Abstract
Objectives
This study examines the impact of multidimensional housing poverty on physical activity and depression among young single-person households in Seoul, with a focus on sex differences.
Methods
A cross-sectional survey of 800 adults aged 19–39 living alone in Seoul was conducted in late 2023. Housing poverty was defined using objective criteria (cost burden and/or spatial deprivation) based on national housing standards and international benchmarks. Among housing-poor participants, additional dimensions, housing and neighborhood dissatisfaction, were assessed to capture perceived disadvantage. Physical activity was assessed using the 2021 Korean Community Health Survey, and depressive symptoms were measured using the 9-item Patient Health Questionnaire. Sex-stratified binary logistic regression models were used.
Results
Young adults facing housing poverty reported higher levels of physical activity but also significantly higher levels of depression. Among male, cost burden and spatial deprivation were positively associated with physical activity, while neighborhood dissatisfaction showed the strongest correlation with depression. Among female, depression was significantly associated with housing dissatisfaction, with less variation in physical activity.
Conclusions
Multidimensional housing poverty was associated with elevated depression and varying physical activity patterns by sex. Policy efforts should reflect these differential vulnerabilities.
Keywords: Housing poverty, Physical activity, Depression, Sex differences, Young adults
1. Introduction
Housing poverty is a growing concern, especially for young single-person households in high-cost metropolitan areas. In South Korea, housing poverty is officially defined for policy and statistical purposes by two criteria: cost burden (spending more than 30 % of income on housing) and/or spatial deprivation (living in less than 14 m2 [approximately 150 ft2] per person, according to the government's Minimum Housing Standards, which require basic facilities such as a bathroom and a kitchenette) (Seoul Institute, 2021). In practice, many of these compact units provide only minimal facilities, sometimes with shared bathrooms or kitchens (see Supplementary Material Figs. S1-S2 for examples). However, these material conditions alone do not fully capture the lived challenges faced by individuals experiencing housing poverty. Economic stress, inadequate living space, poor housing conditions, and deteriorated neighborhood environments may all uniquely impact health and well-being (Ulman and Ćwiek, 2021).
Housing conditions are a recognized social determinant of health (World Health Organization, 2021), with inadequate housing linked to mental health deterioration, infectious diseases, and physical injuries. Previous studies have associated housing poverty with a higher risk of depression, anxiety, and social isolation (Bentley et al., 2011). Young single-person households are particularly vulnerable due to their higher engagement in health-risk behaviors, such as irregular eating habits, excessive alcohol consumption, and smoking (Kim, 2018). However, many studies have treated housing poverty as a singular issue, neglecting how different dimensions contribute to physical and mental health.
In metropolitan Seoul, young single-person households are not only increasingly common but also disproportionately exposed to housing poverty. Recent data show that 64 % of householders aged 19–39 live alone, and over half spend more than 30 % of their income on housing (Statistics Korea, 2023). Furthermore, 62.7 % of young single-person households in Seoul were classified as being in asset poverty, underscoring their structural vulnerability (Byeon et al., 2023). These figures suggest that housing poverty is not an isolated experience but a widespread structural condition among young adults.
This study examines how such living arrangements influence health behaviors and mental well-being. At the same time, South Korea has seen a rise in both physical activity engagement and depression prevalence among young adults (Statistics Korea, 2024; National Health Insurance Service, 2022). While economic constraints in housing poverty have been studied, their differential impacts across multiple dimensions remain understudied. Given that housing conditions shape not only psychological well-being but also opportunities for engaging in health-related behaviors, such as physical activity, sleep, and social interaction, it is necessary to move beyond single-indicator models and adopt a multidimensional approach.
In this study, we adopt a multidimensional perspective on housing poverty to reflect both material conditions and lived experience. While housing poverty was defined using objective criteria, we additionally examined subjective dissatisfaction with housing and neighborhood as distinct indicators of perceived disadvantage among the housing-poor population.
Additionally, sex differences in housing poverty, physical activity, and depression are examined. Men generally engage in higher levels of physical activity, potentially using exercise as a stress-coping strategy (Schuch et al., 2016). In contrast, women face multiple barriers to regular physical activity, including psychological factors, social expectations, and environmental constraints such as safety concerns and accessibility issues (Alyafei and Albaker, 2020). This study analyzes the sex-specific impact of multidimensional housing poverty on physical activity and depression in young single-person households in Seoul.
2. Methods
2.1. Study design and data collection
A cross-sectional study was conducted among 800 young single-person households (aged 19–39) in Seoul, South Korea between October 23 and November 30, 2023. Participants were recruited via a research firm with a pre-registered participant pool of 1.65 million individuals. Participants were recruited via online advertisements, and informed consent was obtained before completing a screening questionnaire. The study was approved by the institutional review board of Seoul National University (2106/002–018, 10 June, 2021). Data were collected anonymously by a third-party research firm to ensure privacy and confidentiality.
2.2. Sample selection
Eligible participants were required to have lived independently as a single-person household for at least two years and resided in their current district for at least six months. Proportionate quota sampling was used to balance participants by sex and age groups based on 2022 Census Korea data. The final sample included 800 participants, with 400 experiencing housing poverty and 400 in the general population (based on the 2017 Census Korea). To ensure comparability, the sample was stratified equally by sex and age group.
2.3. Variables and measurements
Housing poverty was initially defined by official objective criteria, namely cost burden and/or spatial deprivation. To reflect the multidimensional nature of housing poverty, five categories were constructed among those classified as housing poor: three objective (cost burden, spatial deprivation, and both combined) and two subjective dimensions (housing dissatisfaction, and neighborhood dissatisfaction). Subjective indicators were measured using single-item, 4-point scale questions asking about overall satisfaction with one's housing and neighborhood (1 = very dissatisfied to 4 = very satisfied). These global items reflect respondents' holistic judgments about their living environments, rather than specific features. Responses were dichotomized as dissatisfaction (1–2) versus satisfaction (3–4) for analysis. These subjective indicators were not used to define housing poverty, but to identify variation in perceived disadvantage within the housing poverty group. Physical activity was assessed using the, 2021 Korean Community Health Survey, assessing vigorous, moderate, and strength-training activities (Korea Disease Control and Prevention Agency, 2021). A composite score was calculated averaging the three items, and participants whose scores exceeded the sex-specific mean were categorized as high activity level. Depression was measured using 9-item Patient Health Questionnaire (PHQ-9), with a score of ≥10 indicating moderate to severe depression. All measures and coding rules are detailed in Supplementary Table S1.
2.4. Statistical analysis
Descriptive statistics summarized demographic characteristics. Binary logistic regression models stratified by sex examined the association between housing poverty, physical activity, and depression. Adjusted odds ratio (OR) was calculated separately by sex. Binary logistic regression models were adjusted for age, education level, and employment status as proxies of socioeconomic status. Individual income and housing tenure were not collected and therefore could not be included in the models.
Analyses were conducted using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corporation, Armonk, NY, USA).
3. Results
Individuals experiencing housing poverty reported higher levels of physical activity but also significantly greater depressive symptoms compared to those not in housing poverty (Table 1). Within the housing-poor group (n = 400), males showed higher physical activity participation (57 % vs. 40 %) and a greater prevalence of moderate to severe depression (40 % vs. 18 %) than females.
Table 1.
Distribution of demographic characteristics, physical activity levels, and depressive symptoms among young adults by housing poverty status in Seoul, South Korea, 2023.
| Housing Poverty a, n (%) |
Not in housing poverty, n (%) |
p-value | ||||||
|---|---|---|---|---|---|---|---|---|
| Male (n = 200) | Female (n = 200) | Total (n = 400) | Male (n = 200) | Female (n = 200) | Total (n = 400) | |||
| Age group | 19–29 | 97(49) | 100(50) | 197(49) | 67(34) | 100(50) | 167(42) | 0.04 |
| 30–39 | 103(52) | 100(50) | 203(51) | 133(67) | 100(50) | 233(58) | ||
| Education level | High school or less | 38(19) | 25(13) | 63(16) | 21(11) | 14(7) | 35(9) | < 0.01 |
| College and above | 162(81) | 157(79) | 319(80) | 178(89) | 186(93) | 364(91) | ||
| Employment status | Employed | 174(87) | 167(84) | 341(85) | 170(85) | 185(93) | 355(89) | 0.17 |
| Unemployed | 26(13) | 33(17) | 59(15) | 30(15) | 15(8) | 45(11) | ||
| Housing dissatisfaction | 106(53) | 99(50) | 205(51) | 88(44) | 89(45) | 177(44) | 0.06 | |
| Neighborhood dissatisfaction | 45(23) | 39(20) | 84(21) | 32(16) | 29(15) | 61(15) | 0.04 | |
| Physical activity (above median) b | 114(57) | 100(50) | 214(54) | 80(40) | 86(43) | 166(42) | < 0.01 | |
| Depression (PHQ-9 ≥ 10) c | 79(40) | 70(35) | 149(37) | 35(18) | 57(29) | 92(23) | < 0.01 | |
Note: n = number; % = percentage; P-value were obtained using chi-square tests. a Housing poverty was defined as spending >30 % of income on housing and/or living in <14m2 per person, based on national standards. b High physical activity was defined as having a sex-specific average above the mean of weekly frequencies across answers. c PHQ-9 = Patient Health Questionnaire-9.
Physical activity levels varied significantly by objective and subjective housing disadvantage and sex (Table 2). Young adults experiencing housing poverty were more likely to engage in above-average physical activity than those not in housing poverty. The combined experience of both cost burden and spatial deprivation had the strongest association with physical activity (OR = 2.34, 95 % confidence interval (CI): 1.52, 3.60), with males showing the highest odds (OR = 3.00, 95 % CI:1.73, 5.22) and females also exhibiting elevated odds (OR = 2.28, 95 % CI: 1.08, 4.81). Housing dissatisfaction was moderately associated with increased physical activity (OR = 1.65, 95 % CI: 1.17, 2.33), for both males (OR = 1.70, 95 % CI: 1.02, 2.82) and females (OR = 1.69, 95 % CI: 1.04, 2.75). In contrast, neighborhood dissatisfaction was not significantly associated with physical activity in either sex.
Table 2.
Association between housing poverty and physical activity, and depression among young adults in Seoul, South Korea, 2023, stratified by sex.
| Total (OR [95 % CI]) |
Male OR [95 % CI] |
Female OR [95 % CI] |
||
|---|---|---|---|---|
| Reference: | No housing poverty a | 1.0 (Reference) | 1.0 (Reference) | 1.0 (Reference) |
| Physical activity | Cost burden | 1.69 [1.26, 2.27] | 2.33 [1.51, 3.60] | 1.28 [0.86, 1.91] |
| Space deprivation | 2.07 [1.41, 3.04] | 2.64 [1.58, 4.39] | 1.97 [1.04, 3.74] | |
| Both cost burden and space deprivation | 2.34 [1.52, 3.60] | 3.00 [1.73, 5.22] | 2.28 [1.08, 4.81] | |
| Housing dissatisfaction | 1.65 [1.17, 2.33] | 1.70 [1.02, 2.82] | 1.69 [1.04, 2.75] | |
| Neighborhood dissatisfaction | 1.22 [0.75, 1.99] | 1.06 [0.51, 2.21] | 1.48 [0.75, 2.95] | |
| Depression | Cost burden | 2.15 [1.57, 2.95] | 3.35 [2.09, 5.37] | 1.46 [0.95, 2.24] |
| Space deprivation | 2.36 [1.58, 3.54] | 3.91 [2.28, 6.72] | 1.25 [0.64, 2.46] | |
| Both cost burden and space deprivation | 3.17 [2.04, 4.93] | 5.11 [2.86, 9.14] | 1.76 [0.83, 3.71] | |
| Housing dissatisfaction | 2.78 [1.94, 3.99] | 3.76 [2.21, 6.37] | 2.18 [1.32, 3.59] | |
| Neighborhood dissatisfaction | 3.19 [1.96, 5.20] | 6.45 [3.22, 12.93] | 1.57 [0.77, 3.03] |
Note: OR = odds ratio; CI = confidence interval; Reference = no housing poverty (participants not meeting criteria for housing poverty) a Housing poverty was defined as spending >30 % of income on housing and/or living in <14m2 per person, based on national standards.
Depression symptoms significantly increased with both objective housing poverty and subjective housing disadvantage (Table 2). Neighborhood dissatisfaction was associated with a 3.19-fold increase in depression risk (95 % CI: 1.96, 5.20) in the overall sample. Experiencing both cost and space poverty simultaneously was associated with a 3.17-fold increase in depression risk (95 % CI: 2.04, 4.93). In sex-specific analyses, males showed a higher depression risk related to neighborhood dissatisfaction (OR = 6.45, 95 % CI: 3.22, 12.93), and experiencing both housing cost and space poverty (OR = 5.11, 95 % CI: 2.86, 9.14). Among females, only housing dissatisfaction was significantly associated with an increased depression risk (OR = 2.18, 95 % CI: 1.32, 3.59).
4. Discussion
This study highlights the significant impact of multidimensional housing poverty on physical activity and depression among young single-person households in Seoul, demonstrating the need for a more nuanced understanding of housing deprivation. Traditionally, housing poverty has been primarily defined by economic burden or spatial inadequacy (Seoul Institute, 2021; Bentley et al., 2011). Recently, there has been a growing trend to assess housing poverty using multidimensional tools, reflecting the complexity of housing deprivation beyond traditional economic measures (Ulman and Ćwiek, 2021). This study aligns with those perspectives by incorporating five dimensions of housing poverty and analyzing their differential effects on physical and mental health. We distinguished between objective housing poverty and subjective housing-related disadvantage. Although the latter do not meet formal definitions of poverty, they reflect perceived living conditions that meaningfully affect health.
The findings reveal that housing cost burden and spatial deprivation were strongly associated with increased physical activity, particularly among males. This supports that limited living space and financial strain may encourage more outdoor activity, either as a coping response or due to lack of space for rest and recreation (Schuch et al., 2016). However, despite increased physical activity, individuals experiencing housing poverty reported significantly higher depressive symptoms. These two outcomes appear to coexist under housing poverty, although their causal relationship was not directly assessed in this study.
This study also provides a sex-based perspective on how different dimensions of housing poverty impact health. Males' physical activity levels were more sensitive to financial and spatial constraints, while their depression risk was strongly linked to neighborhood dissatisfaction. In contrast, females' depression was associated with housing dissatisfaction, and their physical activity was less influenced by housing conditions. These patterns highlight the distinct roles or perceived safety, social isolation, and housing quality in shaping health outcomes, reinforcing the importance of sex-sensitive interventions (Alyafei and Albaker, 2020).
Our findings further emphasize the importance of multidimensional and perception-sensitive approaches to housing policy. Consistent with urban health research (Cummins et al., 2007; World Health Organization, 2021), interventions must go beyond affordability to address lived experiences of environmental stress. In the South Korean context, recent policy discussions have emphasized the need to improve quality of micro-housing for young adults living alone (Manifesty et al., 2023). However, these discussions often remain limited to unit-level improvements, with less attention to neighborhood-level features that affect health. Our study extends this perspective by identifying modifiable environmental factors linked to physical activity and depression. These include maintaining safe green spaces, expanding access to affordable community facilities, creating indoor communal areas, and fostering local social networks. Enhancing lighting, pedestrian safety, and visible security may be particularly important for supporting outdoor activity among females. These practical targets complement current housing policy directions. They offer actionable strategies for reducing the psychosocial and behavioral health burdens of housing poverty.
Despite using a large, diverse sample, this study has limitations. Its cross-sectional design restricts causal inference and raises the possibility of reverse causality. For example, depressive symptoms may influence dissatisfaction rather than result from it. Individual income and housing tenure were not measured due to institutional review board guidance, but contextual data highlight widespread housing cost burdens and asset poverty among young single-person households in Seoul. Additionally, physical activity was assessed using self-report items from a national survey. While practical for surveillance, such measures are subject to recall bias and may not align with accelerometer-based assessments. Future studies should incorporate device-based methods to improve validity. The positive association between housing poverty and physical activity may reflect coping strategies rather than health promotion. Preliminary findings from a qualitative study by the authors support this interpretation, as participants described using exercise to manage stress and restore daily structure (Lee et al., 2023). Similar patterns were observed during the coronavirus disease 2019 period, when young adults increased physical activity as a way to cope with restricted environments and psychological stress (Ng et al., 2020).
These findings underscore the need to interpret health behaviors within their social and environmental context. Future research should investigate whether physical activity moderates or mediates the relationship between housing deprivation and mental health using longitudinal or mixed-method approaches.
CRediT authorship contribution statement
Jihyun Lee: Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Data curation, Conceptualization. Seunghyun Yoo: Writing – review & editing, Validation, Supervision, Resources, Project administration, Funding acquisition, Conceptualization.
Informed consent statement
Before completing the survey, participants confirmed their consent. Participation was voluntary, and responses were collected anonymously.
Ethical approval
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Ethics Committee at the Seoul National University (2311/002–001, 2024-10-23).
Funding
This study was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean Government (MIST) (NRF-2020R1A2C2012463). The funding agency played no role in the study design and data collection, analysis, or interpretation.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgment
During the preparation of this work, the authors used ChatGPT (OpenAI, 2024) for language editing and word count adjustments. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.pmedr.2025.103305.
Appendix A. Supplementary data
Example photographs illustrating spatial deprivation and the survey questionnaire used in the study.
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Associated Data
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Supplementary Materials
Example photographs illustrating spatial deprivation and the survey questionnaire used in the study.