This review analysed research evidence describing how housing conditions are associated with refugee mental health and wellbeing in high-income resettlement countries. It found refugees experienced significant housing issues which contributed to poor mental health outcomes. This supports previous studies that identified housing as an important social determinant of health for refugees [10, 15]. Unsuitable housing conditions, including inadequate physical conditions and poor location, had a negative impact on mental health and wellbeing outcomes exacerbated by lack of autonomy. The lack of studies exploring housing factors across time in refugee settlement meant it was difficult to fully answer the second research question. We could not conclusively demonstrate if the timing of housing support or access provided any additional benefits. However, homelessness, which represents the most extreme experience of housing problems, was found to be a common occurrence among asylum seekers and refugees, particularly at time points when government assistance was ceased [17, 42, 45, 49, 52, 68, 69, 71, 76].

The challenges refugees face in accessing suitable housing reflect broader systemic issues in resettlement countries. Our findings suggest that housing policies often fail to account for the unique needs and vulnerabilities of refugee populations. Countries vary in the level of settlement support they provide to refugees for housing and other needs. Some offer comprehensive assistance, while others provide little to no help. Lack of settlement support can lead to difficulties in navigating housing systems and an inability to secure suitable housing. This can force refugees to move in search of affordable or appropriate accommodation. Forced moves, and dissatisfaction with housing can result in poor mental health. The inability to establish and maintain social connections, can create a sense of isolation and hinder integration, previous studies confirm this finding [79, 80].

In comparison, privately sponsored refugees in Canada, who received community-based support for housing, employment, and social integration, reported better mental health outcomes than their government-sponsored counterparts lacking equivalent assistance. These findings suggest that policy contexts significantly influence refugee integration into host societies, with long-term implications for both refugee populations and host communities. The association between housing instability and poor mental health outcomes highlights the critical need for more tailored housing support systems. This relationship may be bidirectional; poor mental health could also impede refugees’ ability to secure stable housing, creating a potential cycle of disadvantage.

Furthermore, we found that asylum seekers residing in reception centers, intentionally segregated from local communities, experienced an intensified sense of otherness and discrimination. This segregation was associated with diminished agency, lack of purpose, and limited social connections, collectively impeding integration and reducing psychological wellbeing. Previous research indicates that engagement in meaningful activities and the presence of supportive social connections can mitigate the negative emotional impacts of family separation and prolonged uncertainty [26]. Finding a job is considered one of the more meaningful activities. Allowing and supporting asylum seekers to seek employment would not only help with financial stability but also provide a sense of agency and control, improving mental health [81]. This underscores the need for a policy review to enable asylum seekers to work whilst awaiting the decision on their case. It also raises questions about the long-term impacts of forced destitution on asylum seeker mental health and wellbeing.

The importance of housing suitability extends beyond mere physical adequacy. Our findings indicate that culturally appropriate housing that meets family needs is crucial for mental wellbeing. This suggests that a one-size-fits-all approach to refugee housing is inadequate. The negative impact of unsuitable housing on mental health may be compounded by the stress of cultural adjustment, highlighting the need for housing solutions that facilitate, rather than hinder, the integration process. Supportive housing policies are central for successful integration of refugee populations [15, 82]. Service providers play an important role in creating a supportive environment for refugees. Refugees should be able to easily navigate services and access the settlement resources they need to thrive in their new communities. For example, to improve cultural competency housing services could be provided with training and resourcing for multilingual staff, interpreting and multilingual resources. Additionally, access to data systems that provide a more coordinated approach across settlement, housing and health sectors assists with information sharing decreasing the need for refugees to repeat their story helping reduce stressful experiences when engaging with services.

The significant impact of housing location on mental health and wellbeing underscores the importance of considering broader neighborhood characteristics in refugee resettlement. Our findings suggest that housing in areas with limited access to services, high crime rates, or lacking in community connections can exacerbate mental health issues. Previous research has shown that when refugees have connections to family and community, it promotes their sense of belonging and improves wellbeing. The ability to interact with the local community strengthens social connections providing additional social and emotional support as well as facilitating social cohesion and integration [79]. Suitable, stable, and well-located housing acts as a foundation for promoting wellbeing of refugee populations. This highlights the need for a more holistic approach to refugee resettlement that considers housing within the context of community resources and social networks.

The temporal aspects of housing support emerged as a critical yet often overlooked factor. Our findings suggest that the timing of housing interventions can significantly influence long-term mental health outcomes. Available evidence from a systematic review shows that prior exposure to housing disadvantage is consistently associated with poor mental health [83]. The duration of residency in the host country also plays a significant role in mental health outcomes. Refugees with longer stays often experience multiple relocations in search of more suitable accommodation, a pattern that can disrupt social connections and impede community integration. Studies exploring social networks found social connections to be highly beneficial in the search for housing, linking into information and opportunities within their community [84]. Asylum seekers experiencing protracted periods of uncertainty, characterised by unresolved asylum status, face significant impediments to future planning. This state of prolonged temporariness exerts a detrimental impact on their mental health and overall wellbeing[26, 85]. Our study confirmed previous findings showing that poor mental health was exacerbated if refugees had experiences of uncertainty or temporariness, like time spent in immigration detention, being on a temporary visa and living in a hostile political climate [14, 17, 42, 44, 46, 48, 49, 53, 55, 57, 58, 60, 64, 66, 75,76,77]. Refugees’ experiences can evolve over the course of their resettlement; this temporal aspect should be considered in resettlement policy.

Given that protracted periods of uncertainty are related to poor mental health and wellbeing the provision of stable housing could be one way to address this. Providing refugees and asylum seekers with a sense of security and safety serves as a foundation for rebuilding their lives and integrating into their new communities [22]. Successful integration, has a positive impact on mental health outcomes through access to employment, education, and income security, and opportunities to develop language skills thus building social connections [43,44,45,46, 57, 65, 67, 77]. These factors interact with housing and contribute to a sense of belonging and positive psychological wellbeing. This underscores the need for early, sustained housing support in the resettlement process. It also raises questions about the long-term impacts of initial housing experiences on refugee integration and wellbeing.

These findings collectively suggest that housing is not merely a physical determinant of health, but a complex social determinant that intersects with and influences other key factors such as employment and social support. The interrelated stressors of housing factors (access, suitability, and location), employment insecurity, and social support negatively impact refugees’ mental wellbeing and overall stability in host communities. Challenges in obtaining and retaining employment and housing instability reinforce “double precarity” [86], resulting in poor mental health. Inadequate income either from work or government support forces refugees to move further out creating further issues of access to jobs and services. The challenging process of securing accommodation, coupled with poor quality, overcrowded, and unhygienic housing conditions, that fails to meet refugees’ expectations of safe housing and improved living standards, leads to disappointment and frustration. The search for better quality accommodation resulting in constant moves disrupts social networks, increasing isolation and reducing wellbeing. Insecurity of tenure and lack of autonomy further contribute to poor mental health outcomes, as refugees feel disempowered and stressed about their living situations. The strong association between housing conditions and mental health outcomes implies that housing interventions could be a powerful tool for improving refugee mental health. However, the multifaceted nature of this relationship also suggests that effective interventions will require coordinated efforts across multiple sectors, including housing, health, and social services.

Moreover, our findings highlight a tension between current housing policies in many resettlement countries and the actual needs of refugee populations. Policies should consider both immediate and long-term housing needs to ensure comprehensive support throughout the resettlement process. With better coordination across housing and settlement sectors staged housing plans could be developed that evolve with refugees’ settlement journey, from initial accommodation to long-term, stable housing. The prevalence of housing issues across different national contexts suggests that this is a systemic issue requiring policy-level interventions. It also indicates that improving refugee housing conditions could have far-reaching benefits, not only for individual mental health but also for broader social integration and community cohesion.

A strength our study is the synthesis of evidence of housing domains related to mental health and wellbeing; it has provided insight into protective factors related to mental health. In strengthening our knowledge, it identifies opportunities for the application of future policy interventions. Much of the research focused on early post-arrival housing contexts and did not explore the effects on mental health and housing trajectories of longer-term, well-established refugees. There is a gap in our understanding of how housing impacts the mental health trajectories of refugees over the long term, and further research is needed to fully understand the relationship between the two. This is important because understanding the relationship over time can help develop targeted policy and interventions at crucial points, which could help protect refugee mental health, with significant implications for overall wellbeing and successful integration into society.

Our review has some limitations that should be considered in interpreting its findings. Our search was limited to English language papers, focused on refugees in specific settlement contexts rather than a broader category of forced migrants such as displaced people living within their own or a neighbouring country. Moreover, the academic literature may not provide an accurate reflection of the true landscape of practice in all settlement contexts. Due to the diversity of methodologies in the papers, we were not able to explore or draw conclusions about the impact of geographical or regional differences within or across countries. Further research into this would provide additional insights. A further limitation is in the definition of housing used—we adopted a wide definition, which meant the inclusion of studies with limited housing focus, which included those that only used a single-item measure relating to housing e.g. satisfaction with housing yes or no. Although asylum reception centres are a unique type of housing, and it is hard to compare them to other types of housing we included them so we could examine housing in different arrival contexts. As housing was our focus we did not include literature that explored homelessness, however we acknowledge that this is an extreme experience of lack of availability or affordability of housing. The inclusion of such studies may have provided further insights to mental health trajectories of refugees. Comparing mental health outcomes across varied study methods was difficult given the array of measurement tools and cultural backgrounds of the participants. The instruments used may not be culturally applicable or meaningful across all participant groups.