Impact of housing conditions on changes in youth’s mental health following the initial national COVID-19 lockdown: A cohort study
Authors: Groot Jonathan , Keller Amélie Cléo , Joensen Andrea , Nguyen Tri-Long , Nybo Andersen Anne-Marie , Strandberg-Larsen Katrine 
Published: December 2020

AbstractBackgroundYouth’s mental health has on average declined initially during the pandemic and few studies have investigated whether these declines were dependent on housing conditions.MethodsWe used data from 7445 youth from the Danish National Birth Cohort (DNBC), collected at participants’ 18th year of life and subsequently three weeks into the initial national lockdown (April 2020). We examined associations between housing conditions (access to outdoor spaces, urbanicity, household density, and household composition) and changes in mental health parameters (mental well-being, Quality of Life (QoL) and loneliness. We report results from multivariate linear and logistic regression models.FindingsYouth without access to outdoor spaces had a greater decrease in mental well-being compared to those with a garden, mean difference: -0·83 (95 % CI -1·19,-0·48), and correspondingly greater odds of onset of low mental well-being, OR: 1·68 (95 % CI 1·15, 2·47). Youth in higher density households and those living alone also had greater odds of onset of low mental well-being (OR: 1·23 (95 % CI 1·05, 1·43) and OR: 1·47 (95 % CI 1·05, 2·07), respectively). Onset of low QoL was associated with living in denser households, as well as living alone. Living alone more than doubled odds of onset of loneliness, OR: 2·12 (95 % CI 1·59, 2·82).InterpretationNot all youth were equally affected by the pandemic and our findings inform policy makers that youth living alone, in denser households, and without direct access to outdoor spaces are especially vulnerable to mental health declines.Research in contextEvidence before this studyMental health is associated with certain housing characteristics, such as access to green space and household composition. Additionally, we know that mental health amongst youth has been especially impacted by the COVID-19 pandemic and/or social restrictions, at a time where a majority of youth spend more time at home. Cross-sectional studies have indicated that housing conditions during the initial lockdowns were associated with mental health among youth.Added value to this studyWe are able to provide evidence that housing conditions have been important factors in how youth’s mental health has changed, due to data collections in our cohort before and during the pandemic. We demonstrate that living alone without access to outdoor spaces and in denser households during lockdown are all associated with deteriorations in mental health in a longitudinal design. The deteriorations in mental well-being are at a level indicative of anxiety and/or depression, indicating that these mental health changes are meaningful from a public health perspective. To our knowledge, this is the first study to examine associations longitudinally in a youth cohort.Implications of all the available evidenceNot all youth will be equally affected by the pandemic and social restrictions. Public health recommendations could be that youth avoid living alone, in dense households and without access to outdoor spaces during a lockdown, if this is at all possible to choose. Additionally, mental health and public health professionals should be aware of these vulnerabilities as they seek to assist youth at times when social restrictions are in place to control community transmission. Additionally, as we look to the future and work towards equitable and health-promoting housing, we must consider aspects that are important to mental health during pandemics and otherwise.