Generalized anxiety disorder, or GAD, is characterized by excessive, difficult-to-control worry that interferes with daily functioning. Rates of anxiety have been rising in the United States, particularly among adults under fifty and among women, whose risk exceeds that of men. Worsening mental health among pregnant and parenting women of low socioeconomic status has raised alarms in the maternal health community, because untreated anxiety threatens both mothers and children. Yet scientists have struggled to identify modifiable, upstream drivers of anxiety in marginalized groups, and research explicitly linking manifestations of structural racism to GAD has remained rare. The SECURE investigators argued that residential eviction, which disproportionately affects Black women and children, is one such discernible consequence of structural racism, and that the specific experiences of Black women have been largely absent from the scientific record, a gap the researchers attribute in part to misogynoir, or the systematic dismissal of Black women’s testimony.

The SECURE Study recruited self-identified Black women aged eighteen to forty-five who were parents or had a parenting role and lived in Wayne, Oakland, or Macomb counties in Michigan. Between July 2021 and July 2024, participants completed online or telephone surveys, yielding a final sample of 1,428 women, a remarkable 91.1 percent response rate among confirmed eligible participants. Crucially, the study was designed as participatory action research: a Community Advisory Board of Black women local, national, and international leaders helped shape the survey questions in culturally appropriate language, interpreted the findings, and are named coauthors on the paper. This structure was not merely symbolic; it shaped how eviction itself was measured, distinguishing five separate exposures: eviction during childhood, ever experiencing a court-ordered eviction, ever experiencing an illegal eviction, a court-ordered eviction in the past two years, and an illegal eviction in the past two years.

In Michigan, a lawful eviction requires written notice of a lease violation, a court filing, a judicial eviction order, and a physical removal carried out by a court officer or sheriff. An illegal eviction bypasses all of these protections: the landlord or their representative simply forces a resident out. Anxieties were assessed with the GAD-7, a validated seven-item scale on which participants rated how often they were bothered by symptoms such as nervousness, uncontrollable worrying, restlessness, irritability, and fear that something awful might happen. The scale showed excellent internal consistency in this sample, and scores of fifteen or above, indicating severe symptoms, were analyzed as the outcome. Roughly one in three participants screened positive for moderate or severe anxiety symptoms in the previous two weeks, with about sixteen percent falling into the severe category.

The headline result emerged with striking clarity. In unadjusted analyses, all five eviction measures were associated with elevated risk of severe anxiety symptoms, with relative risks ranging from roughly 1.3 to 2.0. After statistical adjustment for age, income, marital status, education, employment, enrollment year, current housing tenure, and prior clinician-diagnosed anxiety and depression, most associations attenuated. But one held firm: women who reported an illegal eviction in the past two years had 46 percent higher risk of severe GAD symptoms than women with no such experience, a finding that remained statistically significant with a confidence interval of 1.03 to 2.07. A sensitivity analysis comparing women illegally evicted more than two years earlier against those with no lifetime history found no elevated risk, while recent illegal eviction conferred fifty-two percent higher risk, sharpening the picture of a potent, time-sensitive association that resembles an acute threat response rather than a lasting scar of past displacement.

The study’s design cannot prove causation, and the authors are careful on this point, acknowledging possible recall bias and the cross-sectional nature of the data. Yet they argue the estimate is likely conservative, given that half of the sample reported some eviction experience, that prior mental health diagnoses may themselves lie on the pathway between eviction and anxiety, and that self-report is the only feasible way to measure illegal eviction, since such displacements never enter court records. Notably, the researchers found no evidence that Black women are more likely to misremember major life events than other groups, undermining a common methodological objection to within-group research built on lived experience.

The qualitative arm of the study adds the texture that numbers alone cannot supply. Of the ninety-five women reporting a recent illegal eviction, seventy-seven also answered open-ended questions about why they were put out and what their landlords did. Thematic analysis of their responses revealed seven recurring themes. Reasons for illegal eviction included landlord conflict, abuse, and fraud, such as retaliation against tenants who filed discrimination complaints or who knew their rights; landlord neglect, including refusal to repair infestations and dangerous conditions; gentrification, property sales, and unaffordable rent increases; and family or neighborhood conflict. One participant described being deceived by a landlord who ‘came and lied to the police to remove us’ after a court had failed to displace her. Another, seven days late on rent, received a fraudulent notice that mimicked a court document and left within a week, unaware she had a right to stay.

The methods of displacement were often overtly coercive, fitting what researchers call ‘self-help’ eviction: changing the locks while tenants were away, shutting off water and utilities, removing belongings to the street, sending threats by text and email, calling police with false reports, and arriving with groups of people to intimidate. Participants described daily harassment, destroyed property, and inspections they could not refuse. The authors contend that such experiences produce exactly the cognitive conditions that sustain generalized anxiety: anticipatory worry, hypervigilance, an inability to plan, and a pervasive sense of ongoing threat. Because illegal evictions are sudden, violent, unpredictable, and offer no immediate legal recourse, they may generate an intolerable level of uncertainty, a known driver of GAD. The researchers go further, framing the incomplete enforcement of tenant protections as a form of state-sanctioned violence, and drawing a parallel to police brutality, which has likewise been linked to hypervigilance and anxiety in Black communities.

The implications reach well beyond psychology clinics. More than one in three participants carried a prior diagnosis of anxiety or depression, and even after adjusting for those diagnoses, the association between recent illegal eviction and severe symptoms remained strong. People with GAD face elevated risks of additional mental and physical health conditions, and identifying modifiable upstream causes is therefore a public health priority. The authors argue that addressing the dual crises of eviction and poor mental health among reproductive-age Black women is essential to maternal and child health equity, and they call for a layered response: emergency support and mutual aid for those experiencing illegal eviction, trauma-informed interventions, stronger enforcement of tenant rights, and structural solutions including policy change and government-funded reparations for descendants of enslaved people in the United States. As the first and most comprehensive study of its kind, built with rather than merely about the women it studied, the SECURE investigation transforms a largely invisible form of housing violence into measurable scientific evidence, and sends a clear signal that where eviction law ends and landlord whim begins, the mental health consequences are anything but abstract.

Subject of Research: Associations between illegal residential eviction and severe generalized anxiety disorder symptoms among reproductive-age Black women

Article Title: Illegal eviction and risk of severe anxiety disorder symptoms: Qualitative and quantitative data from the Social Epidemiology to Combat Unjust Residential Evictions (SECURE) study

Article References: Sealy-Jefferson, S., Ross, L. J., Mishra, S., Sanders, K., Anderson, T., Anderson-Mays, T., Oneal, R., & Jones-McBryde, C. (2026). Illegal eviction and risk of severe anxiety disorder symptoms: Qualitative and quantitative data from the Social Epidemiology to Combat Unjust Residential Evictions (SECURE) study. SSM – Mental Health, 10, Article 100699. https://doi.org/10.1016/j.ssmmh.2026.100699

Image Credits: AI Generated

DOI: 10.1016/j.ssmmh.2026.100699

Keywords: illegal eviction, generalized anxiety disorder, Black women, structural racism, housing instability, maternal health, SECURE study, GAD-7, self-help eviction, tenant rights, reproductive justice, Michigan

The foundation for the final report was laid earlier, when the first phase of the Pathways study was released in April 2026. That phase established, through hundreds of surveys, that 98 percent of unhoused participants wanted permanent housing, a figure that directly counters persistent public narratives suggesting that many people experiencing homelessness prefer to remain unsheltered. The second phase deepened that quantitative picture by pairing it with qualitative evidence. Researchers interviewed participants about the full arc of their experiences, from the circumstances that preceded housing loss to the slow, often contradictory process of engaging with homeless services. By combining statistical breadth with narrative depth, the study aimed to capture not just how many people are affected but how the pathway into and out of homelessness actually unfolds over time.

A distinctive methodological feature of the research was its co-design with the Transformational Research for Equity and Experience in Shelter committee, a group composed entirely of people with lived experience of homelessness. Rather than treating formerly and currently unhoused individuals as passive subjects, the research team positioned them as analytic partners capable of interpreting patterns in the data. One study participant captured the rationale plainly, noting that people with lived experience are often invited to share stories, but that their capacity to analyze those experiences matters just as much, because they understand the patterns rather than merely witnessing them. This participatory approach gave the report an insider’s view of how housing service systems are experienced from below, including the emotional and cognitive labor that participants expend simply trying to remain eligible for help.

Lead investigator Kathleen Conte, an assistant professor in the OHSU-PSU School of Public Health, summarized the core insight of the findings by explaining that navigating homelessness involves far more than locating a service and accepting it. People, she said, are simultaneously trying to stay safe, meet basic needs, decipher a complicated service system, prove they qualify for assistance, maintain important relationships, advocate for themselves and push forward through long waits and repeated setbacks. The report frames this as a continuous balancing act in which the demands of survival compete directly with the demands of bureaucratic engagement. Missing a call, losing a document or changing shelter locations can unravel weeks of progress, meaning that the population most burdened by the system is also the one asked to perform the most sustained administrative effort within it.

The journey mapping revealed that for many participants, outright homelessness was preceded by a period of hidden homelessness, including couch surfing, living in vehicles and temporary hotel stays. These precursors are largely invisible in official counts, which means the visible crisis often represents a late stage of a much longer decline. Bereavement emerged as a strikingly common trigger: more than 30 percent of interview participants reported that the death of a loved one directly or indirectly contributed to their housing loss. The finding underscores how fragile housing stability can be when household finances and social support depend on a single person’s income or presence, and it suggests that grief and loss deserve greater attention in prevention-oriented policy, which typically focuses on eviction, rent burdens and employment disruption.

Once unhoused, participants described becoming trapped in what the report calls “the churn,” a state in which continuous effort to secure housing is repeatedly frustrated by systemic bottlenecks. These include missing identification documents that are difficult to replace without a fixed address, high turnover among case managers that forces people to retell their histories again and again, and phone calls that simply go unreturned. One participant delivered a pointed assessment of the current service framework, describing it as a system that rewards maintenance rather than transformation. The phrase captures a structural critique: programs are often organized around keeping people engaged and documented rather than around moving them decisively into permanent housing, which can leave individuals indefinitely cycling through shelter beds, waitlists and intake appointments.

Administrative requirements and rigid program thresholds compounded the problem, creating what the researchers describe as a painful mismatch between a person’s immediate needs and the assistance actually available. Participants recounted being denied services because their situations did not fit precise priority definitions, leaving them to navigate fragmented systems without clear guidance about where to turn next. Lori Kelley, planning and evaluation manager for the Multnomah County Homeless Service Department, which supported the study, emphasized that effective policy must be grounded in reality and that the county’s goal was to center the real-world experiences of people using services throughout the entire research process. She described the research as giving policymakers and the public an honest look at what works, what does not and what truly prevents people from reaching their housing goals.

Importantly, the report does not conclude that escape from homelessness is impossible. Participants also described moments when the system worked, when the right support, relationships and opportunities converged at precisely the right time to move them toward housing. Yet the study found that these successes were more often experienced as lucky breaks than as reliable pathways, a distinction with significant policy implications. When exits from homelessness depend on fortunate timing rather than predictable system design, outcomes become inequitable and difficult to scale. The TREES committee pressed this point in its own contribution to the report, stressing that while numbers, charts and data are incredibly important, remembering the humans living without housing, and what those numbers represent, should be the priority guiding interpretation and action.

Based on the combined evidence, the report sets out six core priorities for action, developed in collaboration with the TREES committee. These include expanding diverse affordable housing models tailored to different ages, family structures, disabilities and safety needs; prioritizing prevention and housing stability through flexible early financial support and livable-wage employment before housing is lost; coordinating and standardizing services with centralized information points to reduce administrative runaround; eliminating practices such as involuntary displacements that strip people of belongings, legal documents and case manager relationships; strengthening community support systems through peer networks and culturally specific organizations; and integrating lived experience directly into funding decisions, program design, policy and research. Conte cautioned that no single organization can build the path alone, noting that people in crisis are asked to navigate housing, health care and other systems that do not always connect. If better pathways out of homelessness are the goal, she argued, those systems must work together rather than expecting people to find their own way without a map.

Subject of Research: A lived-experience study of the pathways people take through homelessness and homeless services in Multnomah County, Oregon.

Article Title: New PSU study maps complex journeys through homelessness in final pathways report

Article References: New PSU study maps complex journeys through homelessness in final pathways report. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: homelessness, Portland State University, Multnomah County, housing policy, lived experience, social services, public health, housing instability, poverty, homeless services, prevention, participatory research