Elsevier

Public Health

Volume 129, Issue 3, March 2015, Pages 191-199
Public Health

Review Paper
Living in a cold and damp home: frameworks for understanding impacts on mental well-being

https://doi.org/10.1016/j.puhe.2014.11.007Get rights and content

Highlights

  • This paper reviews evidence on the impacts of cold homes on mental well-being.

  • Impacts affect both positive and negative well-being.

  • Impacts accord with the framework posited by cumulative stress theory.

Abstract

Objective

To carry out a review of recent studies that have explored relationships between mental well-being and how this may be affected by living in cold and damp homes. Attention is focused on intervention studies in which heating and insulation improvements were carried out and impacts on well-being assessed.

Study design

Drawing mainly on a Cochrane Review published in 2013, nine studies of sound methodology are identified and significant effects discussed.

Methods

The review outlines the current frameworks for understanding mental well-being which prevail in psychology and psychiatry, describing the distinctions that can be made between mental well-being and its elements, namely positive mental health and negative mental health (the latter also known as mental disorder). The review then organizes findings from nine studies into the separate domains of positive and negative mental health, giving due consideration to the quality of the research, instruments used to measure mental health, methodological, and ethical issues.

Results

These first nine studies indicate early consensus. Living in cold and damp housing contributes to a variety of different mental health stressors, including persistent worry about debt and affordability, thermal discomfort, and worry about the consequences of cold and damp for health. Improvements to energy efficiency are often associated with significant improvements in mental well-being.

Conclusions

Impacts affect both positive and negative mental health. A cumulative stress framework is hypothesized, within which the mental health impacts of improved energy efficiency can be better understood.

Introduction

The association between living in a cold/damp home and human health has been known for more than a century.1 However, the majority of empirical studies have focused on physical health impacts, particularly on diseases where cold and damp exacerbate symptoms (such as cardiovascular and respiratory ailments). Occasional speculation about the links between cold and damp homes and mental well-being has also featured since the 19th century.2 However, empirical evidence linking the two has emerged only very recently, with almost all relevant investigations being published in the last ten years.3 This paper explores the quality and consistency of that evidence, and uses it to develop a hypothetical causal model that embodies multiple pathways from cold homes to impaired mental well-being.

Section snippets

Defining mental well-being

Mental well-being encapsulates two related but independent dimensions: mental health and mental disorder. The most commonly quoted definition of mental health is the World Health Organization's4(p6):

Mental health is conceptualized as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

In this definition, mental health is

Evidence for an association between improved domestic energy efficiency and mental well-being

In 2013, Thomson and colleagues published a Cochrane Review of the health impacts of housing improvements.11 The interventions they considered included those related to improving domestic energy efficiency, but were not confined to these. The impacts were derived from measures of physical and mental well-being. What follows is a description of the findings of seven studies drawn from the Cochrane Review, all of which explicitly assessed the associations between energy efficiency improvements

Improving the energy efficiency of homes and its association with mental health: summarizing the evidence

When exploring the associations between energy efficiency and mental well-being, nine intervention studies of sufficient rigour were identified. Three studies examined both mental disorders and mental health.12, 14, 19 Three studies examined only mental health15, 16, 20 and three studies examined only mental disorder.13, 17, 18

In summary, Table 1 indicates that 16 of 25 separate tests of statistical significance indicate robust evidence of improved mental well-being after intervention, meaning

Causal pathways linking energy efficiency improvements with improved mental well-being

It is seldom sufficient to demonstrate a link between an intervention and an effect on human well-being, since effects are not always simple or direct. It is conceivable, for example, that the association between energy efficiency improvements and mental well-being is confined mainly to people who are already prone to anxiety or stress. Should this be the case, then an argument could be made for targeting energy efficiency investments towards households with sub-optimal mental health. On the

Conclusions

It is evident that:

  • cold and damp living conditions are typically of multidimensional origin;

  • the impacts of these conditions on well-being are wide-ranging, incorporating stress, positive mental health and mental disorder;

  • each of these aspects of well-being are equally diverse constructs.

Despite this complex matrix, there is consistent evidence linking cold and damp homes with mental well-being. However, there are currently no more than nine studies of sufficient rigour and quality on which to

Acknowledgements

The authors gratefully acknowledge the Oak Foundation (OCAY-12-509) for their financial support.

Ethical approval

Being a review paper, ethical approval was not applied for.

Funding

None.

Competing interests

The authors have no competing interests.

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