State Housing Policy Environments and Suicide Risk among Households Experiencing Eviction and Foreclosure

• In Event: Impacts of Eviction and Access To Opportunity in Rental Assistance Programs

Abstract

Background and Purpose.

The most recent suicide prevention plan by the US Centers for Disease Control and Prevention (CDC) identifies housing security as a social determinant of mental health and promotes interventions like permanent supportive housing in improving mental health outcomes among housing-insecure individuals. However, the CDC’s plan specifically and the literature generally often fail to consider the effects of another important intervention for mitigating housing loss: policies that protect residents from eviction and foreclosure. The goal of this study is to assess whether state housing policy environments moderate risk of suicide death following the initiation of formal eviction or foreclosure proceedings. 

Methods.

To answer the research question, we first have to address a key methodological challenge in assessing the secondary effects of housing policies on outcomes like suicide risk: the fact that estimating the risks of suicide death following housing loss requires linking eviction and suicide outcomes, which is not possible to do using existing administrative datasets. We use techniques from natural language processing to identify suicide decedents who experienced housing loss from narrative texts in the National Violent Death Reporting System (NVDRS) from 2011 to 2021. We then link the NVDRS data to multiple external data sources using county-level identifiers to create a population-scale dataset examining the joint distribution of suicide, eviction, foreclosure, and state policy over an 11-year period. Finally, we test whether three sets of policies are associated with changes in suicide risk following eviction and foreclosure: (1) the state-level eviction and foreclosure policies from 2011-2018, (2) each state’s time-varying enforcement of the federal eviction moratoria from 2020-2021, and (3) the time-varying state-level eviction protections from 2020-2021.

Results.

Between 2011-2018, we find that people who experiencing an eviction are less likely to die by suicide when they live in a state with strong resident protections (risk ratio 0.69, 95% CI [0.47, 0.92]) than in a state with weak protections (risk ratio 1.52, 95% CI [1.07, 1.97]). During the COVID-19 pandemic, states that enforced the federal eviction moratoria had higher suicide risk (risk ratio [95% CI] CARES Act moratorium: 79 [69,89], CDC moratorium: 64 [53,75], None: 52 [49,55]); similarly, additional state eviction moratoria were associated with higher suicide risk. Compared to those in states with weak resident protections, evicted decedents in states with strong pre-pandemic resident protections were less likely to have a number of contributing circumstances including unemployment, health, family, and financial problems. The opposite is true during the pandemic.

Conclusion.

Our results are consistent with the idea that social causation (housing loss leading to other stressors which contributes to elevated suicide risk) and social selection (the presence of other stressors increasing the risk of housing loss and, therefore, of suicide risk) are important mechanisms linking housing policy environments to suicide risk. Our work suggests that state resident protections can be an important point of intervention for suicide risk. Future research could test which interventions are most effective in mitigating the risk of suicide following housing loss.

Author

• Aparna Ananthasubramaniam, University of Michigan Ann Arbor
  Presenting Author