Abstract
The purpose of this study was to conduct an exploratory qualitative study of the impact of foreclosure on health. Twenty-nine interviews were conducted with people who had children under the age of 18 years at the time of the foreclosure. Interviews explored perspectives on the foreclosure experience, including factors that led to the foreclosure, the meaning(s) the foreclosure has had for them, and the health care impact. Thematic analyses identified themes underlying families’ descriptions of their experiences. Participant families described the stress of losing a home and how that had contributed to a number of psychological and physiological ailments. Psychological effects included high levels of perceived stress, anxiety, grief, and a sense of shame and failure, while physiological effects were often described as either stress-induced or existing issues worsened by stress. These findings are discussed with regard to their implications for improving services and policies offered to families.
A person’s home is ideally a haven, a sanctuary, and a refuge from the rest of the world. When housing is insecure, it can instead be a source of anxiety, fear, and trepidation. Owning a home has been such an important part of the American dream and of people’s conceptualization of having “made it” that losing a home can be one of the most devastating experiences of a lifetime (Collins & Berg, 2019; Collins et al., 2018; Nettleton & Burrows, 2000). In 2008, during the economic downturn and the housing crisis, 1 in 54 households experienced the loss of a home through a foreclosure, an increase of 81% from the previous year (Christie, 2009). Foreclosures peaked in 2010 with 2.23% of all housing units in foreclosure and have been falling since, yet there were still over 624,000 foreclosures in 2018 (ATTOM Data Solutions, 2019). However, some areas continue to deal with foreclosures. In 2019, Ohio, for example, had the 3rd highest foreclosure rate among the states, and Cleveland, Ohio, where this research was conducted, had the 3rd highest foreclosure rate in the country among cities with populations greater than 1 million (behind Jacksonville, FL, and Philadelphia, PA). Recent research has indicated that African American homeowners have been particularly affected, accounting for more than two-thirds of foreclosures (Hexter & Schnoke, 2017).
Foreclosure affects people on multiple levels. First, it results in a change in housing status, so people go from having a place of their own to staying with family members in crowded housing, downsizing into smaller living spaces, going from a homeowner to a renter, or in some situations, becoming homeless (Coulton et al., 2009). Researchers have found homeownership is a part of homeowners’ identity and losing the home can be a shocking change in status and to well-being manifest by changes in mental and physical health (Burgard et al., 2012; Downing, 2016; Houle & Light, 2014; Libman et al., 2011; Pollack et al., 2011). The process of losing one’s home can also be lengthy, resulting in prolonged stress and anxiety as people attempt to catch up on delinquent mortgages and negotiate with banks. The uncertainty of the situation can be extremely hard on individuals. Finally, when relocating, people often experience changes in their social networks, neighbors, schools, churches, and so forth. Losing social capital can be difficult for families (Cohen, 2004; Libman et al., 2011).
The purpose of this paper was to explore, through qualitative interviews, the relationship between foreclosure and physical and mental health of individuals living in families with children under age 18 years at the time of the foreclosure. This exploratory study helps to illuminate how people perceive homeownership and health interact, adding depth to the previous literature on the subject.
Previous Literature
Finally, research has found that the negative financial experiences of foreclosure may lead to elevated levels of financial strain, stress, and exhaustion of assets (Thomas, 2013; Turunen & Hiilamo, 2014). Relatedly, foreclosure also has a negative impact, over the short term, on homeowners’ credit scores, and thus, their purchasing power, although recent research has indicated this impact is temporary, as no longer paying one’s mortgage frees funds for paying other bills (Demyanyk, 2017). Lower credit scores could also be indirectly responsible for the foreclosure as those with lower scores are less likely to have been able to obtain prime rate, fixed-rate mortgages. While credit scores may seem to be potentially predictive of health, and some research has indicated that it may be useful as a proxy for socioeconomic status in population health research when more detailed data are not available (Dean & Nicholas, 2018), the research has found that “the relationships between credit scores and health is complex and bidirectional” (p. 1503).
Foreclosure’s Effects on Children and Families
Analyses of large data systems have found that living in or near foreclosures is associated with multiple problematic issues for families, including living in distressed neighborhoods, high blood lead levels, high rates of child maltreatment, high levels of housing instability, and low kindergarten readiness test scores (Coulton et al., 2016). Children and others in these families also suffer emotional distress as a result of foreclosures in their family households. Research has found that children experience diminished self-image (Lovell & Isaacs, 2008) and feelings of loss and distress (Vidmar, 2008) related to foreclosure. This emotional distress can impact behavior at school with increases in violent episodes and other maladaptive behaviors (Schneider et al., 2016). Recent research has suggested that the impacts of foreclosure can have effects on children over the long term. Research examining later homeowning patterns of children whose families experienced foreclosures during the housing crisis found that they are less likely to become homeowners and/or more likely to postpone homeownership (Xu, 2020).
Family stress theory provides a useful framework for understanding how and why foreclosure affects families and children. Researchers of family stress theory have argued that not all stressors are created equal. Indeed, Hobfoll and Spielberger (1992) argued that loss and/or the threat of loss, combined with a shared cultural understanding of the loss as negative has been argued to be an important determinant of the stressor’s negative impact. Very recent research suggests that one stressor, family economic strain, such as that experienced before foreclosure, is influenced by several factors, however, perceptions of resources, specifically in the form of spousal support, buffer the negative impacts of such strains on families (Ross et al., 2019). Similarly, McCubbin (1979) argued community support could bolster families’ ability to cope with stress. Boss (1992) argued that it is impossible to understand the impact of a stressor without understanding the underlying meaning of the experience for individuals within the family experiencing the stressor, and Patterson (2002) identified familial meaning-making as a mediator of the stress and resource appraisal process. These perspectives suggest that gathering qualitative data is essential to fully understand the impact of stressors such as foreclosure on families.
Foreclosure and Mental Health
Research using county-level data has found positive associations between area foreclosure rates and declining mental health (Houle, 2014). Overwhelmingly, research has found that foreclosure is negatively related to mental health (Downing, 2016; Houle, 2014; Tsai, 2015). Quantitative analyses have found that as foreclosure rates increase, so do rates of bipolar and depressive disorders (Menzel et al., 2012), suicide attempts (Currie & Tekin, 2015) and suicide rates (Houle & Light, 2014). Research has shown that people who have lost their homes to foreclosure also experience higher rates of anxiety and depression (Burgard et al., 2012; McLaughlin et al., 2012). Because the foreclosure process can be lengthy, the uncertainties associated with mortgage delinquency, worries about housing insecurity and foreclosure can lead to stress, anxiety, and depression (Alley et al., 2011; Bennett et al., 2009; Lindblad et al., 2015; Pollack & Lynch, 2009). Changes in mental health have also been found to result from the stress and anxiety of foreclosure and financial hardship, from failed efforts to remedy the situation, and/or from the loss of ontological security (Dupuis & Thorns, 1998; Libman et al., 2011; McCormack, 2012; Santiago et al., 2015; Santiago et al., 2011). Mental health issues have also been related to physical health issues, as stress and anxiety are closely associated with and/or can exacerbate physical health issues.
Foreclosure and Physical Health
While studies on the mental health impact of foreclosure are many, fewer studies have documented the impact of foreclosures on physical health symptoms and diagnoses. Motivated to understand the effects of the housing crisis, social scientists began to investigate the impact of foreclosures on individuals and families and explore connections between losing one’s home and health (Rohe & Lindblad, 2014). Large-scale studies have found negative associations between foreclosure and health. One study using zip code level longitudinal data from Arizona, California, Florida, and New Jersey examined health data over four years (2005–2009) and found higher rates of suicide attempts, heart attacks, strokes, and non-elective hospital visits in high foreclosure areas (Currie & Tekin, 2015). Other research has found relationships between foreclosure and increased incidence of high blood pressure (Jones et al., 2014), heart disease (Pollack & Lynch, 2009), and self-reports of poorer health (Cannuscio et al., 2012; Houle & Keene, 2014). One study documented increased emergency room and outpatient visits in the two years before foreclosure among individuals experiencing a foreclosure (Pollack et al., 2011). Research also found that people going through foreclosure were less likely to report that they had a primary care physician visit in the previous six months (Pollack, et al., 2011) and were more likely to report prescription drug nonadherence due to cost (Alley et al., 2011; Pollack & Lynch, 2009). The financial cost of healthcare can also contribute to foreclosure when health care expenses mount and pressure household budgets. Medical debt, illness, and injury, lack of adequate health insurance, as well as caring for disabled extended family members and taking on their health care costs have been identified as triggers for mortgage delinquency and risk of home loss (Pollack & Lynch, 2009). Thus, the relationship between health and foreclosure is complex and foreclosure has been studied as both a precursor and consequence of physical health issues.
Study purpose
Given the extant research finding relationships between foreclosure and negative mental and physical health, and the difficulty of disentangling causes and effects of foreclosure, this study sought to qualitatively explore families’ experiences with foreclosure and explore their beliefs about its relationship to their physical and mental health.
Method
Sample and Setting
Participants were 29 homeowners who had a related child (children or grandchildren) under age 18 years living with them at the time they were dealing with their foreclosure. More than three-quarters (83%) of interviewees were women, and about two-thirds (68%) were African American. The average age of participants was 49 years (SD = 9.0), a little more than a third (38%) were married, and an average of two children under age 18 years lived with participants (SD = 1.0). About 80% of the sample reported having a household income below the area’s median. The study protocol was approved by a university-based institutional review board.
The study was conducted in Cuyahoga County, Ohio, home to Cleveland, the state’s second-largest city. Located in northeast Ohio, the county’s 2018 population was 1,243,857, with a median income of $45,435 (U.S. rate was $60,293), median home value of $128,000 (U.S., $204,900), and a poverty rate of 17.9% (U.S. rate was 11.8%; U.S. Census Bureau, 2016). The recession and foreclosure crisis hit Cuyahoga County while it was already struggling economically after job losses due to large scale changes to manufacturing and steel mill closures, and the county had high foreclosure rates even before the foreclosure crisis. Cuyahoga County had the highest rates of foreclosure filings in Ohio between 2007 and 2011 (Ohio Supreme Court, 2012), the results of which have included population decline and reduced associated tax base, and high rates of vacant properties. Despite declining nationwide foreclosure rates, Cleveland’s rates remain among the top three highest in the country (ATTOM Data Solutions, 2020). Further, racial segregation in housing has led to African Americans being overrepresented in foreclosure rates in Cuyahoga County (Coulton et al., 2008; Coulton et al., 2010; Hexter & Schnoke, 2017). This has also been found to be true in other areas of the country (Rugh & Massey, 2010).
Recruitment
Participants were recruited through housing counseling (n = 23), legal assistance (n = 3) organization referrals, and snowball sampling (n = 3). Housing counseling and legal assistance agencies were contacted to ask for their help in identifying and recruiting potential families at risk for foreclosure for the research. Service providers contacted eligible clients and informed them of the study. Potential participants then contacted the researchers directly via email to express their interest in participating. Clients were told they were eligible for the study if they were: (a) currently undergoing or had undergone a foreclosure in Cuyahoga County, (2) an adult with the most knowledge of the foreclosure details and experience, and (c) living with a child under the age of 18 years at the time of the foreclosure experience.
Measures
The study was part of a larger effort to examine families’ experiences with foreclosure. All participants were asked to tell their foreclosure story, starting with obtaining their original mortgage, through to the foreclosure. Questions asking about the foreclosure included: (a) What would you say was the first event that eventually led to the foreclosure? (e.g., job loss, health issue, divorce, etc.), (b) What happened next?, (c) How did you first know there was a problem?, and (d) Please tell me a little bit about your experiences with people involved in the foreclosure process, for example, mortgage servicers, sheriffs, and others. Participants were then asked to discuss the meaning of the foreclosure experience for them. Questions included: (a) Please tell me a little bit about your feelings about the experiences you have had and (b) What did losing your home to foreclosure mean to you? Finally, clients were asked to discuss the impact of foreclosure. Questions included: (a) Please tell me about what you see the effect(s) of the foreclosure have been for you/your children/your family in general?, (b) How do you think the foreclosure has affected your child/children? and (c) How has his/her/their physical health been affected?
Procedure
Interviews were conducted in a place most convenient to the participant. These included the participant’s home, workplace, local library, or at the housing counseling agency that referred them. Interviews lasted approximately one hour (but ranged between 40 minutes and 2 hours). Participants were compensated with a $50 gift card to thank them for their time. Interviews were recorded using a digital voice recorder, were transcribed by a professional transcriptionist.
Data analysis, qualitative data trustworthiness, and credibility
Building on previous research that drew on data from housing service providers, we looked for codes generated in that study (see Collins et al., 2018) to help contextualize the families’ experiences. Having this larger perspective of families’ experiences via service providers’ lenses, we also were able to ask participants about the extent to which their experiences were similar to others’. Having these data also allowed us to determine the extent to which saturation was achieved (Miles & Huberman, 1994) and sample recruitment could be ended.
Two researchers used ATLAS.ti to code the data. The coders met regularly to discuss the coding process, compare coding strategies, and discuss differences in approach to coding. The first author met with other team members as data were being collected to discuss early findings and potential interpretations. A thematic coding process was undertaken, in which the team highlighted important or meaningful text segments, discussed interpretations of those segments, and agreed on a coding strategy. Interrater reliability was established during these meetings, as any differences in interpretation of codes were discussed and resolved. Transcripts were coded deductively coded, and transcripts were analyzed for participants’ responses regarding the perceived relationship of foreclosure to (a) mental health and (b) physical health. After coding for these two general categories, coders took an inductive approach to coding participants’ responses, grouping quotations regarding similarities, and then developing more specific categories that were then grouped as themes. Table 1 demonstrates the general process by which participants’ responses were examined.
Coding Scheme.
Results
More than three-quarters (80%) of participants reported having incomes below the median for the area ($50,000) at the time of the interview. About 40% of participants mentioned some kind of predatory, illegal or unethical behavior in reference to their original mortgage. Although we were missing data regarding loan details for about half the sample, of those data we had, almost all (13 of 15) had 30-year loans, and 7 of 11 on whom we have the type of mortgage had traditional, fixed-rate mortgages, as opposed to an adjustable rate. Reasons for facing foreclosure that participants cited included they or their spouse losing job or having hours cut (n = 14), death of a spouse or partner (one to suicide after job loss; n = 7), birth of a child with medical issues (n = 2), having to leave a job care for an ailing spouse or parent (n = 9), excessive medical expenses (n =16), taking out large loans on the home for home repairs or helping others with their debts (n = 9).
The findings below are roughly broken down according to participants’ experiences around mental health and physiological health. Concerning mental health, participants described experiencing symptoms of psychological distress they described as being caused by the stress of their foreclosure situations. In turn, the stress of the situations was interwoven with the physiological impact, with participants seeing their physiological issues as either stress-induced or exacerbated by stress.
Mental Health and the Foreclosure Experience
All participants described the foreclosure experience as having had some kind of psychological impact on them, with more than three-quarters describing it as a devastating loss. Three distinct themes were developed in the overall category of perceived mental health impacts, including sadness/depression/feeling worn down/hopeless/out of control, stress and overwhelm, and fear and anxiety. One participant, a 57-year-old widowed African American grandmother summed up her feelings about how she felt her mental health had would be affected by (completed) foreclosure: “If I lost my home, I would be devastated. They would have to put me in the psych ward.”
Sadness, depression, feeling worn down, hopeless, or out of control
Just under half (48%) of participants reported symptoms of depression. Some outright reported they had been diagnosed with depression or said they were depressed, while others reported symptoms associated with a diagnosis depression, including sadness, feeling hopeless, effects on sleep, feeling guilty, such as a failure, feeling worn down, without passion, and/or lacking energy. One White widow in her 50s living with a young granddaughter said she was diagnosed with depression but did not treat it. “The doctor gave me medication for depression, but I did not take it. So, dealt with it on my own.”
Another participant, a married African American mother of three talked about how sad she felt, but how she hid her feelings from her children. She said, “I cry sometimes at night silently so they would not hear cause they will be ‘Mommy, what is wrong?’” Participants expressed feelings of powerlessness, frustration, and injustice at their banks’ inability and/or unwillingness to work out loan modifications, and to this point, participants talked about feeling worn out, and like their daily work, at their jobs, was for naught. Along these lines, other homeowners talked about feeling “weary,” “exhausted,” and “worn down” by the process of going through foreclosure. Another spoke to exhaustion and overwork. One participant, a married African American father of two in his early 50s described his experience: So, I go to work, and then I go to work, and you would think that that would mean something, but it doesn’t, and so when you ask me you know feelings about that, yeah, that’s kind of hard to swallow. . .. I’ve worked 68 hours a week for the last two years. I haven’t seen a sunset. I used to like to go down on the lake and watch. . .. I haven’t not seen that I mean cause on Sundays is my only day off and a brother is pretty tired.
Other feelings included anger and sadness over the prospect of losing their home and the experience as a whole. A mixed-race married father of four in his early 40s said the experience led to an overall loss of energy and also hope: I lost sleep. . .. I’ve lost the vigor and the passion to be healthy and keep my body in shape and do all those different things that I normally would do. . .. I think really where this takes a toll on the family is it takes a toll on their health, their mental state, their desire, their hope, their passion. It takes away a lot.
This quote describes several symptoms of depression and theorizes that the foreclosure process directly affects the mental health and health of those involved by decreasing positive expectations about the future.
Stress, anxiety, and fear
About half (48%) of participants reported they experienced anxiety or fear. Participants described being diagnosed with anxiety, and in general, being anxious about their situations, not knowing whether they would have to give up their homes, being in a kind of limbo. “When I found out that they didn’t do the money and when I found out about the house, I think I had went to the doctor and I had like a panic [sic]” (African American single mother of two in her early 40s). Panic attacks were listed as having occurred for at least two participants; one described having a panic attack, and a man said his wife suffered from a panic attack due to the foreclosure. Another client said her hair began falling out during the foreclosure process, and another described her inability to sleep, saying “I mean if I tell you I wake up at about 5:00 or 4:30 with sweats, it’s the truth.” Another client described the process overall, saying “it was so traumatic,” and another described his sense of desperation: “Put it this way, if I was a drowning man, I would have grabbed on to anything that was even the impossible.”
Participants described fear, sometimes more generally, and some with more specific references. One general comment was, “it’s very scary” and another expressed a decreased sense of power and agency, saying, “I’m vulnerable now,” One participant, a White widow in her 50s who was caring for a young granddaughter whose husband died from suicide after being laid off expressed her fear of homelessness specifically. “Poverty is hell, and I’m a tell you something. I see those pictures of people living in tents and living under bridges. I said I don’t want to be like that.”
Shame, self-blame, and stigma seemed to be the dominant drivers of participants’ depression, stress, fear, and anxiety. Several talked about being careful to hide their situations from their children, other family, friends, and neighbors. They also worried about what would happen to their families. More than half of the participants described feeling like they had failed, in that their homes, which they had worked so hard for was being taken from them. One participant, a married White father of four, in his 40s said, “for me the biggest thing was are they going to put a big sign up in our front yard for our neighbors to know?” and went on to describe how traumatic the experience had been, saying, “this is up there next to death.. . . I hope that as you interview other people, I hope they’re able to express this it’s a mental, emotional devastating experience.” Such expressions of devastation were both directed internally at their perceived failure and outward, with concerns about how others viewed them.
Family mental health issues
Participants also talked about their family members’, especially their children’s mental health challenges for which both prescription medications were required to maintain their mental states, resulting in medical bills, but also time for doctor’s appointments, sometimes resulting in the parent(s) losing hours and/or work wages. Two participants mentioned the challenges of managing their children’s attention deficit hyperactivity disorder (ADHD). One 55-year-old married African American mother of two described how she was trying to maintain her daughter’s stability, “she’s medicated, therapy, that kind of thing, trying to keep her from crashing.” A 37-year-old White married mother of three described dealing with her son’s dual diagnosis of ADHD and oppositional defiant disorder (ODD).
Prescriptions are like $34 just for his meds, and I fought to get him on the meds and it’s helped dramatically, but all these extra costs. . .every time I get a little bit in savings. . .it’s like gone again. So yeah, medical costs are becoming the big one in our house now.
This mother described the toll the stress from foreclosure, along with the medical issues took on family relationships, both on her marriage and her and her husband’s relationships with their children. She said, “my husband is always stressed. [He] now is working seven days a week. . .sometimes 12 hours a day. . .and then he has to maintain medical for all the children.” This quote outlined the interconnected nature of this particular family’s issues, but the theme was common for our participants. The fragility of their economic situations meant they had to work harder and longer to keep up with family medical costs and avoid foreclosure, but working that hard and long also had emotional costs for the families.
Physical Health Issues
A majority (66%) of participants mentioned some kind of physical health issue–defined broadly, including mentions of the participants’ physical health issues and family members’ physical health issues–they felt was related to the foreclosure in some way. Unlike perceptions of the causal impact of foreclosure on mental health, not all participants reported that foreclosure had affected their physical health. Instead, physical health issues were described as both causes and effects of the foreclosure. More than half (55%) of participants cited physical health issues as preceding the foreclosure, including having to take time off from work to care for ill family members and/or keeping up with the high cost of medical bills. Participants also described having to make difficult choices such as choosing between paying medical bills or buying food and choosing which ailments to treat due to cost. More than one-third (41%) described having health issue(s) that were stress-related.
Delaying, forgoing or prioritizing treatment for health issues
Participants talked about the extent to which their financial troubles had a direct effect on their ability to treat their medical problems. One White single father of four in his 40s said that he had made the decision not to see a doctor for his physical health issues due to lack of insurance, saying, “You know, Medicaid covered the kids but I’m not going to go into debt.” Financial pressures were such that difficult decisions needed to be made on which health problems were prioritized. One participant, a White widow in her 50s supporting a young granddaughter, said she chose to treat her physical health instead of her mental health issues.
The doctor gave me medication for depression, but I didn’t take it. . .but I do have high blood pressure and high cholesterol so I do take something for that. Figure it’s all I need. Keep that down–keep me from having a stroke. I went to the doctor last time my blood pressure was 220/128 or something. . .they wanted to put me in the hospital and I said, “I don’t think so. . .just give me something.”
A 53-year-old married African American mother of two said, “now I have Type II Diabetes and I don’t do what I need to do.. . . I do have insurance, but you have to pay copays and I didn’t have the money.”
Stress-related medical issues
Participants described the impact of stress on them physically. Some participants talked about having chest pains, being diagnosed with high blood pressure, and having to be put on blood pressure medication as a result of the stress of foreclosure. A 70-year-old White widow who was supporting her daughter and granddaughter said she believed the foreclosure was a cause of her symptoms, saying “I didn’t have to see a doctor before all this crap happened.” Another participant, a White married father of four in his 40s talked about the stress of the foreclosure, and how it ultimately led to heart surgery.
The stress, losing sleep, not being able to sleep, waking up just as tired as when you went to bed, not being able to sleep, tossing and turning wondering. . .. It puts a strain on families. . .through the process I had to increase my depression medication and in the 4th year or 5th year, I had a quadruple bypass.
He went on to say, Having a quadruple bypass surgery, like, I went through and the doctor telling me this is so stress-related. . . You know, it’s not like you can say. . . “Oh, I’m just going to put it out of my head and not think about it and everything is going to be fine.”
A married White mother of three in her 30s echoed these sentiments, saying, “According to my doctor, because of all the stress, now I’m on medication for my heart and my blood pressure.” Another participant, an African American grandmother in her early 50s living with two young grandchildren, talked about being diagnosed with an autoimmune disease she says was triggered by the stress of the foreclosure.
The biggest part of it was with me and, you know, being diagnosed with the Graves’ Disease. And I thought. . .and it comes on by stress cause it lays dormant until something in your life triggers it. And I was just running, running, running. Always sick . . . when I got to the doctor, they said, “you are really sick.” And my heart was palpitating, but it just pushed me right over the edge into, you know, a place where I couldn’t see myself anymore. I was just running trying to keep my head out of the chaos. . . After they gave me the treatment and I went to bed and I slept, and I slept, and I slept, and I slept and I slept cause I hadn’t been sleeping. . . . Now, I can see. . . . It [foreclosure] really shakes the rest of everything else around you. So, it’s hard to bring other things into perspective when you shake the room where a person sits. And it affects a lot of things.
For some participants, the stresses of dealing with family members’ medical issues, bills, and the ensuing march toward foreclosure affected their physical health. One participant, an African American widowed grandmother in her early 60s with two grandchildren explained how her inability to work due to health issues led her deeper into financial distress.
I just couldn’t understand it, but I was actually feeling chest pain and I couldn’t work. . .. Everything began to just go down. I started borrowing money from these payday loans and stuff and got behind that trying to catch up.
This description of families’ desperation to keep their heads above water was common in the interviews; they frequently said they would do whatever it took to keep from losing their homes and keeping their families stable, sometimes worsening their situations.
Family members’ medical issues
About one-third of participants talked about the stresses of their family members’ medical issues as well, and how they have contributed to the negativity of the foreclosure experience. The stresses of family members’ medical issues included struggling to pay those medical bills, but needing to take time off of work to care for a family member contributed to participants’ financial strain. For those who had relied on partners or another family member financially, when that person became ill or died, the loss of that income/financial resource support was additionally devastating. One participant, an African American widow in her 60s living with two grandchildren explained how the trajectory of her foreclosure as it related to her husband’s illness.
The home had been paid off twice, but my husband, when he got sick, I had to put him in a nursing home, so I borrowed money on the home in order to keep him in the nursing home you know and to consolidate some bills.
This participant went on to explain that she had also allowed her daughter, who had two children and was in and out of jail due to her mental health issues, to come live with her, which placed additional strain on her household.
A White father of four in his 40s described his children’s medical issues, explaining that his daughter had pediatric Grave’s disease.
She’s got a lot of autoimmune concerns and so we’ve got to watch her. [My son] is probably going to end up in special needs because he’s below 100% of his class as far as cognitive [issues go]. . .so he may end up there too.
Another participant, a married, White mother of one in her early 30s, described the challenges she and her husband faced with paying for the formula for her lactose-intolerant baby when their income did not allow them to qualify for the Women, Infants, and Children (WIC) program.
Her milk is like $30 a can. So, it was like an extra $400 a month just for that. . .my husband who has a 13-year-old child as well, you know with child support, so it’s $400 extra a month. So, living check to check, you can’t live check to check.
Another mom talked about the devastating impact on her child of having to move to lower quality housing due to foreclosure: “My kids’ lead level in 11 months went from 1 to 9½.”
One participant, a White woman in her 40s described the complexity of her family’s medical situation, which involved both physical and psychological issues and a multitude of accompanying bills.
I’m trying to find ways around. My son has problems. . .but my husband has diabetes, rheumatoid arthritis, scoliosis. . .bipolar disorder. . .glaucoma so he’s like going to a lot of specialists for a lot of that stuff and that’s expensive. . .that’s $40 bucks each time he goes and plus the medicine and everything once [he gets] the prescription. . .it adds up. . .he was going through a point where he was in the hospital. . .the mental ward of the hospital what was it. . .three times or four times? I think it was three different times and then there. . .so four times within a year. That’s like ongoing care he needs for diabetes and glaucoma and stuff like that that you know that stuff he needs you always gotta keep up with that. . . . So, I’ve got to keep up with their bills.
She went on to explain that they had to make choices about which ailments get treated, deciding that not treating diabetes could be life-threatening, so the husband’s glaucoma, arthritis, and bipolar disorder go untreated, which caused a string of other issues in the household. The participant also described her son’s need for hearing aids that are too expensive for her family to afford. She went on to say, “So we’re trying to go through places with charities and stuff trying to find. . .so it’s frustrating for him cause he can’t hear. And his dad yells at him for not being able to hear.”
Discussion
This study explored the meaning of foreclosure experiences in terms of physical and mental health issues for families living with children under age 18 years at the time of foreclosure. Families in this study described experiencing extreme stress that was frequently expressed physically and psychologically through stress-related physical ailments as well as mental health struggles. This study adds to previous qualitative research examining the meaning of losing one’s home (Collins & Berg, 2019; Collins et al., 2018) by identifying participants’ experiences regarding how psychological and physical issues both contributed to and resulted from the anticipated loss of their homes. Stress was described as being a result both of having a tenuous financial situation, which was in part due to their own or a family member’s physical health issues (and associated bills and/or loss of wages to deal with them), as well as uncertainty about their housing situations. Being responsible for school-aged and often, other children and aging parents, many were the primary wage-earners in their families, and much pressure rested on their shoulders. Discussions of their homes were infused with deep meaning, and the loss of the home through foreclosure was described as a profound loss (devastating, as found in previous studies (Collins & Berg, 2019).
Three significant findings emerge from this study. First, participants described their foreclosure experience in terms that suggested its impact on both psychological and physical health with reports ranging from heart problems to sadness and depression. The most common reported feelings were those of sadness, stress, and fear, summed up as devastation. Two-thirds of the sample reported physical health impacts as well as struggling to afford treatment for conditions and having to make decisions about what and who to treat. These findings support those from previous studies indicating the detrimental impact of foreclosure on health (Burgard et al., 2012; McLaughlin et al., 2012) and mental health as found in both qualitative (Keene et al., 2015) and quantitative studies (Downing, 2016; Houle, 2014).
Second, it appears that many of the reported physical health responses were tied to the psychological strain that people endure during the protracted foreclosure process. Nearly all of the physical symptoms that were reported could be attributed to stress such as elevated blood pressure, cardiac symptoms and a loss of sleep (WebMD, n.d.). This finding is consistent with previous research indicating how stressful foreclosure can be (Alley et al., 2011; Bennett et al., 2009; Lindblad et al., 2015; Pollack & Lynch, 2009) and suggests it is challenging to separate psychological health from physical health in understanding foreclosure’s impact.
Third, findings from this research support the idea that health care expenses and household financial strain are inextricably related. The people in this study reported they had little money for medical care while they were going through a foreclosure, resulting in conditions going untreated, prescriptions not being filled, and difficult decisions being made about who and what to treat. This is consistent with previous research on this topic (Alley et al., 2011; Pollack & Lynch, 2009). It was also financially disastrous for some to take time off from work to care for their illness or that of a family member due to lost wages. Additionally, family members’ (spouses, children, etc.) health problems and health care expenses added up, resulting in medical debt that contributed to household financial problems, findings consistent with past research (Pollack & Lynch, 2009).
Previous research on foreclosure has examined homeowners’ experiences, but not specifically experiences of homeowners living with families with kids under age 18 years. Such research is important given the relationship between housing instability in general, and foreclosure in particular, and children’s outcomes (Coulton et al., 2016; Vidmar, 2008). This study helps provide insight into the relationship between foreclosure in particular (disentangled from housing instability) and mental health and health problems. The study expands the literature by helping illuminate the nature of the association and its meaning for families with children. Research on family stress and health indicates that it is the meaning of an event that is most important to understanding the impact of stress on the family (Boss, 1992; Patterson, 2002) and that the meaning as related to one’s perceived identity that is most important to predicting how stressful it is and how damaging to self-esteem (Thoits, 1991, 2013). Such stress on parents’ poor self-esteem, low self-efficacy, in turn, can lead to negative outcomes for children (Kingsley et al., 2009; Yeung et al., 2002). The most effective research approach for understanding the meaning of foreclosure to families and thus, the extent to which it affects families, therefore, is qualitative research. This study contributes to the literature by outlining their perceptions of foreclosure regarding physical and mental health.
Our study also adds to the literature in arguing specifically that foreclosure, given its meaning to people, especially families with children in elementary or high school, is a significant source of stress with potentially devastating consequences. While quantitative research has been able to outline associations between financial strain, foreclosure, housing instability, and health outcomes, it cannot speak to causality. This research indicates foreclosure is not “just” a financial strain or stress experienced over a poor investment. Foreclosure is not just about housing instability or mobility per se. This study specifically explored how families appraise the stressor of foreclosure and how they see it as related to both physical and mental health. In sharing the voices of those who experience foreclosure, we can better understand the people behind statistics of increased suicide rates (Currie & Tekin, 2015; Houle & Light, 2014), hospital admissions (Currie & Tekin, 2015), and prescription nonadherence (Alley et al., 2011; Pollack & Lynch, 2009) and better determine appropriate interventions to assist struggling families.
While these data were collected in the Cuyahoga County, Ohio, area, because our findings are strikingly similar to those of other studies, we assert that they should transfer to other areas affected by foreclosure. While the Cleveland area has some particular characteristics, for example, it is more affordable than many areas of the country with a median home sale price of $130,300 (Zillow, 2019) making homeownership a possibility for lower-income families for which it might not be possible in other areas (e.g., single mothers). Given the similarity of experiences of people in this study to those in the literature in general, we have little reason to believe that people’s attachments to their homes and the negative impact of foreclosure would be unique based on Cleveland’s location.
Limitations
There are several limitations of these data that should be considered, including our sample, lack of triangulation, and the cross-sectional nature of the study. First, our sample represents people who actively sought help in saving their homes and who volunteered to participate in the research, so our data may represent the perspectives families experiencing foreclosure who were particularly motivated to save their homes. This is important because we may be representing primarily homeowners for whom the home held deep meaning, rather than a broader sample of homeowners. Second, we have relied primarily on the accounts of our interviewees, and thus are unable to corroborate their claims of health and mental health impacts from other sources. Gathering perspectives of other family members could have been a source of triangulation. We also relied on participants’ emic views of their situations, and because no quantitative standardized scales were administered, we do not know the extent to which the participants met even minimal thresholds for clinical diagnoses of depression, anxiety, or psychological distress. Similarly, conclusions drawn about the sample participants’ loan details should be drawn cautiously. We were missing data on participants’ loan details because the loan details were self-reported and some could not remember the details of their loans or did not fully understand their loans. Triangulating clients’ reports of their loan details via documentation could have strengthened our data on loan details. Finally, we cannot assert with certainty that foreclosure definitively caused the participants’ health and mental health challenges, nor rule out that mental health conditions led to the foreclosure, rather than the reverse. Because the study was conducted at a point-in-time, we also cannot verify that the issues did not exist before or co-occur with the foreclosure. Incorporating triangulating and longitudinal aspects to the study would have allowed us to confirm the pathways through which negative impacts of foreclosure are manifest.
Implications
Practice implications
Stressors resulting from foreclosure are associated with worse health. Thus, it is important for service providers who work with or encounter people dealing with foreclosure to recognize foreclosures’ devastating impact. Health and social practitioners must be aware of the issues and develop strategies to best support people undergoing foreclosure and assist them in ensuring they can adequately meet their own and their family members’ health and mental needs, without having to pick and choose which needs are addressed. Homeowners facing foreclosure might also benefit from coordinated, affordable health, and social services (Cannuscio et al., 2012). Support groups for people undergoing foreclosure that address the clear mental health impacts such as depression and anxiety are warranted, as are resources that can help families bridge gaps and do not force homeowners to make choices such as taking care of a loved one or losing their job and home at times of need. Such supports could help people with appraising their situations differently, helping them feel less alone and stigmatized, be become less socially isolated, addressing the fear of having people know about their situations (Cohen, 2004; Thoits, 2010, 2013).
Feedback from interviewees about the interview process suggested that simply talking about their experiences was helpful. Our interviewees had been through a great deal—struggling with their banks, loan servicers, going to housing counseling agencies when they felt they had run out of options, and seeking legal assistance. They described feeling “worn out” from the process of dealing with all these different entities, each of which wanted some kind of information from them. While most interviewees were not sure what to expect from the interview, they talked about how helpful it had been to be given a chance to speak about their foreclosure experience in a way they had not previously spoken—in a free-form way—and not for some purpose (e.g., getting loan information, giving advice). Two participants mentioned feeling “lighter” after the interviews, and two said they felt participating in the interview was like having gone through a therapy session. Although the project did not explicitly intend to offer formal help, assistance, or other formal counsel to families, families suggested that simply talking about their experiences nevertheless ended up being therapeutic, an unexpected outcome of the study.
Policy implications
From these findings, several policy implications are apparent. First, it seems clear that being able to somehow keep people in their homes could go a long way toward reducing uncertainty, perhaps reducing both mental and physical health problems, improving children’s and family’s outcomes. Policies that are compassionate toward fully understanding the full impact of foreclosure on not only individual families, but communities as a whole, could go a long way toward avoiding the problems observed here. Second, if the U. S. had some level of universal access to affordable health care, the country may be able to eliminate the pressures health care crises put on families’ finances. Research on states that have adopted universal health insurance has found that a series of financial distress indicators are reduced when people have access to health insurance including medical debt, bankruptcies, and third-party collections (Mazumder & Miller, 2016). Finally, a guarantee to paid sick days could also allow people to simultaneously manage work and health care responsibilities without a loss of pay or fear of putting one’s job in jeopardy. Much research has been done that documents the relationship between having sick leave and being able to manage acute and preventive health care (DeRigne et al., 2016; DeRigne et al., 2017). Researchers have also found a relationship between having paid sick leave and a decreased likelihood of experiencing poverty along with a decreased likelihood of usage of welfare programs (Stoddard-Dare et al., 2018a; Stoddard-Dare et al., 2018b). Passage of a federal guarantee of paid sick days could go a long way in supporting the financial health of today’s workers.
Future research
The work of medical anthropologists suggests some reasons why the loss of the home might be psychologically and physically devastating. While the process of dealing with the banks and servicers and the uncertainty of their situations caused stress, the mechanism driving that stress might likely relate strongly to the meaning foreclosure had for the families. Dressler’s work on cultural consonance theorizes that when people adhere, cognitively, to a shared cultural model—in this case, for families experiencing foreclosure it may the American Dream of homeownership—but are unable to fulfill the expectations of that model (i.e., owning a home), the person will be affected on psychological and physical levels (Dressler, 2012) with stress as a driving mechanism of those health effects. Dressler argues that the stressors one experiences are moderated by the resources one has which, in turn, affect how we appraise the stressor, and our physiological response, however that there are sociocultural dimensions to both the appraisal of the threat and to defining what is stressful. Dressler’s work on the relationship between cultural consonance and health has shown a robust relationship between having low cultural consonance and higher blood pressure and depressive symptoms (Dressler, 2012; Dressler & Bindon, 2000; Dressler et al., 2007). This provides an important model for future investigations for understanding the impact of particular meaningful life events such as foreclosure on the body. Having a stronger understanding of what home means to people might help explain the devastating effects, not only of foreclosure but other kinds of housing instability on individuals and families. These issues become increasingly interesting and important as the model of homeownership as an ideal seems to be changing. One question of interest might include: For whom is a model of homeownership changing, and what are the implications of such a change.
Conclusion
Families undergoing foreclosure experience enormous stress and strain that is both the result of health issues and can result in poor health outcomes both psychologically and physically. Policies that better support families could reduce the number of foreclosures and help families to maintain housing and well-being. Social work and other fields should recognize the potential to help ameliorate the impact.
Footnotes
Acknowledgements
We would like to acknowledge the work of Debbie Taylor, LISW, who helped code the data and David Rothstein of the Cities for Financial Empowerment Fund who helped recruit participants and conducted interviews. We would also like to thank our research partners, Dr Claudia Coulton of The Center on Urban Poverty and Community Development at Case Western Reserve University, Jill Korbin and Gabriela Celeste of The Schubert Center for Child Studies at Case Western Reserve University, and David Rothstein, all of whom assisted in study development and advised us during data collection.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by Social Justice Institute at Case Western Reserve University (CWRU) and Provost’s Office Interdisciplinary Alliance Investment Grant.
