Poster #121 - Perceived Stress in Low-Income Renters: Testing Associations in an RCT of Direct-to-Tenant Rental Assistance

• In Event: Friday Poster Reception

Abstract

Background: Housing instability and low socioeconomic status are associated with perceived stress in both cross-sectional and longitudinal research, suggesting that stabilizing housing and improving housing may reduce perceived stress. Determining what life circumstances are associated with reduced perceived stress may help inform the development of social programs to effectively target health and psychological outcomes. This analysis uses qualitative and longitudinal quantitative data from the PHLHousing+ study, a randomized control trial testing two forms of rental assistance in a low-income sample of Philadelphia families. 
Research question: This study tests associations between worry about ability to stay in current housing, worry about neighborhood safety, ability to cover monthly expenses, and perceived stress. 
Methods: This study uses an exploratory sequential mixed methods design, drawing from participant interviews conducted between 2023 and 2025 and survey data collected at wave 1 (summer of 2022) and wave 7 (winter 2026),  approximately 3.5 years later. The analysis was conducted in two phases. First, using thematic analysis, I explored qualitative data to understand participants’ experiences related to the interventions and mental health and identify potential predictors of stress. Second, I explored corresponding survey data on predictors of stress, including worry about ability to stay in current housing, worry about neighborhood safety, and ability to cover monthly expenses. I created binary indicators of ever reporting worry about neighborhood safety or ability to stay in current housing, or reporting going into debt or living on savings, at any wave. Regression analyses tested associations between these indicators and perceived stress scale (PSS-4) total scores. Given the correlation between housing worry and financial strain, each was tested controlling for the other.
Results: Qualitative analysis identified housing worry, safety, and financial strain as key indicators of stress, which informed the selection of survey-based indicators. 94% of participants reported worrying about their neighborhood safety, 92% of participants reported worrying about their ability to stay in current housing, and 69% of participants reported living on savings or going into debt. Ever reporting worry about neighborhood safety was not significantly associated with PSS-4 total scores (b=0.32, p=0.517). Worry about ability to stay in current housing was associated with higher wave 7 PSS-4 scores (b=1.66, p=0.000), and the association remained after accounting for participants’ reports of their ability to pay monthly expenses (b=1.47, p=0.001). Inability to cover monthly expenses was associated with higher wave 7 PSS-4 scores (b=1.12, p=0.000), and the association remained after accounting for  worry about ability to stay in current housing (b=0.97, p=0.000) 
Conclusion: Both worry about staying in current housing and ability to pay monthly expenses were independently and significantly associated with lower perceived stress scores, indicating that perceptions of control over finances and housing stability are important factors in determining levels of stress in this low-income population. Interventions that target structural determinants of mental health, such as housing assistance, may need to substantially improve housing stability and financial wellbeing to meaningfully reduce perceived stress.

Author

• Emilie M Tanski, University of Pennsylvania
  Presenting Author