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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Sociol.</journal-id>
<journal-title-group>
<journal-title>Frontiers in Sociology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Sociol.</abbrev-journal-title>
</journal-title-group>
<issn pub-type="epub">2297-7775</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
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<article-meta>
<article-id pub-id-type="doi">10.3389/fsoc.2026.1612133</article-id>
<article-version article-version-type="Version of Record" vocab="NISO-RP-8-2008"/>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Perspective</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>From housing to home and belonging: structural violence, ontological (in)security and women&#x00027;s mental health</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Keynejad</surname> <given-names>Roxanne C.</given-names></name>
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<name><surname>Gaif&#x000E9;m</surname> <given-names>Francisca</given-names></name>
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<name><surname>Nikoli&#x00107;</surname> <given-names>Ivana</given-names></name>
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<name><surname>Belay</surname> <given-names>Sewhareg</given-names></name>
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<name><surname>Amare</surname> <given-names>Hiwot Hailu</given-names></name>
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<name><surname>Abera</surname> <given-names>Hiwot</given-names></name>
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<name><surname>Mautner</surname> <given-names>Maria-Christine</given-names></name>
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<name><surname>Lichtwarck</surname> <given-names>Hanne Ochieng</given-names></name>
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<aff id="aff1"><label>1</label><institution>Health Service and Population Research</institution>, <city>Institute of Psychiatry, Psychology &#x00026; Neuroscience, King&#x00027;s College London</city>, <city>London</city>, <country country="gb">United Kingdom</country></aff>
<aff id="aff2"><label>2</label><institution>Department of Clinical Medicine, Aarhus University</institution>, <city>Aarhus</city>, <country country="dk">Denmark</country></aff>
<aff id="aff3"><label>3</label><institution>Department of International Law, University of Belgrade</institution>, <city>Belgrade</city>, <country country="rs">Serbia</country></aff>
<aff id="aff4"><label>4</label><institution>School of Public Health, College of Medicine and Health Sciences, Hawassa University</institution>, <city>Hawassa</city>, <country country="et">Ethiopia</country></aff>
<aff id="aff5"><label>5</label><institution>School of Public Health, College of Medicine and Health Sciences, Dilla University</institution>, <city>Dilla</city>, <country country="et">Ethiopia</country></aff>
<aff id="aff6"><label>6</label><institution>Internal Medicine III, Endocrinology, Metabolism and Gender Medicine, Medical University of Vienna</institution>, <city>Vienna</city>, <country country="at">Austria</country></aff>
<aff id="aff7"><label>7</label><institution>International Development, University of Vienna</institution>, <city>Vienna</city>, <country country="at">Austria</country></aff>
<aff id="aff8"><label>8</label><institution>Department of Community Medicine and Global Health, University of Oslo</institution>, <city>Oslo</city>, <country country="no">Norway</country></aff>
<aff id="aff9"><label>9</label><institution>Lovisenberg Diaconal University College</institution>, <city>Oslo</city>, <country country="no">Norway</country></aff>
<author-notes>
<corresp id="c001"><label>&#x0002A;</label>Correspondence: Roxanne C. Keynejad, <email xlink:href="mailto:roxanne.1.keynejad@kcl.ac.uk">roxanne.1.keynejad@kcl.ac.uk</email></corresp>
</author-notes>
<pub-date publication-format="electronic" date-type="pub" iso-8601-date="2026-03-09">
<day>09</day>
<month>03</month>
<year>2026</year>
</pub-date>
<pub-date publication-format="electronic" date-type="collection">
<year>2026</year>
</pub-date>
<volume>11</volume>
<elocation-id>1612133</elocation-id>
<history>
<date date-type="received">
<day>15</day>
<month>04</month>
<year>2025</year>
</date>
<date date-type="rev-recd">
<day>23</day>
<month>01</month>
<year>2026</year>
</date>
<date date-type="accepted">
<day>30</day>
<month>01</month>
<year>2026</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2026 Keynejad, Gaif&#x000E9;m, Nikoli&#x00107;, Belay, Amare, Abera, Mautner, Lichtwarck and Eick.</copyright-statement>
<copyright-year>2026</copyright-year>
<copyright-holder>Keynejad, Gaif&#x000E9;m, Nikoli&#x00107;, Belay, Amare, Abera, Mautner, Lichtwarck and Eick</copyright-holder>
<license>
<ali:license_ref start_date="2026-03-09">https://creativecommons.org/licenses/by/4.0/</ali:license_ref>
<license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License (CC BY)</ext-link>. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</license-p>
</license>
</permissions>
<abstract>
<p>Women&#x00027;s mental health is profoundly shaped by structural violence through housing, which impacts their experience of home and sense of belonging. This Perspective advances an integrative sociological framework across a continuum from the most concrete manifestation of shelter (housing) through symbolic representations of home, to the psychological experience of belonging to a place. We synthesize evidence for relationships between unstable, unsafe housing, abusive homes, social dislocation, and mental ill-health. Drawing on interdisciplinary scholarship, we specify how housing insecurity erodes community, relationships, and safety, generating ontological insecurity that amplifies vulnerability to interpersonal violence. We show that these dynamics are bidirectional: mental health conditions can impede access to resources and secure housing, reinforcing insecurity, while housing adversity is associated with worsened mental health. An intersectional lens reveals that minoritised women experience compounded harm through migration status, precarity, and policy regimes that limit protection and support. Our framework connects macro-level structures (national and international policy), meso-level institutions (welfare, health, and housing services), and micro-level lived experience, demonstrating how structural conditions become embodied as mental health symptoms. This Perspective situates ontological (in)security as central to the relationships between shelter, place, and women&#x00027;s mental health, identifying actionable leverage points for change. We argue for gender-sensitive, integrated interventions that expand access to safe, stable housing, co-locate mental healthcare with rights-based and anti-discrimination services, and address feedback loops between shelter, place, and mental health. By foregrounding housing as a key conduit of structural violence, this Perspective advances sociological understanding of how belonging and mental health are co-constituted and offers directions for research and policy to improve women&#x00027;s health and flourishing.</p></abstract>
<kwd-group>
<kwd>belonging</kwd>
<kwd>home</kwd>
<kwd>housing</kwd>
<kwd>ontological security</kwd>
<kwd>ontological insecurity</kwd>
<kwd>structural violence</kwd>
<kwd>women&#x00027;s mental health</kwd>
</kwd-group>
<funding-group>
<funding-statement>The author(s) declared that financial support was received for this work and/or its publication. RK is supported by an Academy of Medical Sciences Starter Grant for Clinical Lecturers (SGL030\1047). The views expressed in this manuscript are those of the authors and not necessarily of the funder.</funding-statement>
</funding-group>
<counts>
<fig-count count="1"/>
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<custom-meta-group>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Gender, Sex and Sexualities</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="s1">
<title>Introduction</title>
<disp-quote><p><italic>I thought how unpleasant it is to be locked out; and I thought how it is worse perhaps to be locked in</italic>.</p>
<attrib>Virgina Woolf</attrib></disp-quote>
<p>Although the human need for shelter is one of the most basic, the depth of psychological, social, and interpersonal significance of home and belonging to mental health is rarely considered or addressed. Woolf&#x00027;s epigraph captures the complexity of literal and symbolic meanings which home and belonging have for diverse women across cultures and spatio-temporal contexts. &#x0201C;Home&#x0201D; holds power as a refuge from political and societal threats, and Woolf&#x00027;s &#x0201C;room of one&#x00027;s own&#x0201D; can offer &#x0201C;a transitional space&#x0201D; in which women may separate from social expectations and chart an autonomous path (<xref ref-type="bibr" rid="B6">Alexander, 2000</xref>, p. 287). Equally, however, home can be a place of women&#x00027;s oppression or violence, as expressed here by Woolf.</p>
<p>This Perspective is grounded in experience of clinical mental healthcare and seeks to integrate interdisciplinary perspectives to elicit understanding with practical applications. We propose a framework for recognizing the gendered influence of shelter and place on women&#x00027;s mental health, integrating interdisciplinary perspectives from psychiatry, psychology, sociology and anthropology. We propose a framework situated across a continuum from the most concrete manifestation of shelter (housing), through the more symbolic concept (home), to the most psychological construct (belonging). We approach these three over-arching facets of shelter and place as lenses through which to integrate interdisciplinary evidence for positive and negative feedback loops involving structural violence/social protection, ontological in/security and women&#x00027;s mental (ill-)health.</p>
<p>We begin by situating our Perspective within the concept of structural violence. We then consider relationships between women&#x00027;s mental health and the three facets of shelter and place, moving from housing, through home, to belonging. When considering tangible access to housing, we review evidence for the mental health impacts of homelessness and &#x0201C;temporary&#x0201D; accommodation on women. We next consider how violations of the symbolic meaning of home through domestic abuse and displacement impact women&#x00027;s mental health, introducing the central concept of ontological (in)security. We then discuss how subversion of women&#x00027;s psychological experience of belonging by discrimination, migration, and gendered expectations impacts mental health. Finally, we unify the evidence through an integrative framework and discuss its implications for future research and practice, in times of evolving global instability.</p></sec>
<sec id="s2">
<title>Gender dimensions of structural violence</title>
<p>The concept of structural violence is highly relevant to women&#x00027;s mental health, but not always familiar to clinicians. First coined by Johan Galtung, structural violence refers to often-unnoticed systemic inequities intrinsic to social structures at local, national, and international levels, which hinder people&#x00027;s ability to achieve their full potential (<xref ref-type="bibr" rid="B56">Galtung, 1969</xref>). Medical anthropologist Paul Farmer developed the concept, arguing that these inequities produce vulnerabilities in affected populations, enacting violence through harm and injury <xref ref-type="bibr" rid="B49">Farmer et al., (2006)</xref>, including poor health. Using examples from Human Immunodeficiency Virus (HIV) care, <xref ref-type="bibr" rid="B49">Farmer et al. (2006)</xref> illustrated how the health impacts of social forces such as housing, poverty and racism are readily apparent to clinicians in practice, but lacking in biomedically dominated training and research.</p>
<p>Structural violence has been characterized as the &#x0201C;invisible social machinery of inequality that reproduces social relations of exclusion and marginalization&#x0201D; (<xref ref-type="bibr" rid="B129">Scheper-Hughes, 2004</xref>, p. 13). This concept explains the pervasive impact of demographic, economic, neighborhood, environmental, and socio-cultural factors (<xref ref-type="bibr" rid="B99">Lund et al., 2018</xref>): &#x0201C;social determinants&#x0201D; on health (<xref ref-type="bibr" rid="B102">Marmot, 2005</xref>). Differential exposure to this range of social determinants arises from social stratification: not only by social class, occupation, education or income, but also through intersecting aspects of people&#x00027;s identities, which confer the benefits of privilege or the harms of oppression (<xref ref-type="bibr" rid="B18">Bell, 2017</xref>). The unequal access to prevention, care, treatment, education, resources, and opportunities which arises from structural violence becomes embodied as health inequities, cyclically exacerbated by structural barriers to healthcare and other remedies (<xref ref-type="bibr" rid="B52">Fjelltorp-Veland et al., 2025</xref>; <xref ref-type="bibr" rid="B66">Hamed et al., 2020</xref>).</p>
<p>These cyclical relationships between inequity, adversity and health are especially apparent in mental healthcare, where the effects of structural violence on relapse and recovery are often marked (<xref ref-type="bibr" rid="B5">Alegr&#x000ED;a et al., 2023</xref>). For example, a study of 300 adults with severe mental health conditions in the United States found that adversities of home environment, social and economic circumstances interacted with gender to mediate recovery (<xref ref-type="bibr" rid="B32">Compton et al., 2020</xref>). However, the influence of such inequities can be compounded by the structures intrinsic to many mental health services, which normalize forms of violence, such as compulsory hospitalization and restraint.</p>
<p>Gender norms are complex, context-specific, and intersect with other social factors to influence the health of women and men across the life course (<xref ref-type="bibr" rid="B160">Weber et al., 2019</xref>). Although gender inequity, restrictive gender norms, and other forms of discrimination are social determinants of health (<xref ref-type="bibr" rid="B70">Heise et al., 2019</xref>), most psychiatric research has until recently been conducted without a gendered lens (<xref ref-type="bibr" rid="B76">Howard et al., 2017</xref>). Gender differences in the prevalence of mental health conditions are well-documented, worldwide, including among those with minoritised identities (<xref ref-type="bibr" rid="B114">Newcomb et al., 2020</xref>). Analyses of World Mental Health Survey data from 15 countries found elevated mood and anxiety disorders (odds ratios: 1.3 to 2.6) among women, relative to men (<xref ref-type="bibr" rid="B130">Seedat et al., 2009</xref>). The authors examined gender role traditionality, through female workforce representation, female education, median marital age and birth control. Reductions in gender role traditionality were associated with narrowing of gender differences in depression across countries, suggesting that social structures driving gender inequity impact the prevalence of mental health conditions.</p>
<p>The psychosocial pathways model (<xref ref-type="bibr" rid="B138">Stansfield and Bell, 2019</xref>) offers a framework for understanding how structural violence and its risk factors interact. Synthesizing findings of the World Health Organization (WHO) commission on the social determinants of health and related initiatives, as well as evidence syntheses and expert consensus, the psychosocial pathways model provides a visualization of the relationships between social determinants, psycho-social factors, health behaviors, physical and mental health outcomes. A key insight is how the effects of social determinants on health are mediated by psycho-social pathways, such as stress, control, self-efficacy, resilience, relationships, social cohesion and social capital. The model shows that integrating interdisciplinary understanding of how social determinants interact with psychological processes to influence mental health outcomes can illuminate complexity, to inform research, policy and practice. The psychosocial pathways model provides a specific example of <xref ref-type="bibr" rid="B49">Farmer et al. (2006)</xref>&#x00027;s contention that linking public health activities to structural interventions can provoke &#x0201C;virtuous social cycles&#x0201D;. In the following sections, we consider the evidence for vicious and virtuous cycles between women&#x00027;s mental health and three facets of shelter and place: housing, home and belonging.</p></sec>
<sec id="s3">
<title>Housing</title>
<p>Structural violence is perpetuated through lack or violation of social and economic rights to the fulfillment of basic needs (<xref ref-type="bibr" rid="B49">Farmer et al., 2006</xref>). International law affirms the right to adequate housing (article 11.1; <xref ref-type="bibr" rid="B144">UN General Assembly, 1989</xref>) and provides a common legal consensus on key aspects of this right. However, national laws often fail to address the full scope of housing difficulties, enabling commodification, precarity, and homelessness (<xref ref-type="bibr" rid="B147">UN General Assembly, 2019a</xref>). Structural violence is compounded by the fact that safe, secure, affordable housing is not uniformly distributed. Groups minoritised in terms of ethnicity, sexuality, gender identity, disability, refugee and sole caregiver status disproportionately experience unstable and poor quality housing, homelessness and negative treatment by services (<xref ref-type="bibr" rid="B134">Shelter Scotland, 2024</xref>). Homelessness and temporary accommodation are two examples of housing adversity with established mental health impacts, the gender dimensions of which are often overlooked.</p>
<sec>
<title>Homelessness</title>
<p>Pathways to homelessness are gendered. In many countries, women lack equal rights to land and property ownership, which may depend on their relationship with a male relative (<xref ref-type="bibr" rid="B147">UN General Assembly, 2019a</xref>). When relationships end, women may face eviction, often becoming &#x0201C;hidden homeless:&#x0201D; staying transiently with a series of successive friends and family.</p>
<p>Mental health conditions and substance use disorders are prevalent in homeless, populations, although women are proportionally under-represented in research studies (<xref ref-type="bibr" rid="B62">Gutwinski et al., 2021</xref>). Homeless women appear to have a higher prevalence of mental ill-health and past trauma than homeless men (<xref ref-type="bibr" rid="B106">Milaney et al., 2020</xref>; <xref ref-type="bibr" rid="B121">Power, 2023</xref>). Furthermore, social isolation and traumatic experiences while homeless can exacerbate existing mental health conditions and substance use, increasing vulnerability and further hindering women&#x00027;s ability to secure stable housing (<xref ref-type="bibr" rid="B60">Greene et al., 2024</xref>). A study of over 2,000 women in the United States found that housing instability and disarray but not material conditions were associated with depression and generalized anxiety disorder (<xref ref-type="bibr" rid="B141">Suglia et al., 2011</xref>). Thus, in high-income country settings, the uncertainty and disorganization of precarious housing may be more detrimental to mental health than specific housing conditions.</p>
<p>Less is known about the mental health of homeless people in low- and middle-income countries. Few studies have investigated severe mental health conditions, such as schizophrenia, bipolar disorder, and severe depression, among people who are homeless in these settings (<xref ref-type="bibr" rid="B137">Smartt et al., 2019</xref>). In Addis Ababa, Ethiopia, 90% of 217 street homeless adults had a mental health or substance use disorder (<xref ref-type="bibr" rid="B50">Fekadu et al., 2014</xref>). The 10% of the sample who were female reported high rates of sexual abuse, indicating the relevance of gendered traumatic experiences to women&#x00027;s experiences of homelessness. Although the needs of homeless people with severe mental health conditions in low and middle-income countries are beginning to receive research attention (<xref ref-type="bibr" rid="B67">Hanlon et al., 2025</xref>), a gendered lens is essential. Qualitative studies in Addis Ababa have identified how childhood trauma and sexual abuse (<xref ref-type="bibr" rid="B171">Yohannes, 2025</xref>), poverty, family and relationship instability predisposed women to homelessness and prevented their exit from it (<xref ref-type="bibr" rid="B64">Haile et al., 2020</xref>).</p></sec>
<sec>
<title>Temporary accommodation</title>
<p>Although street homelessness is the most publicly visible form of housing adversity, precarious housing is extremely common. Despite high morbidity and mortality, more than 1.8 billion people live in informal settlements or inadequate housing, worldwide (<xref ref-type="bibr" rid="B151">UN Human Rights, 2025</xref>). Inadequate housing is also a gendered problem. In 80% of the 59 low and middle income countries providing data, women were overrepresented in urban slum areas disconnected from essential services (<xref ref-type="bibr" rid="B150">UN Habitat, 2020</xref>). Unsafe, insecure housing with limited community or police oversight and poor sanitation facilities was associated with gender-based violence victimization in Delhi and Nairobi (<xref ref-type="bibr" rid="B150">UN Habitat, 2020</xref>): a vicious cycle of structural violence.</p>
<p>Although informal settlements are more common in low and middle-income countries, lack of affordable accommodation in high-income countries means that many people with mental health conditions are housed &#x0201C;temporarily&#x0201D; for protracted periods (<xref ref-type="bibr" rid="B133">Shelter, 2025</xref>), with a range of adverse health impacts (<xref ref-type="bibr" rid="B132">Shelter, 2004</xref>). Although the quality of shelter and provision of essential infrastructure are central to adequate housing (<xref ref-type="bibr" rid="B145">UN General Assembly, 2011</xref>), temporary accommodation is rarely designed to address caring responsibilities, safety and security concerns, which disproportionately affect women (<xref ref-type="bibr" rid="B134">Shelter Scotland, 2024</xref>).</p>
<p>Housing insecurity entails continuous uncertainty, including the threat of eviction. A range of studies in high income countries has identified poor mental health as a risk factor and consequence of eviction, especially for low-income families (<xref ref-type="bibr" rid="B29">Clarke et al., 2017</xref>; <xref ref-type="bibr" rid="B156">V&#x000E1;squez-Vera et al., 2017</xref>). In low and middle-income countries, forced eviction is associated with poor mental health (<xref ref-type="bibr" rid="B125">Richardson et al., 2016</xref>) and increased risk of sexual violence (<xref ref-type="bibr" rid="B80">Jelle et al., 2021</xref>). Following forced eviction, women may be relocated to transient camps or detention centers, where they report difficulty adjusting to poor conditions and feeling trapped, suffocated, dehumanized, ashamed, devalued, mistrustful, and isolated (<xref ref-type="bibr" rid="B1">Abdulrahman, 2025</xref>).</p>
<p>A broad literature supports associations between housing adversity, poor mental health and violence exposure among women in low, middle and high-income country contexts. In keeping with the psychosocial pathways model (<xref ref-type="bibr" rid="B138">Stansfield and Bell, 2019</xref>), protracted uncertainty and lack of control can both precipitate and perpetuate mental health conditions among women with insecure housing. Despite the importance of housing to mental health, relevant services work largely in isolation. The exceptions are homeless shelters responsive to addictions, and specialist mental health supported housing, which have been most widely studied in high income countries such as Canada (<xref ref-type="bibr" rid="B14">Barker et al., 2022</xref>; <xref ref-type="bibr" rid="B87">Kirst et al., 2020</xref>).</p>
<p><xref ref-type="bibr" rid="B49">Farmer et al. (2006)</xref> described addiction as having been &#x0201C;desocialised&#x0201D;: &#x0201C;viewed as personal and psychological problems rather than societal ones&#x0201D; (p. 1690) which followed legacies of oppression, including genocide and slavery. Similarly, the commodification of housing by capitalist, individualistic societies allows its gender dimensions and relationship to mental health to be disregarded in favour of personal attribution of responsibility. Having discussed the relevance of tangible accommodation to women&#x00027;s mental health, we next consider the symbolic and emotional experience of home.</p></sec></sec>
<sec id="s4">
<title>Home</title>
<p>Adequate housing is necessary but not sufficient for mental health. For example, &#x0201C;housing first&#x0201D; initiatives provide accommodation to homeless persons without imposing any requirements on residents, such as abstinence from substances or medication concordance. Research in Canada found that provision of such housing did not, in isolation, improve homeless women&#x00027;s mental health (<xref ref-type="bibr" rid="B117">O&#x00027;Campo et al., 2023</xref>). This finding supports other studies suggesting that beyond shelter, the sense of home offers women social, psychological, and cultural foundations (<xref ref-type="bibr" rid="B35">D&#x00027;Alessandro and Appolloni, 2020</xref>) for mental health.</p>
<p>Influential feminist thinkers have long critiqued the valorising of home for women (<xref ref-type="bibr" rid="B55">Friedan, 1963</xref>), pointing to its weaponisation to perpetuate oppression. However, exclusive critique misses the value home can have for women&#x00027;s mental health. <xref ref-type="bibr" rid="B172">Young (2005)</xref> proposed four normative values of home: safety, individuation, privacy, and preservation. <xref ref-type="bibr" rid="B172">Young (2005)</xref> characterized home as &#x0201C;the site of the construction and reconstruction of one&#x00027;s self&#x0201D; (p. 181). Thus, while women&#x00027;s wellbeing can be nurtured by positive experiences of home, unsafe or threatening homes pose risks.</p>
<p>A central concept capturing the psychological benefits of home is that of ontological (in)security. Ontological insecurity captures feelings of vulnerability and instability arising from a lack of control over one&#x00027;s living conditions, including a lack of &#x0201C;biographical continuity that typically underpins confidence in life&#x00027;s stability&#x0201D; (p. 4; <xref ref-type="bibr" rid="B101">Manzo and Grove, 2024</xref>). Ontological security was coined by <xref ref-type="bibr" rid="B89">Laing (1960)</xref>, who proposed that lacking a coherent sense of self drives distorted perceptions of reality in schizophrenia. More recently, ontological insecurity has been used to understand experiences of disturbed identity among people with emotionally unstable personality disorder (<xref ref-type="bibr" rid="B103">McDonald et al., 2010</xref>). Attachment theory proposed that infants explore new environments, using their primary caregiver as a secure base (<xref ref-type="bibr" rid="B4">Ainsworth, 1964</xref>). For adults, individuated from their attachment figure, a stable home base from which to explore a potentially threatening outside world may support a sense of personal coherence, affording ontological security.</p>
<p>A study which interviewed home owners in New Zealand identified four (context-specific) facets of ontological security (<xref ref-type="bibr" rid="B42">Dupuis and Thorns, 1998</xref>). These were consistent social and material surroundings, a space in which daily life is enacted, a safe place free from scrutiny and over which the person has control, and &#x0201C;a secure base around which identities are constructed&#x0201D; (p. 24). Ontological security highlights psychological mechanisms by which a stable home may confer mental health benefits.</p>
<p>In a further vicious cycle of structural inequity, ontological insecurity is associated with gendered forms of structural violence. A study which interviewed women in Ontario found that perceived ontological insecurity was influenced by gendered, trauma-associated housing adversity and harmful substance use (<xref ref-type="bibr" rid="B120">Perri et al., 2025</xref>). Similarly, feeling safe from sexual violence and exploitation were central to the benefits of a home for women with severe mental health conditions in New York (<xref ref-type="bibr" rid="B119">Padgett, 2007</xref>). In keeping with the psychosocial pathways model, ontological security provided by home has potential to further a virtuous cycle, benefitting mental health. However, the safety, stability, and security of home can be violated from within and without. Two examples with well-documented mental health impacts are domestic abuse (<xref ref-type="bibr" rid="B40">Devries et al., 2013</xref>) and displacement (<xref ref-type="bibr" rid="B19">Bendavid et al., 2021</xref>).</p>
<sec>
<title>Domestic abuse</title>
<p>Perhaps the most common violations of women&#x00027;s right to a safe and secure home are violence and abuse perpetrated in domestic settings. Across 201 studies enrolling over 250,000 women, the lifetime prevalence of intimate partner violence (IPV) victimization was 37%; past-year prevalence was 24% (<xref ref-type="bibr" rid="B161">White et al., 2024</xref>). The structural violence of patriarchal norms and women&#x00027;s economic, social, and political disempowerment are barriers to leaving abusive relationships, which further increase the prevalence of IPV. Many victim-survivors lack autonomous access to accommodation (<xref ref-type="bibr" rid="B88">Lacmanovi&#x00107; and Nestorov, 2021</xref>), leaving them dependent on often limited voluntary sector or charitable provision. Meta-analyses of longitudinal studies have shown that IPV victimization is bidirectionally associated with depression, suicide attempts (<xref ref-type="bibr" rid="B40">Devries et al., 2013</xref>), and alcohol use (<xref ref-type="bibr" rid="B39">Devries et al., 2014</xref>). That is, IPV is associated with subsequent depression, suicide attempts and alcohol use <italic>and</italic> these conditions are themselves associated with subsequent IPV.</p>
<p>Although the terms IPV and domestic abuse are often used interchangeably, they have distinct definitions. Domestic abuse as defined in UK law encompasses harm caused by adult family members as well as partners and ex-partners (<xref ref-type="bibr" rid="B72">Home Office, 2013</xref>). People with severe mental health conditions have higher prevalence of domestic abuse victimization than the general population (<xref ref-type="bibr" rid="B86">Khalifeh et al., 2015</xref>), and can face additional barriers to help-seeking. Coercive control is a type of domestic abuse, now a criminal offense in its own right in the UK (<xref ref-type="bibr" rid="B73">Home Office, 2023</xref>). Coercive control comprises acts dominating the person, including removing means of independence and escape. Previously conceptualized as &#x0201C;intimate terrorism&#x0201D; (<xref ref-type="bibr" rid="B139">Stark, 2010</xref>), such abuse can &#x0201C;colonise&#x0201D; the mind of the victim, changing their behavior through anticipatory anxiety, impacting mental health through feelings of entrapment (<xref ref-type="bibr" rid="B96">Lohmann et al., 2024</xref>). This phenomenon enables threats, intimidation, traumatic memories and associations to continue to influence women&#x00027;s mental states after they leave the domestic setting.</p>
<p>Despite the term, domestic abuse can be perpetrated outside the home, including through online activity (<xref ref-type="bibr" rid="B126">Rogers et al., 2023</xref>). Relatively recently acknowledged, technology-facilitated abuse exploits digital developments to extend a perpetrator&#x00027;s reach beyond the home. While both men and women report technology-facilitated abuse victimization, its perpetration appears to be largely by men (<xref ref-type="bibr" rid="B126">Rogers et al., 2023</xref>). Tracking technology, online platforms and novel digital threats, often designed to shame or humiliate the victim for violating culturally mandated gender roles, mean that physically leaving does not afford escape. Digital coercive control is &#x0201C;spaceless,&#x0201D; with cyber-stalking and online harassment leaving women under constant surveillance. Despite its untethered nature, digital coercive control is still shaped by place and space, as it has different forms and consequences depending on women&#x00027;s geographical locations, be they isolated rural areas or readily accessible urban settings. This new form of domestic abuse is &#x0201C;transcending borders and boundaries in new ways&#x0201D; (<xref ref-type="bibr" rid="B68">Harris and Woodlock, 2019</xref>, p. 537), leaving women feeling unsafe online and offline.</p>
<p>As <xref ref-type="bibr" rid="B68">Harris and Woodlock (2019)</xref> outline, technology-facilitated abuse can be deeply private, leading women to police their own behavior and online activity in anticipation of surveillance. It can also be extremely visible, co-opting friends, family, and colleagues to shame women&#x00027;s public persona. The potential psychological impacts of such experiences might include hypervigilance, avoidance, compulsive checking, paranoia and self-scrutiny. The emerging field studying technology-facilitated abuse is yet to grapple with the full mental health implications of its psychodynamic complexities.</p>
<p>While relationships between violence, abuse, and mental health are a focus of research (<xref ref-type="bibr" rid="B118">Oram et al., 2022</xref>), the meaning given to home by women who experience these intersections has received less attention. Intrusion of fear and violence through domestic abuse into what should be a safe and sacred space has clear psychological effects. In Turkey, domestic violence survivors characterized home making, to create a &#x0201C;home feeling,&#x0201D; as a defense against their &#x0201C;unhomely&#x0201D; marital houses, enabling them to cope with the transition after leaving (<xref ref-type="bibr" rid="B97">Lordoglu, 2023</xref>). In Canada, female IPV survivors&#x00027; understandings of &#x0201C;home&#x0201D; were grounded in ontological security, through safety, community, and comfort, as well as material stability (<xref ref-type="bibr" rid="B168">Woodhall-Melnik et al., 2017</xref>).</p>
<p>Adverse childhood experiences, the majority of which take place in the home, including maltreatment, witnessing domestic abuse, parental mental ill-health and substance use disorders are risk factors for a range of future mental health conditions (<xref ref-type="bibr" rid="B93">Lewis et al., 2019</xref>). Childhood abuse is also a risk factor for revictimisation in adulthood, by domestic or sexual violence (<xref ref-type="bibr" rid="B31">Coid et al., 2001</xref>), including among people with severe mental health conditions (<xref ref-type="bibr" rid="B7">Anderson et al., 2016</xref>). The authors found that both men and women with severe mental health conditions and a history of childhood abuse were at elevated risk of adulthood abuse, but the association was higher for women. Despite a wealth of evidence about the impacts of abuse on mental health, psychological associations with home, as an arena for abuse, a trigger for traumatic memories or a place of healing remain under-studied.</p></sec>
<sec>
<title>Displacement</title>
<p>In contrast to the interpersonal impacts of domestic abuse on mental health, are the geopolitical forces driving women&#x00027;s displacement from their homes. Women, children and families are increasingly uprooted by events beyond their control, such as climate change and armed conflict (<xref ref-type="bibr" rid="B135">Simmons, 2023</xref>). These causes of displacement have mental health impacts independent of those resulting from the experience of being displaced. Damage and disruption to homes, communities and livelihoods by extreme weather events are detrimental to women&#x00027;s health (<xref ref-type="bibr" rid="B27">Charlson et al., 2021</xref>), as are heat exposure, air pollution, dietary deficiencies, and infectious diseases arising from climate change (<xref ref-type="bibr" rid="B127">Rothschild and Haase, 2023</xref>). Gender inequity exacerbates these harms (<xref ref-type="bibr" rid="B90">Lawrance et al., 2021</xref>), through compounding by food insecurity, forced migration, and loss of social networks caused by climate events (<xref ref-type="bibr" rid="B58">Goudet et al., 2024</xref>). Many such experiences entail the loss and destruction of ancestral lands. A systematic review identified adverse mental health impacts of land dispossession as well as increases in gender-based violence (<xref ref-type="bibr" rid="B115">Ninomiya et al., 2023</xref>).</p>
<p>Women&#x00027;s mental health and physical safety are impacted directly by conflict, and indirectly by displacement (<xref ref-type="bibr" rid="B19">Bendavid et al., 2021</xref>). Bereavement, injuries, and socio-economic hardship arising from conflict are associated with common mental disorders (depression, anxiety disorders, and post-traumatic stress disorder) and suicidal ideation (<xref ref-type="bibr" rid="B167">Woldetsadik et al., 2022</xref>). In addition, war places women at risk of conflict-related physical and sexual violence perpetrated by military personnel, combatants, other strangers, and intimate partners (<xref ref-type="bibr" rid="B10">Asefa et al., 2024</xref>; <xref ref-type="bibr" rid="B75">Hossain et al., 2014</xref>). Feeling undermined by subversion of traditional gender expectations and economic pressures may increase men&#x00027;s perpetration of IPV during turbulent times (<xref ref-type="bibr" rid="B46">Falb et al., 2014</xref>; <xref ref-type="bibr" rid="B124">Restrepo et al., 2024</xref>), exposing women to abuse inside and outside the home. A negative feedback loop has been proposed, whereby social unrest, violence, and conflict are fostered by reduced social cohesion and community participation, which arise from poor community mental health (<xref ref-type="bibr" rid="B107">Miller, 2023</xref>). A mixed methods study in Uganda identified additive effects of IPV and armed conflict on women&#x00027;s depressive symptoms (<xref ref-type="bibr" rid="B109">Mootz et al., 2019</xref>). A study in post-war districts of the Amhara region of Ethiopia found that anxiety and depression were the commonest consequences of violence against women (<xref ref-type="bibr" rid="B10">Asefa et al., 2024</xref>).</p>
<p>The long-lasting nature of many current conflicts, in urban settings directly affecting civilians, has increased women and children&#x00027;s exposure to traumatic experiences (<xref ref-type="bibr" rid="B19">Bendavid et al., 2021</xref>). Women and children comprise the majority of forcibly displaced persons, and for many, displacement becomes protracted. For people displaced long-term, the transitional state of <italic>liminality</italic> captures the experience of powerlessness and marginalization while exerting agency to create a home despite the many barriers to doing so (<xref ref-type="bibr" rid="B24">Brun and F&#x000E1;bos, 2015</xref>).</p>
<p>The adverse mental health impacts of armed conflict are also not confined to those directly affected. Accumulating individual and collective traumas also impact the day-to-day well-being and collective memory of diaspora communities overseas (<xref ref-type="bibr" rid="B71">Hirschberger, 2018</xref>). Diasporic collective memory is shaped by aspects of the new country of residence and evolving armed conflict in the country of origin (<xref ref-type="bibr" rid="B83">Karim and Baser, 2022</xref>). There is growing evidence that learning about conflict in one&#x00027;s home country through social and other media is associated with anxiety, depression and vicarious trauma among diaspora communities caught between two worlds (<xref ref-type="bibr" rid="B57">Gesesew et al., 2025</xref>).</p>
<p>Diasporic memory evolves continuously, reshaped and reinterpreted by each generation in light of new geopolitical events (<xref ref-type="bibr" rid="B16">Baser and Toivanen, 2024</xref>). The integration of past and present can be positive, mobilizing diasporic communities to aspire to alternative individual and collective futures (<xref ref-type="bibr" rid="B110">M&#x000FC;ller-Funk et al., 2023</xref>). Aspirations can facilitate hope and strengthen emotional resources, to endure struggles in the present. However, feminist theory has highlighted the disproportionate emotional labor upon women to invoke the past and evoke the future. An anthropological study of Greek women who emigrated to English-speaking countries following the Second World War found that they performed substantial cultural labor, &#x0201C;sandwiched&#x0201D; between their parents&#x00027; nostalgia and their children&#x00027;s distance (<xref ref-type="bibr" rid="B143">Tsolidis, 2011</xref>). Diaspora women&#x00027;s mental health can be impacted by tensions between patriarchal cultural legacies and xenophobia in their new home.</p>
<p><xref ref-type="bibr" rid="B24">Brun and F&#x000E1;bos (2015)</xref> proposed a tripartite conception of home, as an idea and a practice, in contexts of protracted displacement. They distinguished &#x0201C;home&#x0201D; (daily tasks of home-making) from &#x0201C;Home&#x0201D; (values, traditions, memories, and feelings of home), and &#x0201C;HOME&#x0201D; (political, historical and institutional conceptions). This approach offers a framework for understanding how the complexity of displaced women&#x00027;s conceptions and experiences of home may &#x0201C;retreat, emerge, or reappear in different configurations over time&#x0201D; (p. 15) &#x02013; and how this may help them to endure extended uncertainty. These strategies may explain psychological resilience and preserved mental health among many individuals living in states of profound uncertainty.</p>
<p>The concept of ontological (in)security and the examples of domestic abuse and displacement are instructive for understanding the cyclical impacts of structural violence on women&#x00027;s mental health. If housing is the most concrete manifestation of shelter and home the more symbolic, belonging captures psychological experiences conferred by attachment to community and place.</p></sec></sec>
<sec id="s5">
<title>Belonging</title>
<p>Place-making is the active process of building a relationship with a new (<xref ref-type="bibr" rid="B91">Lems, 2016</xref>) or familiar (<xref ref-type="bibr" rid="B33">Cresswell, 2014</xref>) location. This process is often described in diasporic studies as a dynamic, multi-layered practice, continually negotiated across place, time, and social relations (<xref ref-type="bibr" rid="B65">Hall, 2015</xref>; <xref ref-type="bibr" rid="B173">Yuval-Davis, 2006</xref>). Anthropologists moved, during &#x0201C;the spatial turn,&#x0201D; from viewing people against the backdrop of their geographical context to seeing place and space as forces which shape human experience. While this transition drew scholarly attention to displacement, the shift to viewing people as &#x0201C;boundless&#x0201D; (<xref ref-type="bibr" rid="B9">Appadurai, 1988</xref>) has been argued to neglect the importance of place to people&#x00027;s realities (<xref ref-type="bibr" rid="B91">Lems, 2016</xref>).</p>
<p>Similar to scholars identifying benefits of home in the face of its dismissal as a place of women&#x00027;s oppression, <xref ref-type="bibr" rid="B91">Lems (2016)</xref> challenged characterisations of putting down roots as being trapped in one place. She presented the case of Halima, a Somali woman in Australia. Rather than yearning for freedom, &#x0201C;her fear is the fear to remain in transit and unfitting forever, to never arrive anywhere, to never be someone in relation to somewhere anymore&#x0201D; (p. 333). Lems identified the existential importance of &#x0201C;being in place&#x0201D; and belonging to Halima&#x00027;s sense of self. Halima says &#x0201C;I don&#x00027;t want to be in transit. My heart is working hard to settle, to settle and to belong to this country&#x0201D; (p. 324). However, <xref ref-type="bibr" rid="B173">Yuval-Davis (2006)</xref> argues that belonging comprises not only a personal sense but also the public, institutional processes that draw boundaries, gatekeep, and decide who can belong, on what terms.</p>
<p>If belonging captures the ultimate sense of ontological security, migration, discrimination, and marginalization are forces of structural violence which threaten both, with impacts on women&#x00027;s mental health. Even in conditions of exclusion, othering and judgement, however, women identify home, community, and faith as routes to belonging and wellbeing.</p>
<sec>
<title>Migration</title>
<p>The importance of belonging is clear when considering the health and social adversities faced by the increasing numbers of people who migrate (<xref ref-type="bibr" rid="B163">WHO, 2023</xref>). Both the mobility and health implications of migration are highly gendered (<xref ref-type="bibr" rid="B2">Abubakar et al., 2018</xref>). Many women who migrate are exposed to violence and exploitation before, during and after the journey, leading to dependence on others in transit, and once settled in their destination.</p>
<p>Rooted in colonial legacies, border regimes shape inequities between those who migrate, through differing attitudes to citizenship and legal status (<xref ref-type="bibr" rid="B36">Damsa and Franko, 2023</xref>). Structural violence by racialised border regimes in destination countries (<xref ref-type="bibr" rid="B54">Freedman et al., 2022</xref>) includes efforts to constrain migrant women&#x00027;s reproductive autonomy (<xref ref-type="bibr" rid="B21">Bhatia, 2023</xref>) and may unintentionally exacerbate gender-based violence by placing women at greater risk (<xref ref-type="bibr" rid="B123">Reilly et al., 2022</xref>).</p>
<p>The mental health of undocumented migrant women is affected by experiences of existential displacement, leading to feelings of &#x0201C;embodied unbelonging&#x0201D; (<xref ref-type="bibr" rid="B20">Bendixsen, 2020</xref>). That is, state actions enacting the classification of women as &#x0201C;illegal&#x0201D; impact their health and bodily experience of &#x0201C;being-in-the-world&#x0201D; in their host nation, exacerbated by restricted access to healthcare and other rights. Depressive and anxiety symptoms are highly prevalent among undocumented migrants. In Norway, 86% of undocumented migrants (<italic>n</italic> = 90, 43% female), endorsed clinically significant mental health symptoms (<xref ref-type="bibr" rid="B111">Myhrvold and Sm&#x000E5;stuen, 2017</xref>). Precarity, fleeing war or persecution and histories of abuse were associated with distress. Anxiety about providing for dependents and exploitative practices meant that family and work were not protective. Structural violence also appears to contribute to increased perinatal mortality and adverse maternal outcomes among undocumented migrants (<xref ref-type="bibr" rid="B43">Eick et al., 2024</xref>; <xref ref-type="bibr" rid="B108">Misje et al., 2025</xref>), a group which already faces elevated prevalence of perinatal mental health conditions compared to the general population (<xref ref-type="bibr" rid="B140">Stevenson et al., 2023</xref>).</p>
<p>Even in settings with access to paid employment, many female migrant workers suffer from structural violence. Large numbers of women migrant care workers deliver and improve health services worldwide, without themselves receiving full social protections (<xref ref-type="bibr" rid="B162">WHO, 2017</xref>). They often face precarity, exploitation, and gender-based violence. The mental health impacts on female migrant workers (<xref ref-type="bibr" rid="B63">Habtamu et al., 2017</xref>) diminish opportunities to integrate into the new country, worsening alienation and isolation (<xref ref-type="bibr" rid="B45">European Network of Migrant Women, 2021</xref>). Women who migrate for care work enter a &#x0201C;global care chain&#x0201D;, often leaving their own children in the care of others (<xref ref-type="bibr" rid="B112">Nadasen, 2017</xref>), underlining inequities with their employers, and reinforcing their separation from home. Such experiences have established mental health impacts on female migrant workers (<xref ref-type="bibr" rid="B158">Vianello et al., 2024</xref>), such as depressive and anxiety symptoms (<xref ref-type="bibr" rid="B79">Jecker and Chin, 2019</xref>).</p>
<p>However, despite hardships and adversities, studies have identified a range of coping strategies for attaining a sense of belonging. <xref ref-type="bibr" rid="B20">Bendixsen (2020)</xref> found that &#x0201C;irregular&#x0201D; migrants in Norway combatted embodied unbelonging through acts of resistance and exertions of agency. Where available, they established their sense of belonging by being-in-the-world through faith, religious community, and friendship. There is growing acknowledgment that trauma-informed mental healthcare for migrant women must recognize these and other sources of strength and resilience (<xref ref-type="bibr" rid="B11">Babatunde-Sowole et al., 2020</xref>).</p></sec>
<sec>
<title>Discrimination</title>
<p>While migration can impede women&#x00027;s sense of belonging in their host country, discrimination against those perceived as &#x0201C;other&#x0201D; targets citizens and immigrants alike, for arbitrary reasons which evolve with socio-political preoccupations. Othering is a fluid, shifting process enacted by dominant actors and institutions through discourse, representation and institutional practice. Othering groups social identities, with those who are minoritised being classified as alien (<xref ref-type="bibr" rid="B25">Canales, 2000</xref>; <xref ref-type="bibr" rid="B74">Horowitz, 1989</xref>, pp. 66-67). Potential means of othering which scholars have identified range from biopolitical categorization (<xref ref-type="bibr" rid="B53">Foucault, 2003</xref>), division between settlers and &#x0201C;natives&#x0201D; (<xref ref-type="bibr" rid="B48">Fanon, 1961</xref>) and homonationalism (<xref ref-type="bibr" rid="B122">Puar, 2018</xref>; <xref ref-type="bibr" rid="B136">Slootmaeckers, 2019</xref>) to hospital systems for undocumented migrants (<xref ref-type="bibr" rid="B52">Fjelltorp-Veland et al., 2025</xref>), multiculturalism (<xref ref-type="bibr" rid="B44">Equihua, 2017</xref>, pp. 19&#x02013;20) and white feminism (<xref ref-type="bibr" rid="B26">Cavanaugh, 2023</xref>, pp. 284&#x02013;285; <xref ref-type="bibr" rid="B157">Verg&#x000E8;s, 2021</xref>; <xref ref-type="bibr" rid="B174">Zakaria, 2021</xref>). Othering may be considered the other side of the coin that is belonging, with different facets of social identity defined by contrast to what one is not (<xref ref-type="bibr" rid="B22">Bhugra et al., 2023</xref>). The resultant marginalization of those occupying any micro-identities classified as &#x0201C;other&#x0201D; threatens their sense of belonging, depending on the context.</p>
<p>Internalized othering of Black people by white colonizers was central to the pioneering psychoanalysis of <xref ref-type="bibr" rid="B47">Fanon (1952)</xref>. The minority stress model encapsulates how internalized prejudice, negative societal attitudes, expectations and actual experiences of discrimination predispose minoritised groups to poor mental health (<xref ref-type="bibr" rid="B105">Meyer, 1995</xref>). The mental health impacts of racism are well-known, including intersections with sexism toward ethnically minoritised women (<xref ref-type="bibr" rid="B159">Vines et al., 2017</xref>). These harms are compounded by complex relationships between intergenerational and historical racial trauma, parental and child experiences of and reactions to discrimination. Cycles of disempowerment arising from structural and identity-driven exclusion are thought to drive excess psychosis among ethnic minority (<xref ref-type="bibr" rid="B82">Jongsma et al., 2021</xref>) and migrant groups (<xref ref-type="bibr" rid="B69">Hatch et al., 2016</xref>), via processes of alienation and socioeconomic disadvantage. These cycles are amplified by interactions between systems of inequality, such as race and gender-based discrimination (<xref ref-type="bibr" rid="B116">Nixon, 2019</xref>).</p>
<p>The routine othering of women is captured by Simone <xref ref-type="bibr" rid="B38">De Beauvoir (1949)</xref>&#x00027;s characterization of man as &#x0201C;the subject&#x0201D;, &#x0201C;the absolute&#x0201D;, &#x0201C;the essential&#x0201D; and woman as &#x0201C;the Other.&#x0201D; Indeed, inclusion of women, including pregnant women, and reporting of sex and gender in medical research publications is sufficiently variable to merit a dedicated policy framework in the UK (<xref ref-type="bibr" rid="B166">Witt et al., 2023</xref>). White, able-bodied, majority language-speaking men are usually the template for the design of health and social care systems, services and research, which then inadvertently discriminate against minoritised service users (<xref ref-type="bibr" rid="B34">Criado Perez, 2019</xref>). Even in high-income countries, outside perinatal-specific mental healthcare, women routinely follow trauma-uninformed pathways designed for the needs of men (<xref ref-type="bibr" rid="B128">Saunders et al., 2023</xref>).</p>
<p>Lack of consideration of women&#x00027;s specific, holistic needs may perpetuate discrimination by increasing the use of coercive mental healthcare. For example, a meta-analysis found that associations between minoritised ethnicity and compulsory detention in psychiatric hospital were stronger in studies with larger proportions of female participants (<xref ref-type="bibr" rid="B15">Barnett et al., 2019</xref>). This finding has at least two possible drivers. People with intersecting marginalized identities (in this case, females of minoritised ethnicity) may experience more severe mental health crises than those with non-minoritised identities&#x02014;perhaps in part due to increased structural violence exposure&#x02014;increasing their need for involuntary admission. In addition, people with multiple minoritised identities might provoke greater concern within the social structures (invariably established by people with non-minoritised identities) which respond to illness episodes, such as police and emergency medical services, increasing the likelihood of compulsory hospitalization. To optimize mental healthcare for minoritised women and others, both factors require intervention.</p>
<p>Clustering of structural violence exposure means that people with mental health conditions may experience othering through a range of marginalized micro-identities. For those recovering from severe mental health conditions, belonging has been understood as connecting with others, affiliation, inclusion and integration (<xref ref-type="bibr" rid="B41">Doroud et al., 2018</xref>). The authors found that the concept of place played a central role in processes of being, doing, becoming and belonging during mental health recovery. Thus, while othering may both predispose women to mental ill-health and result from it, finding belonging can offer pathways to healing.</p></sec>
<sec>
<title>Gendered expectations</title>
<p>A final means by which women&#x00027;s sense of belonging is threatened, is through norms and expectations of femininity and womanhood. The mental health of women with intersecting marginalized identities, such as those who sell sex, is impacted by inter-related, stigmatized vulnerabilities, to substance use (<xref ref-type="bibr" rid="B95">Lichtwarck et al., 2023</xref>), gender-based violence (<xref ref-type="bibr" rid="B17">Beattie et al., 2020</xref>), HIV infection (<xref ref-type="bibr" rid="B131">Shannon et al., 2014</xref>), and criminalization (<xref ref-type="bibr" rid="B100">Lyons et al., 2020</xref>). These intersecting forms of structural violence increase women&#x00027;s need to access health and social care but feeling &#x0201C;undesired by society&#x0201D; impacts women&#x00027;s ability to trust service providers (<xref ref-type="bibr" rid="B94">Lichtwarck et al., 2024</xref>).</p>
<p>For women violating social norms, the ontological security of a safe home has potential to provide a sense of control essential to rebuilding their life and work, toward a sense of belonging. A study of women leaving prison in New Zealand found high exposure to domestic abuse and substance use in their homes prior to and during offending (<xref ref-type="bibr" rid="B98">Low and Mills, 2025</xref>). Women identified their new homes, free from these adversities, as physical expressions of their new identity, which reinforced desistance from offending.</p>
<p>While motherhood can foster a sense of belonging or inclusion, difficult experiences and disappointed expectations can generate feelings of dissonance (<xref ref-type="bibr" rid="B84">Keynejad et al., 2023</xref>) and ontological insecurity. For example, qualitative studies have identified feelings of alienation among migrant women who had children in their host country, via isolation, powerlessness and contradictory role expectations (<xref ref-type="bibr" rid="B170">Yang et al., 2022</xref>).</p>
<p>As well as a time of major biological, psychological, and social adjustment and high socio-cultural expectations, the perinatal period is one of elevated mental health risk (<xref ref-type="bibr" rid="B77">Howard and Khalifeh, 2020</xref>). Women experiencing intersecting forms of structural violence and trauma alongside severe mental health conditions have more social care involvement in their family life (<xref ref-type="bibr" rid="B92">Lever Taylor et al., 2023</xref>). Cycles of family disruption can become established, with child removal associated with further structural violence (<xref ref-type="bibr" rid="B23">Broadhurst and Mason, 2020</xref>) as well as maternal mortality (<xref ref-type="bibr" rid="B37">De Backer et al., 2025</xref>).</p>
<p>Struggling with motherhood not wishing to become a mother, or having difficulty conceiving can provoke profound distress. However, social structures which offer a sense of wider belonging such as education, employment, income, health insurance, social support, and religion appear to be important protections (<xref ref-type="bibr" rid="B12">Bagade et al., 2023</xref>; <xref ref-type="bibr" rid="B169">Xie et al., 2023</xref>) against feelings of alienation.</p></sec></sec>
<sec sec-type="discussion" id="s6">
<title>Discussion</title>
<p>A broad, interdisciplinary literature supports the impacts of shelter and place, from housing, through home, to belonging, on women&#x00027;s mental health in diverse contexts (<xref ref-type="fig" rid="F1">Figure 1</xref>). Across the evidence, positive and negative feedback loops recur: the virtuous and vicious cycles described by <xref ref-type="bibr" rid="B49">Farmer et al. (2006)</xref>. In terms of positive reinforcement, women with social protection often have more stable housing, affording ontological security, predisposing them to better mental health. Those experiencing structural violence often face housing precarity, creating ontological insecurity and increasing their risk of mental health conditions. In terms of negative reinforcement, different forms of structural violence cluster together. For example, increased domestic abuse is associated with climate events (<xref ref-type="bibr" rid="B104">Medzhitova et al., 2023</xref>), food insecurity (<xref ref-type="bibr" rid="B81">Jewkes et al., 2023</xref>), and armed conflict, each of which is independently linked to precarity.</p>
<fig position="float" id="F1">
<label>Figure 1</label>
<caption><p>Psychological and structural impacts of the presence or absence of housing, home, and belonging and their relationships to structural violence and ontological security.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fsoc-11-1612133-g0001.tif">
<alt-text content-type="machine-generated">Infographic presenting housing, home, and belonging as central concepts. Facets of each of these are shown above a dividing line (representing absence) or below the line (representing presence) of housing, home and belonging. On either side of this depiction are two double-sided arrows, representing the continuum between structural violence and social protection on one side and between ontological insecurity and ontological security on the other</alt-text>
</graphic>
</fig>
<p>Despite the compelling evidence that action against structural violence against women is needed, an escalating backlash has caused the stagnation or reversal of programmes addressing gender inequity (<xref ref-type="bibr" rid="B149">UN General Assembly, 2024</xref>) in recent years. Policies are being dismantled and reframed, implementation mechanisms undermined, and accountability processes eroded, especially in fragile democracies and countries with anti-democratic governments (<xref ref-type="bibr" rid="B152">UN Women, 2020</xref>). Global health funding cuts initiated in 2025 mean that half of women-led and women&#x00027;s rights organizations in humanitarian settings were predicted to close (<xref ref-type="bibr" rid="B153">UN Women, 2025a</xref>). Decimation of the sector will substantially diminish the provision of social protections mitigating structural violence, including refuge from domestic abuse, temporary accommodation for displaced persons, group interventions fostering belonging, and gender-focused programming to address patriarchal norms which perpetuate inequity. Based on the evidence surveyed here, widespread cuts to social protection can be expected to exacerbate ontological insecurity, adversely impacting women&#x00027;s mental as well as physical health, and safety.</p>
<sec>
<title>Implications for research and practice</title>
<p>Now more than ever, action is needed to center gender equity at the heart of social policy. Complex, non-linear relationships between risk factors for mental health conditions demand multisectoral interventions at all stages of the psychosocial pathways model (<xref ref-type="bibr" rid="B138">Stansfield and Bell, 2019</xref>). This includes commitment to tackle distal drivers (gender inequity, stigma, discrimination, economic oppression, punitive laws), alongside proximal needs (interventions addressing women&#x00027;s health, housing, and gender-based violence victimization; WHO OHCHR, <xref ref-type="bibr" rid="B165">2023</xref>). Gender-inclusive polices must be integrated into &#x0201C;shock-proofed&#x0201D; social protection initiatives, to limit the potential for women&#x00027; rights to be rolled back, following political fluctuations (<xref ref-type="bibr" rid="B154">UN Women, 2025b</xref>).</p>
<p>Mental health services need to be tailored for gender differences, including age of onset, clinical presentation, gender roles, sexual, and reproductive health and preventive health needs and trauma histories (<xref ref-type="bibr" rid="B51">Ferrara and Srihari, 2021</xref>). Gender responsive, trauma-informed approaches to mental healthcare should be standard practice (<xref ref-type="bibr" rid="B142">Sweeney et al., 2018</xref>). Despite a large literature on housing and health, the lack of a gendered perspective hinders the development of interventions responding to these complex, intersectional phenomena (<xref ref-type="bibr" rid="B155">V&#x000E1;squez-Vera et al., 2022</xref>). Currently available evidence suggests that mental health interventions tailored for homeless women are acceptable and effective (<xref ref-type="bibr" rid="B8">Anderson et al., 2024</xref>). However, complex social factors, including transient accommodation and IPV can impede rigorous intervention research with marginalized women (<xref ref-type="bibr" rid="B61">Greene et al., 2021</xref>). Future research requires sufficient resources to permit longitudinal follow-up of groups who relocate frequently.</p>
<p>Gender-based disadvantage intersects with other aspects of women&#x00027;s identities. The scale of structural violence against minoritised groups requires political will to develop co-produced, holistic services which engage with therapeutic cultural practices, amplify indigenous perspectives on healing, and rebuild trust (<xref ref-type="bibr" rid="B13">Bansal et al., 2022</xref>). The importance of place-making offers opportunities to enhance marginalized women&#x00027;s sense of belonging, build trust (<xref ref-type="bibr" rid="B59">Graham-Brown, 2022</xref>) and combat isolation (<xref ref-type="bibr" rid="B3">Adlington et al., 2023</xref>) by fostering cohesion and facilitating social interaction through community interventions and housing policies. However, interventions furthering ontological security require meaningful action against threats to women&#x00027;s physical and mental health and safety in domestic settings. Political commitment and public health approaches (<xref ref-type="bibr" rid="B148">UN General Assembly, 2019b</xref>) are essential to mitigate mental health impacts of IPV across the life course (<xref ref-type="bibr" rid="B118">Oram et al., 2022</xref>).</p>
<p>The impacts of wider policy decisions on the social determinants of women&#x00027;s health and health equity require recognition. The assertion that there can be &#x0201C;no health without mental health&#x0201D; (<xref ref-type="bibr" rid="B164">WHO, 2025</xref>) recognizes the need to mainstream mental health across government decision-making. A structured approach to policy integration can be taken through resources such as the Mental Wellbeing Impact Assessment Toolkit (<xref ref-type="bibr" rid="B113">National MWIA Collaborative, 2011</xref>). Tested in sites across England, the toolkit guides implementers to consider, systematically, how four protective factors (inclusion, participation, control, and community assets) are affected by population characteristics, wider determinants, and social relationships. Implementers are then guided to consider how each protective factor is in turn impacted by aspects of equity and social justice. This approach has been applied to over 1,000 initiatives globally, demonstrating the feasibility of integrating attention to social determinants of mental health into policy making (<xref ref-type="bibr" rid="B30">Coggins, 2025</xref>).</p>
<p>However, the cascade of global disinvestment in health research and practice mitigating inequity in 2025 leaves the field in a position of profound uncertainty (<xref ref-type="bibr" rid="B85">Keynejad et al., 2026</xref>), while populist anti-migrant sentiment continues to rise. Until recent ideological shifts, the 2030 Agenda for Sustainable Development (<xref ref-type="bibr" rid="B146">UN General Assembly, 2015</xref>) and Global Compact for Safe, Orderly and Regular Migration (<xref ref-type="bibr" rid="B78">IOM, 2018</xref>) had attracted broad consensus. Abrupt loss of consensus at a time when displaced, traumatized and conflict-affected populations are growing creates conditions threatening to community mental and physical health. Without action, decimation of international aid and research programmes amid multiple extended wars fought in urban settings threaten catastrophic impacts on women, intersectionally minoritised groups, their children and families (<xref ref-type="bibr" rid="B28">Clark, 2025</xref>).</p></sec></sec>
<sec id="s7">
<title>Conclusions</title>
<p>This Perspective presents an integrative sociological framework for understanding the impacts of a continuum of relationships to shelter and place, from housing, through home, to belonging on women&#x00027;s mental health. Drawing on interdisciplinary evidence and grounded in clinical understanding, we show how the concept of structural violence illuminates complexity by identifying positive and negative feedback loops between diverse forms of social prosperity/adversity and mental (ill)health. We demonstrate how ontological (in)security is an instructive organizing principle for the experiences of personal coherence, security and consistency fostered by housing, home and belonging, through examples of harm and resilience in the face of their violations and deprivations. While many distal drivers of structural violence are beyond practitioners&#x00027; individual influence, the personalized perspective offered by centring ontological security is an essential defense against systems and ideologies which dominate, dehumanize and other. In the current moment of global precarity, we call for a renewed commitment to research and care which dismantles architectures of structural violence, starting with the foundational importance of safe, secure, habitable housing and community environments fostering belonging. Researchers, policy-makers, clinicians, housing providers, voluntary sector professionals, cultural, spiritual and community groups, and people with lived experience must unite to reaffirm the universal rights of all people to the highest attainable standards of health and living.</p></sec>
</body>
<back>
<sec sec-type="author-contributions" id="s8">
<title>Author contributions</title>
<p>RK: Writing &#x02013; review &#x00026; editing, Supervision, Resources, Conceptualization, Writing &#x02013; original draft, Formal analysis, Project administration, Visualization, Data curation, Methodology. FG: Writing &#x02013; review &#x00026; editing, Conceptualization, Methodology, Investigation, Visualization, Formal analysis, Writing &#x02013; original draft, Data curation. IN: Writing &#x02013; original draft, Formal analysis, Writing &#x02013; review &#x00026; editing, Methodology, Investigation, Conceptualization. SB: Data curation, Writing &#x02013; original draft, Writing &#x02013; review &#x00026; editing, Investigation, Conceptualization. HAm: Writing &#x02013; original draft, Writing &#x02013; review &#x00026; editing, Conceptualization, Investigation, Data curation. HAb: Writing &#x02013; review &#x00026; editing, Formal analysis, Conceptualization, Writing &#x02013; original draft, Data curation, Investigation. M-CM: Conceptualization, Writing &#x02013; original draft, Writing &#x02013; review &#x00026; editing. HL: Conceptualization, Writing &#x02013; review &#x00026; editing, Investigation, Writing &#x02013; original draft, Validation, Methodology, Formal analysis, Data curation. FE: Conceptualization, Validation, Data curation, Writing &#x02013; review &#x00026; editing, Supervision, Methodology, Writing &#x02013; original draft, Investigation, Visualization, Formal analysis.</p>
</sec>
<sec sec-type="COI-statement" id="conf1">
<title>Conflict of interest</title>
<p>The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="ai-statement" id="s10">
<title>Generative AI statement</title>
<p>The author(s) declared that generative AI was not used in the creation of this manuscript.</p>
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<sec sec-type="disclaimer" id="s11">
<title>Publisher&#x00027;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
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<fn fn-type="custom" custom-type="edited-by" id="fn0001">
<p>Edited by: <ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/2858299/overview">Ulrika Dahl</ext-link>, Uppsala University, Sweden</p>
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<p><ext-link ext-link-type="uri" xlink:href="https://loop.frontiersin.org/people/3326279/overview">Ceren Lordoglu</ext-link>, Mimar Sinan Fine Arts University, T&#x000FC;rkiye</p>
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