标题：Dampness and Mold in the Home and Depression: An Examination of Mold-Related Illness and Perceived Control of One’s Home as Possible Depression Pathways
摘要：Objectives. We evaluated a previously reported association between residence in a damp and moldy dwelling and the risk of depression and investigated whether depression was mediated by perception of control over one’s home or mold-related physical illness. Methods. We used survey data from 8 European cities. A dampness and mold score was created from resident- and inspector-reported data. Depression was assessed using a validated index of depressive symptoms. Results. Dampness or mold in the home was associated with depression (odds ratio [OR]=1.39, 1.44, and 1.34, for minimal, moderate, and extensive exposure, respectively, compared with no exposure). This association became attenuated when perception of control (OR=1.34, 1.40, and 1.24; global P =.069) or a physical health index (OR = 1.32, 1.37, and 1.15; global P = .104) was included in the model. The mediation effects of perception of control over one’s home and by physical health appeared to be additive. Conclusions. Dampness and mold were associated with depression, independent of individual and housing characteristics. This association was independently mediated by perception of control over one’s home and by physical health. Little is known regarding pathways between housing conditions and mental health. 1 Studies have found independent associations between general housing quality, at both the neighborhood and individual levels, with psychological distress 2 and depression. 3 – 5 Dose–response associations have been found between the number of housing problems and residents’ emotional problems 6 and between the degree of housing improvement and alleviation of psychological distress. 7 Several specific housing characteristics, including overcrowding, 8 – 10 noise, 11 , 12 indoor air quality, 13 housing type, 7 and floor level 1 , 14 have also been associated with residents’ mental health. We studied a less intuitive association, that of damp and moldy conditions within a dwelling and depressive symptoms. Molds are fungi that are found in many environments but grow best in warm, damp, and humid conditions. 15 Therefore, dwellings that have problems with dampness also commonly have problems with mold. Although the physical health sequelae of residence in a damp and moldy dwelling have been relatively well investigated, 15 – 17 the effect of living in such an environment on mental health has not. Two studies that used both objective and subjective measures of dampness and mold produced results showing associations with depression and with reports of emotional distress. 18 , 19 Residence in damp housing was also linked with reported problems with physical energy, sleep, and social isolation. 20 However, these studies did not include multivariate analyses. Of the 3 studies that included multivariate analyses, 2 found independent associations between residence in damp and moldy housing and mental distress, 21 , 22 but the third did not. 23 Investigators have hypothesized that the psychological and financial stress of keeping a house clean in the face of recurrent mold may result in a degree of anxiety or depression. 18 , 21 Housing is inextricably linked to one’s perception of control. 24 Individuals faced with high demands but low control experience elevated risk of anxiety and depression. 25 , 26 Thus, a sense of high demand and compromised control over one’s living environment may mediate a potential link between residence in a damp and moldy dwelling and depression. Perception of control has been studied in the context of crowding and noise within a home 10 , 11 , 27 but not with respect to dampness and mold growth. Physical health is another likely mediator of the potential link between residence in a damp and moldy dwelling and risk of depression. Residence in a damp and moldy dwelling is linked with poor physical health outcomes, including respiratory problems, 17 asthma, 16 , 18 diarrhea, 18 nausea, 28 and headaches. 20 Such recurring conditions may be associated with anxiety and depression, thus mediating the potential association between exposure to dampness or mold and depression. All extant studies of dampness or mold and mental health have been conducted in the United Kingdom. Methodological shortcomings of some of these studies make it difficult to convincingly assert an association between dampness and mold and mental health. Moreover, the hypothesized pathways through which dampness and mold may lead to psychological symptoms are unsubstantiated. Our study advances the field in 3 ways: (1) we examined whether the reported association between dampness and mold and depressive symptoms could be replicated in areas outside the United Kingdom, (2) we accounted for a larger number of individual and housing characteristics than was previously possible, and (3) we examined whether the individuals’ perception of control over their housing conditions and their mold-related physical health mediate a possible association between dampness and mold and depressive symptoms.
