have affected the accuracy of reporting among participants. Second, we could not include a factor related to the contextual appropriateness of participants’ housing cost burden, such as ability to pay their rent or mortgage, or being able to buy a home. However, we were able to include some housing-related variables such as housing benefit, housing tenure, and housing type. Third, because personality characteristics and medical history are likely to be associated with depression, our inability to include these in our statistical models may have resulted in exaggerating the associations under investigation.
Despite these limitations, this study has several strengths. First, this study worked to identify associations by using three-year longitudinal data relying on a national sample; thus, the results may be generalized to the Korean population as a whole with some confidence. The study expands our knowledge of the effects of substandard housing outside its most common context. Most previous studies in this area have targeted European populations, rarely studying the effects of substandard housing in Asian populations. Thus, this study contributes to the literature by using minimum housing standards as a measure of substandard housing and its potential association to depression among South Koreans.