Journal of Urban Health: Bulletin of the New York Academy of Medicine, Vol. 85, No. 5
* 2008 The New York Academy of Medicine
Residential Transience and Depression:
Does the Relationship Exist for Men and Women?
Melissa A. Davey-Rothwell, Danielle German, and Carl A. Latkin
ABSTRACT Residential transience may contribute to adverse mental health. However, to
date, this relationship has not been well-investigated among urban, impoverished
populations. In a sample of drug users and their social network members (n=1,024), we
assessed the relationship between transience (frequently moving in the past 6 months)
and depressive symptoms, measured by the CES-D, among men and women. Even after
adjusting for homelessness, high levels of depressive symptoms were 2.29 [95%CI=
1.29–4.07] times more likely among transient men compared to nontransient men and
3.30 [95% CI=1.10–9.90] times more common among transient women compared to
nontransient women. Stable housing and mental health services need to be available,
easily accessible, and designed so that they remain amenable to utilization under
KEYWORDS Mental health, Housing instability, Residential mobility, Depression
Housing instability, a common problem among individuals living in urban environ-
ments, has been linked to poor health status, HIV risk behaviors, violence, and
mental health problems including depression.1–4
Housing instability has been operationalized in a variety of ways including being
“literally homeless” (i.e., living on the street or outdoors) or living in a temporary
housing situation such as a shelter or single-room occupancy (SRO).5,6There is a
tendency among researchers to focus on the physical place or structure of residence.
Other dimensions of housing stability, such as residential transience or frequently
changing residences, have begun to receive attention in the published literature.7,8
Increasingevidencesuggeststhatfrequentmovingmayhave healthimplications. In
a study of a variety of housing situations, Weir and colleagues found that individuals
who reported having two or more residences in the past 6 months were more likely to
engage inrisky sex behaviors including unprotected intercourse and exchangingsex for
money or drugs.9Likewise, our previous research demonstrated that residential
transience was associated with HIV drug-related behaviors including sharing needles
and going to a shooting gallery.10Transient individuals also tended to be younger,
have lower income, and were less likely to have a main sexual partner than non-
transient respondents, suggesting that these individuals may have differing needs.10
Davey-Rothwell, German, and Latkin are with the Department of Health, Behavior and Society, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Correspondence: Melissa A. Davey-Rothwell, Department of Health, Behavior and Society, Johns
Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 2nd Floor, Baltimore, MD 21205,
USA. (E-mail: email@example.com)
Research among children has consistently demonstrated a negative association
between residential mobility and mental health problems.11In a longitudinal study,
Gilman and colleagues found that moving three or more times before the age of
7 years was significantly associated with depression diagnosis by age 14.12Although
prior research suggests that relocation and moving is associated with poor mental
health problems including anxiety and schizophrenia, much of this research is based
on population studies and has focused on moving as an infrequent stressful life
There is a lack of research that has explored the impact of frequent relocation on
the psychological well-being of urban-disadvantaged adults. Individuals with low
socioeconomic status have higher rates of depression compared to the general
population.16This association may be because of stressful life events, less control of
life events, and fewer social and economic resources to meet the demands of these
stressors. It is likely that similar factors contribute to transience, which may heighten
vulnerability to additional stressors in turn.
Inaddition,the experienceof relocationmayinfluencemenand womendifferently,
which would have differential impacts on their psychological well-being. In a study
conducted in Madrid, Munoz and colleagues compared depression levels between
homeless individuals (defined as sleeping mainly on the street, shelters, abandoned
buildings, or outdoors) to a group of individuals who were at risk for homelessness
(defined as utilizing services designed to serve homeless individuals).17Both groups
reported high rates of depressive symptoms, but rates of depression were highest
among homeless women. In a longitudinal study of over 10,000 Chicago residents,
Magdol found a significant relationship between residential mobility and depres-
sion.18In an analysis stratified by gender, women who reported at least one move
within a 5-year period had significantly higher CES-D scores compared to women
who did not move. There was no significant association between moving and
depression among men. These findings both indicate that housing instability is linked
to psychological well-being and that important gender differences may exist.
Women experience depression more often than men.19,20Several explanations for
this disparity have been offered including differences in opportunities, increased stress
among women, role captivity, lack of economic resources, biological factors, and role
strain.21Although researchers have not examined gender differences in the link
between transience and depression, recent research indicates that women, compared
to men, experience higher exposure to housing-related stressors.22In a community
sample of couples, Nazroo and researchers found that women were more likely to
experience depression after a stressful life event related to children, housing, or
reproduction compared to their male partners.23As the effect did not hold for other
life stressors, the researchers suggested that the association was because of women’s
increased roles in these areas.
The purpose of the present study is to examine the association between residential
transienceand depressive symptomsina sampleofinner-city residents. We alsoexplore
if this relationship exists for both men and women. The rationale for exploring gender
differences is twofold. First, as there is a disparity in depression rates among men and
women, research is needed to identify additional contributors of depression. Second,
the experience of frequent relocation may affect men and women differently as moving
may be aresultof differenttypesofcircumstances suchaschangeinpartneroreviction.
We anticipated that even after accounting for homelessness, frequency of residential
relocation would be associated with depressive symptoms.
DAVEY-ROTHWELL ET AL.708
Data were collected from participants in the STEP into Action (STEP) study. The STEP
study is an HIV prevention intervention for active drug injectors and their social
network members. Participants (i.e., primary participants) were recruited through
targeted outreach and local advertisements. Eligibility criteria included: (1) 18 years or
older; (2) no participation in other HIV prevention or social network studies in the past
year; (3) self-reported injectionof heroin or cocaine;(4) willingness tointroduce atleast
one social network member to the study; and (5) Baltimore City resident. Primary
participants referred their social network members to the study. Eligibility criteria for
social network members included: (1) 18 years or older and one of the following: (2)
self-reported heroin or cocaine use; (3) drug partner of primary participants (i.e., used
drugs with primary participant); or (4) sex partner of primary participant. Although all
primary participants were drug users, not all social network members used drugs.
Baseline data were collected through face-to-face interviews that lasted approxi-
All study protocols were approved by the Johns Hopkins Bloomberg School of Public
Health Institutional Review Board before implementation.
Residential transience was assessed by asking participants “In the past 6 months, how
many times did you move?” Responses were recoded as “one or no moves in the past
6 months” and “two or more moves.”
Depressive symptoms were assessed through administration of the Centers for
Epidemiological Studies Depression Scale (CES-D).24The CES-D is a 20-item scale
with four response categories including: (1) rarely or none of the time; (2) some or a
little of the time; (3) occasionally or a moderate amount of time; (4) most or all of the
time. A summary score for all responses was computed, and the variable was recoded
as high depression symptomology or “depressed” (16 or higher) vs. low symptomol-
ogy or “not depressed” (less than 16). Previous research has shown that CES-D scores
of 16 or higher are predictive of clinical depression in community and urban
samples.25,26Thus, this cutpoint is used as a standard proxy for depressive symptoms.
In addition to these main variables of interest, we also measured several
sociodemographics, such as age, employment, and education, and drug-related
behaviors (refer to Table 1). Homelessness was measured by asking participants “At
any time in the past 6 months, have you been homeless?” Two drug-related behaviors
were assessed: (1) injection drug use in the past 6 months; and (2) use of heroin,
cocaine, or crack (regardless of administration) in the past 6 months. Because of the
skewed distribution, several sociodemographic characteristics were dichotomized.
1,024) who completed baseline study visits from March 2004 through March 2006.
Data were analyzed using Stata Version 8.0 (StataCorp, 2005) and SPSS 15.0 (SPSS,
2006). Exploratory analysis was conducted to examine the distributions and
associations among study variables. Data were stratified by gender. As the outcome
(depression) was a dichotomous variable, data were analyzed using logistic regression.
In each of the gender multivariate models, we controlled for several covariates,
RESIDENTIAL TRANSIENCE AND DEPRESSION 709
including homelessness, education, race, employment, prison history, and drug use,
that were associated with depression in the bivariate analyses. As the sample was
comprised of participants and their social network members, the general estimating
equation (GEE) was employed to account for correlation among variables. GEE
adjusts for variance within and between clusters of social network members.27
The characteristics of the study population are presented in Table 1. Data were
collected from 1,024 participants who were primarily African American (82.1%) with
a mean age of 43 years. Approximately 60% (n=621) of the participants were male
and 40% (n=403) were female. Whereas 142 (13.9%) participants moved two or
more times in the past 6 months, approximately one third (33.7%) reported
homelessness in the past 6 months. Most had used heroin, cocaine, or crack in the
past 6 months (94.9%), many (82%) through injection drug use. Close to half
completed 12 or more years of education (45.9%) and had a monthly income less
than $500 (50.9%). The majority had a current main partner at the time of the survey
(59.7%), and over one quarter had spent time in prison in the past 6 months (26.8%).
TABLE 1 Demographic characteristics of STEP participants stratified by gender
Number of participants
Age, mean (SD)
Transient (moved two
or more times in
the past 6 months)
Homeless in the past
Education: high school
diploma or higher
Income (individual) in
past month G$500
Currently has a main partner
Employed at least part-time
Spent time in prison in the
past 6 months
Used heroin, cocaine, or crack
(regardless of administration)
in the past 6 months
Injected heroin, cocaine,
or speedball in the past
Depression: CES-D score ≥16
345 (33.7) 228 (36.7)117 (29.0)0.011
470 (45.9) 287 (46.2)183 (45.4)0.800
972 (94.9)593 (95.5) 379 (94.0) 0.303
842 (82.2)536 (86.3)306 (75.9)
652 (63.7)364 (58.6)288 (71.5)
All variables are mutually exclusive.
DAVEY-ROTHWELL ET AL.710
Comparison of Males and Females
In this sample, 89 (14.3%) males and 53 (13.2%) females reported moving two or more
times in the past 6 months. There were several statistically significant differences by
gender. Males were more likely to report recent homelessness (36.7% vs. 29.0%, pG
0.05), to be employed at least part-time (21.3% vs. 9.2%, pG0.001), to have spent time
in prison in the past 6 months (31.6% vs. 19.4%, pG0.001), and to have injected drugs
in the past 6 months (86.3% vs. 75.9%, pG0.001). Women were more likely to have
monthly incomes less than $500 (pG0.001). Approximately 59% of males and 71.5%
of females (pG.001) reported high levels of depressive symptoms (CES-D score ≥16).
Mental Health Data
Table 2 displays the data on the comparison between depressed participants and
participants who were not depressed as reported through CES-D scores. As shown in
the table, severe depressive symptoms did not vary by age, income level, having a
main partner, and injection drug use. Depression was more common among indi-
viduals who moved two or more times (pG0.001) and who reported homelessness in
the past 6 months (pG0.001). In addition, depression was more common among
participants who were African Americans (pG0.01), had less than a high school edu-
cation (pG0.01), were not employed (pG0.001), spent time in prison (pG0.01), and
used heroin or cocaine (pG0.01) in the past 6 months.
TABLE 2Bivariate comparison of STEP participants stratified by Depression score
Number of participants
Age, mean (SD)
Transience (moved two
or more times in past
Homeless in past 6 months
Education: high school diploma
Income (individual) in past
Currently has a main partner
Employed at least part-time
Spent time in prison in the past
Used heroin, cocaine, or crack
(regardless of administration)
in the past 6 months
Injected heroin, cocaine, or
speedball in the past 6 months
628 (96.3)344 (92.5)0.007
541 (83.0) 301 (80.9)0.407
All variables are mutually exclusive.
RESIDENTIAL TRANSIENCE AND DEPRESSION711
Multivariate regression analyses of the association between transience and depression among STEP participants
Unadjusted odds ratio
Adjusted odds ratio
Unadjusted odds ratio
Adjusted odds ratio
2.98**** (1.75, 5.09)
2.29*** (1.29, 4.07)
5.69*** (2.07, 15.6)
3.30** (1.10, 9.90)
Homelessness in the past 6 months
2.18**** (1.52, 3.11)
1.50* (1.00, 2.26)
2.24*** (1.33, 3.77)
1.32 (0.74, 2.37)
Heroin or cocaine use in the past 6 months
2.27** (1.00, 5.14)
1.94 (0.79, 4.75)
2.24* (0.98, 5.11)
1.97 (0.82, 4.77)
Race: African American
0.65** (0.43, 0.99)
0.79 (0.50, 1.25)
0.26*** (0.11, 0.62)
0.32** (0.13, 0.78)
Employment: at least part-time
0.51*** (0.34, 0.75)
0.56*** (0.37, 0.84)
0.38*** (0.19, 0.76)
0.45** (0.22, 0.90)
Education: high school diploma or higher
0.65** (0.47, 0.90)
0.67** (0.48, 0.93)
0.75 (0.48, 1.18)
0.88 (0.55, 1.39)
Time in prison in the past 6 months
1.77*** (1.24, 2.54)
1.45 (0.99, 2.10)
2.06** (1.11, 3.82)
1.41 (0.74, 2.68)
All variables were included in the multivariate model simultaneously.
*pG0.10; **pG0.05; ***pG0.01; ****pG0.001
DAVEY-ROTHWELL ET AL.712
Table 3 shows the results of multivariate analyses conducted separately for males and
females. Overall, depression was more common among women than men. Transient
males were 2.29 times more likely to have higher depressive symptoms than
nontransient males (95%CI=1.29, 4.07). Among women, transient individuals were
3.30 times more likely to be depressed (95%CI=1.10, 9.90). Males who reported being
employed at least part-time (pG0.01) and had at least a high school diploma (pG0.05)
had a lower likelihood of being depressed.
Among females, being employed at least part-time (pG0.05) and being African
American (pG0.05) were associated with decreased odds of depressive symptoms.
This study has shown that residential transience or frequent relocation in a 6-month
period is associated with depression, independent of homelessness. Although the
association between transience and depression was not significantly different for men
and women, the strength of this association was higher among women. This finding
may be a result of differences between men and women, as shown in the descriptive
analyses. Consistentwithotherresearch, ourstudyshowedsignificantlyhigherlevelsof
depressive symptoms among women compared to men.19,20In addition, the men in
this study were more likely to be employed at least part-time and to report monthly
incomes greater than $500. Employment was an independent predictor of depression
for both men and women, but income was not associated with depression.
Nonetheless, it is possible that economic advantage among the men helps protect
against the negative mental health implications of transience. It may also be that
transience among women is driven more strongly by economic need, which may
compound the effect of transience as a mental health stressor.
Our sample represented a marginalized inner-city population with high levels of
drug use and low socioeconomic status. However, controlling for drug use in the final
multivariate model provides evidence that the association between transience and
depression is not unique only to drug users; thus, we believe that the findings do have
relevance for nondrug users and for low-income urban residents regardless of drug use.
The relationship between transience and depression may be explained by life in an
urban environment. Housing-related stressors, such as physical decay of the structure
and high crime activity, are common in urban neighborhoods.28,29These housing
stressors may have a negative impact on one’s psychological well-being. Another
contributing factor may be neighborhood violence. Crime and violence are common
stresses in urban neighborhoods that contribute to depression.30Individuals who
experience violence or live in a violent neighborhood may be more likely to relocate
and experience depressive symptoms.
In addition, the impetus for moving among inner-city residents may be different
than for the general population. Research among the general population points to life-
coursechanges, suchasemployment, housingconditions, andneighborhoodcharacter-
istics, as common contributors to residential moves.31,32In contrast, our qualitative
data (data not shown) indicates that low-income urban residents move for a variety of
negative and positive reasons, including changes in relationships, eviction, becoming
sober, financial problems, and disasters such as fires. In contrast, it is possible that
moving because of an unpredictable event such as eviction or loss of job may
contribute more strongly to increased depressive symptoms. It is also likely that each
of these events leads to stress and is further detrimental to one’s psychological well-
RESIDENTIAL TRANSIENCE AND DEPRESSION713
being. Instability in one area of life is likely to exacerbate other difficulties, creating
further stress and challenges to one’s ability to achieve stable life circumstances.
Because women are often caregivers and guardians of children, they may experience
additional concerns under transient circumstances.
One pathway through which transience may impact depression is disruption or
change in social relationships. Frequent relocation may challenge one’s ability to
maintain social relationships. Specifically, individuals who move frequently may
experience decreased social support and disruption of existing social networks.33
Likewise, individuals who move around may have greater difficulty developing
social bonds with other people thus leading to social isolation. Particularly under
stressful circumstances, this disruption in social networks may further contribute to
depressive symptoms and may make it more difficult to deal with associated
Another explanation for the association between transience and depression is
that frequently moving around may interfere with accessing health and social
services and other resources. Duchon and researchers found that residential mobility
was associated with lack of a usual source of health care and dependence on
emergency rooms.7The authors suggest that mobility may prevent individuals from
being attached to care providers. Thus, they are more likely to utilize emergency
rooms as their usual source of care. Similarly, transience is likely to disrupt
consistent and appropriate mental health care and utilization of other social services,
such as employment and public assistance. Likewise, transient individuals may not
have a permanent address that is required for a variety of services. In addition to
formal health and social services, transience may also interrupt informal sources of
care such as self-help and church groups.
Although we found a significant association between transience and depression, it
may contribute to both transience and depression and may be partially responsible for
this association. Women in unstable living circumstances often become victims of
violence.34In a qualitative study among women, Tomas and Dittmar found that
women relocate from one residence to another as a way of coping with unfortunate
circumstance such as interpersonal abuse.35This abuse would cause both the
transience and depression.
The present study has several limitations that should be noted. First, the data were
cross-sectional. In addition, there is a temporal limitation. Transience was assessed in
the past 6 months, yet depressive symptoms were measured in the past week. Our data
do not include information on the length of time since the last move and, therefore, we
cannot determine whether recent transience is more highly associated with recent
depressive symptoms. Finally, the study population was a disadvantaged group which
limits its generalizability.
Many researchers have shown that homelessness is detrimental to mental health;
our data suggest that frequent relocation is also a substantial contributor to poor
mental health status.36Therefore, these findings indicate that housing strategies
should be implemented such that affordable housing is plentiful and accessible, but
also that strategies are needed to ensure that housing can be sustained over time. This
may include emergency assistance programs and low threshold housing options that
make housing more attainable for those who use substances or have severe mental
illness. In addition, economic programs which offer assistance to individuals who are
at risk of losing their home are needed, such as emergency cash assistance and
budgeting guidelines. Likewise, job training and placement services may overcome
DAVEY-ROTHWELL ET AL.714
any financial barriers that lead to transience. In addition to providing stable housing,
mental health services need to be available and easily accessible among urban
residents and designed so that they remain amenable to utilization under transient
Sources of Support This work was funded by the National Institute on Drug Abuse
(grant no. 1RO1 DA016555).
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