Economic deprivation as a mediator in the relationship between housing affordability stress and mental and general health among humanitarian migrants in Australia

BACKGROUND: Housing is a critical social determinant of health for migrant and refugee populations in high-income countries; however, the causal pathways linking housing affordability to health outcomes remain underexplored. This study aimed to examine the relationship between housing affordability stress and both mental and general health, and to assess the role of economic deprivation as a mediator of this relationship. METHODS: This study uses data from the five waves (2013-2018) of the Building a New Life in Australia study, which followed 2399 humanitarian migrants who arrived in Australia or were granted a permanent protection visa in 2013. Causal mediation analyses using marginal structural models were conducted to decompose the total effect of housing affordability stress on mental and general health into the natural direct effect and natural indirect effect mediated through economic deprivation. RESULTS: The total effect of housing affordability stress on mental health was 1.56 (95% CI 1.26 to 1.92). Economic deprivation mediated 37% (95% CI 19.5% to 68.8%) of the total effect, and 79.6% (95% CI 60.3% to 113.9%) of the total effect could potentially be eliminated by intervening on economic deprivation. For self-rated general health, the total effect of housing affordability stress was 1.43 (95% CI 1.15 to 1.74). Economic deprivation accounted for 27.7% (95% CI 5.3% to 62.6%) of the total effect, and 65.9% (95% CI 29.9% to 101.9%) of the total effect could potentially be eliminated by intervening on economic deprivation. CONCLUSIONS: The findings demonstrate that housing affordability stress leads to elevated psychological distress and poor self-rated general health among humanitarian migrants. A substantial portion of this impact occurs through economic deprivation, which could be attenuated by targeting economic deprivation as a key intervention point during early years of resettlement.