The study, led by a University of Maryland researcher, found that one in five people in default on their mortgages have serious symptoms of depression. About one-third have seen their finances so crimped that they cannot afford to fill prescriptions and get enough to eat, which worsen health problems.
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"We knew of the link, but we were surprised by the magnitude of the problem," said Dawn E. Alley, an assistant professor of epidemiology in the University of Maryland School of Medicine. "These people were more than bummed out."
The study, published online Thursday in the American Journal of Public Health, relied on data collected from 2006 to 2008 as part of a government-funded survey of the labor force and workers' health. The surveys are given to a nationwide sample of more than 26,000 Americans over age 50 every two years.
Others in the counseling field in Maryland are seeing the health consequences in homeowners facing foreclosure. At the Pro Bono Counseling Project, a nonprofit statewide mental health counseling referral service, almost one-third of cases now involve people who have lost their homes or their jobs.
"It's becoming a coexisting condition," said Bailey Susic, outreach program and professional education manager there. "They didn't have depression before."
Susic noted a new client who typifies the problem — a 57-year-old woman who lost her home to foreclosure after quitting her job to care for her husband. After her husband died of prostate cancer, she then had to care for her brother, who had lung cancer. Susic said the woman stopped caring properly for herself, which is "the No. 1 thing people do in this situation."
On the mortgage counseling side, Ruth Griffin, director of the Maryland Housing Counselor Network, a coalition of providers, said they too are hearing from clients about medical care deferred and the toll of stress. Typically, the counselors do not address those problems.
"We aren't mental health counselors," Griffin said. "We don't have the resources."
Griffin and Susic say they want to join forces to ensure that services are offered to those who need them. Alley hopes to help set that up.
Foreclosure prevention counseling is not required in Maryland. But lawmakers passed a law last year that requires lenders to provide more information about special financial aid programs available to homeowners in default. And if lenders proceed with a foreclosure, they must also agree to mediation. The state set up a hot line for those in default to call for help, 877-462-7555.
The system, Alley and others say, could be used to link homeowners to other services, such as mental health counseling.
The needs will only grow, they say: The Mortgage Bankers Association estimates the foreclosure crisis will eventually affect one in 200 homes.
Investigators from Princeton and Georgia State universities found in a study published in August by the Bureau of Economic Research that emergency room visits for anxiety and suicide attempts and preventable conditions such as hypertension and other stress-related maladies were higher in four states — Arizona, California, Florida and New Jersey — that were among the hardest hit by foreclosure.
Sometimes, health problems can lead to foreclosure. About 25 percent of those polled by the Homeownership Preservation Foundation said a health crisis was a tipping point.
Alley said a separate survey conducted by the researchers showed that mortgage counselors have noticed depression or a sense of hopelessness in about 70 percent of their clients. One-third of counselors said they had worked with a client in the past month who had expressed an intention to harm himself or herself.
Across the country, there are few models for a comprehensive approach to counseling. Philadelphia, which launched a program in 2008, might be the first.
Judge Annette Rizzo of the Philadelphia Court of Common Pleas helped create a program of mandatory housing counseling for all in foreclosure. The counselors use a questionnaire to determine homeowners' needs and make referrals to programs that help with such things as utility bills, repairs, health costs and health counseling.
About 70 percent of those in foreclosure have participated. Those who do not call the program get a home visit, the judge said.
In all, more than 12,500 homeowners have participated in the program's court-supervised negotiations since 2008. Nearly 4,000 of those homeowners have had their homes saved from foreclosure and more than 5,000 cases remain in negotiations, according to the Philadelphia Office of Housing and Community Development.
Rizzo said counselors have found the main reasons for default include a change in the family situation such as death or divorce, unemployment or health problems.
"Then they develop other problems because of their stress and depression," she said. "We very much care-take and channel them to social services. We need to address all the issues. It's never a straight line."