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Altres ajuts: Agència de Salut Pública de Barcelona; Recercaixa. Objective: This study aims to analyse the effects of housing insecurity on health and whether they are modified by employment status of people belonging to the Treball als Barris programme in Barcelona (Spain) between 2015 and 2016. Method: We conducted a longitudinal study using a survey which included sociodemographic, employment and housing status information. This was administered to 469 individuals at baseline and after one year of follow-up. We then carried out a descriptive analysis and fitted regression models to estimate the effects of housing insecurity and employment status on health, and the interaction between them. Results: Among women, we found negative effects of housing insecurity on health (the prevalence ratio [PR] of poor self-reported health among women with housing insecurity was 2.29, with a 95% confidence interval [95%CI] of 1.36-3.84, compared to those in secure housing), while, among men, the main effects on health were due to employment status (PR of poor self-reported health among men who were unemployed without subsidy was 3.16 [95%CI: 1.02-6.15] compared to those who were employed after follow-up). In addition, the results suggest an interaction between housing and employment status on mental health among men. Conclusion: Housing insecurity rates have increased in recent years. It produces negative effects on health and can interact with other social determinants such as employment, mainly on men's mental health.

La inseguridad residencial por motivos económicos es un grave problema de salud pública que ha aumentado en los últimos años en el Estado español. Incluye diversas situaciones como el no poder pagar el alquiler o la hipoteca, estar bajo una demanda judicial de ejecución, ser desahuciado/a o residir en alojamientos sin título legal. En este contexto, esta tesis incluye tres estudios con el objetivo de: i) Identificar y sistematizar la evidencia científica sobre los efectos del proceso del desahucio en la salud ii) Evaluar el estado de salud de colectivos bajo situaciones de inseguridad residencial en Cataluña y compararlo con la población general y, iii) Conocer los mediadores entre la inseguridad residencial y la salud. Los resultados permiten afirmar que en países y contextos diversos la inseguridad residencial genera evidentes efectos negativos sobre la salud mental (ej., depresión, ansiedad y suicidios) y física (ej., mala salud auto-percibida, hipertensión arterial, maltrato infantil y mayor mortalidad), aunque su magnitud varía según los ejes de desigualdad social. Lo anterior fue confirmado a nivel local donde personas afectadas por situaciones de inseguridad residencial pertenecientes a la Plataforma de Afectadas por la Hipoteca de Cataluña presentaron mayor probabilidad de presentar mala salud mental y mala salud auto-percibida comparadas con la población general. Por último, nuestros resultados mostraron que los cambios psicológicos (ej. vergüenza, culpa, sensación de fracaso personal y pérdida de control), la adopción de conductas menos saludables, el deterioro material de la vivienda, la pérdida de la red social, el acoso de las instituciones financieras, entre otros, serían mediadores entre la inseguridad residencial y la salud. Housing insecurity due to economic reasons is a serious Public Health problem which has increased in recent years throughout Spain. It includes different situations such as rent or mortgage payments arrears, foreclosure, eviction or dwelling under illegal conditions (e.g. squatting). In this context, this thesis gathers three studies aim to: i) Identify and systematize scientific evidence on the effects of the threat of eviction on health; ii) Describe and compare the health status of people under housing insecurity from Catalonia to a sample of the general population and; iii) Identify perceived mediators of the relationship between housing insecurity and health among affected groups. The findings showed that housing insecurity has negative effects on mental health (e.g. depression, anxiety, and suicides) and physical health (e.g. poor self-reported health, high blood pressure, child abuse, and mortality) in different countries and contexts, although these effects may vary according social inequality axes. This was supported at local level where people under housing insecurity from the Catalonian Platform of People Affected by Mortgages reported worse mental and physical health compared to general population. Finally, our results showed that psychological changes (e.g. feelings of shame, guilty, personal failure and loss of control), unhealthy behaviors, deterioration of the physical conditions of the dwelling, the loss of social network, harassment by financial institutions, etc. would be mediators and pathways between housing insecurity and health. This complex phenomenon is an important social determinant which interacts with others such as energy poverty and employment precariousness in its effects on health.

Recommendations for tackling negative effects of housing insecurity on health. (DOCX 20 kb)