Housing as Sanctuary and Constraint: A Qualitative Study of Mental Health Among Older Adults in Government-Assisted Housing

While government-assisted housing programs primarily aim to reduce financial burden for low-income older adults, depression and anxiety rates remain elevated among residents, suggesting that housing environments shape mental health through pathways beyond economic relief. This study examined how housing environments influence mental health among older adults through a socioecological framework. We conducted semi-structured interviews with 16 older adults (ages 60-86) residing in government-assisted housing in rural Alabama between July and September 2024. Using hybrid thematic and framework analysis, we organized emergent themes across individual, interpersonal, community, and organizational levels following Bronfenbrenner's framework. Eleven themes emerged revealing complex paradoxes: housing as simultaneously sanctuary and constraint, anxiety as active controller of daily life, social isolation providing protection while creating loneliness, and transportation barriers operating as gatekeepers across life domains. Mental health service gaps persisted despite explicit resident requests. Ten themes spanned multiple ecological levels, validating multi-level intervention approaches.