Beyond Shelter: Housing Instability, Health-Related Quality of Life, and Mental Health as Public Policy Priorities

Abstract Housing instability has emerged as a significant social determinant of health. While prior research links distinct forms of instability, such as homelessness and foreclosure, to adverse health outcomes, few studies examine how multiple forms of housing instability, in the form of affordability, stable occupancy, and safety and decency, simultaneously affect mental well-being. We explore how multidimensional housing instability and health-related quality of life (HQoL) jointly relate to perceived stress, depression, and anxiety. Using a representative survey (N = 850) of Fort Bend County residents and Machine Learning Gradient Boosting Regression, we find that the contributions of housing instability, HQoL, their interaction, and socio-demographic covariates, with tuned hyperparameters and hold-out validation, achieved high out-of-sample fit (R² ≈ 0.88–0.93). Perceived quality of life and HQoL were the strongest predictors across outcomes, while housing instability showed a mainly conditional association: the interaction between higher housing instability and worse HQoL substantially increased predicted stress, anxiety, and depression, with the largest effects for perceived stress. Education and income were modestly protective, and basic demographics added little once living conditions and quality of life were included. We find that these patterns vary spatially, with stronger correlations between health and place in certain geographic areas compared to others within our area of analysis, underscoring that structural housing conditions and health-related quality of life are central to understanding psychological distress and support integrating “housing vital signs” and stability-first housing interventions into population health and clinical practice.