Many U.S. households face a growing challenge in meeting basic energy needs, and a new study suggests this struggle may carry mental health consequences. According to research published in JAMA Network Open, American adults who experienced any form of energy insecurity in the past year were more likely to report symptoms of depression and anxiety. The findings highlight energy insecurity as a potentially overlooked social factor that may shape psychological well-being and deserve greater attention in public health efforts.
While food and housing insecurity have long been considered important public health concerns, energy insecurity has received less attention. Yet, energy access is essential for basic daily functioning—from heating and cooling to food storage and medical device usage. The researchers wanted to understand whether households that struggle to afford energy or maintain safe indoor environments are also more likely to experience emotional distress.
“Millions of people in the United States experience energy insecurity, yet we know less about how this form of hardship affects their daily lives and well-being,” said study author Michelle Graff, an assistant professor at the Jimmy and Rosalynn Carter School of Public Policy at the Georgia Institute of Technology.
“My coauthor, Ther Aung, and I were especially interested in the health consequences of situations like being unable to pay an energy bill, keeping a home at unsafe temperatures, or cutting back on food or medicine to pay an energy bill. We hypothesized that these experiences would be linked to mental health challenges, including symptoms of depression and anxiety. This study allowed us to examine that relationship using nationally representative data.”
The study drew on responses from over 1.1 million adults, representing a weighted U.S. population of more than 187 million. The data came from the U.S. Census Bureau’s Household Pulse Survey, a national questionnaire that collects information on housing, income, food access, health, and other household conditions.
The researchers focused on three specific experiences to measure energy insecurity. These included being unable to pay an energy bill, keeping the home at unsafe or uncomfortable temperatures, and reducing or skipping essential expenses like food or medicine in order to pay energy costs. Respondents were classified as energy insecure if they reported experiencing any of these situations within the past year.
To assess mental health, the study used short validated screening tools for depression and anxiety. The depression scale included questions about loss of interest and feelings of sadness. The anxiety scale asked about persistent nervousness and difficulty controlling worry. Both tools used a cut-off score that signaled the likelihood of clinically significant symptoms.
The results showed that 43 percent of U.S. adults reported at least one form of energy insecurity. About one in five respondents had been unable to pay an energy bill, and nearly the same proportion kept their homes at uncomfortable or unsafe temperatures. One-third reported sacrificing other necessities to cover energy costs.
These experiences were not confined to a narrow segment of the population. Although lower-income households were more likely to experience energy insecurity, it was also present among a range of demographic groups, including renters, large families, and people with disabilities.
Adults who experienced energy insecurity were more likely to screen positive for anxiety and depression symptoms. Among those who reduced spending on essentials to pay for energy, nearly 39 percent reported anxiety symptoms, and 32 percent reported symptoms of depression. In contrast, those who did not experience that tradeoff reported much lower rates. These patterns remained even after adjusting for other social and demographic factors, including income, education, employment, food security, and housing stability.
When looking at energy insecurity more broadly, the researchers found that adults who experienced at least one of the three energy insecurity indicators had more than twice the odds of reporting symptoms of anxiety or depression compared to those who did not. Specifically, energy-insecure respondents had 2.29 times the odds of anxiety symptoms and 2.31 times the odds of depression symptoms. These findings were statistically significant and consistent across the study’s models.
“Nearly half of U.S. adults experienced at least one form of energy insecurity between 2022 and 2024,” Graff told PsyPost. “Even after accounting for other forms of hardship, individuals facing energy insecurity had higher odds of reporting symptoms of depression or anxiety. This suggests that energy insecurity has its own distinct and meaningful relationship with health.”
The researchers also examined other social determinants of health, such as food insecurity, housing instability, and unemployment. Each of these was also associated with higher odds of mental health symptoms. Among these, food insecurity had a particularly strong relationship with psychological distress. Still, energy insecurity appeared to be more common than either food insecurity or housing instability, suggesting that energy access may be an under-recognized factor in public health.
The study found that each component of energy insecurity may relate to mental health in distinct ways. For example, being unable to pay a bill may cause ongoing financial worry, while living in uncomfortable indoor conditions may create daily physical discomfort and emotional stress. Choosing between energy and basic needs such as food or medicine may intensify feelings of instability. Although these forms of hardship often co-occur, understanding how each one contributes to psychological symptoms could help shape more targeted solutions.
One finding that stood out was the apparent lack of mental health benefit associated with state-level protections against utility disconnection. Some states prohibit utility shutoffs during certain times of the year, but these policies did not appear to reduce symptoms of depression or anxiety. This may suggest that policy protections alone are not sufficient to relieve the broader stress associated with energy insecurity.
“Energy insecurity is a meaningful social determinant of health. While we often talk about food and housing insecurity, fewer people recognize energy as a basic necessity that shapes comfort, safety, and stress,” Graff said. “Our results show that energy insecurity is widespread and that it is associated with worse mental health outcomes among U.S. adults. Addressing energy insecurity is not just an economic issue; it is also a public health concern that needs to be further explored across multiple geographic and time dimensions.”
But there are some limitations. Since the study used cross-sectional data, it cannot determine causality. It’s possible that people experiencing anxiety or depression may be more likely to fall behind on energy bills. Additionally, the time frames for mental health symptoms and energy insecurity differed. The former focused on the past two weeks, while the latter asked about the past year. The study also relied on self-reported experiences, which may introduce bias or subjectivity, especially in assessing what counts as an unsafe indoor temperature.
Despite these limitations, the study offers a national snapshot of how energy access may relate to mental health. The findings suggest energy insecurity is both common and potentially impactful. The authors argue that recognizing energy insecurity as a distinct issue, rather than subsuming it under broader poverty measures, could help guide both public health and social policy responses.
“Sometimes, energy bills are treated as a secondary expense compared to rent or mortgage payments, but our study underscores that the two are not interchangeable,” Graff said. “Being able to afford your home does not guarantee you can afford to safely heat, cool, or power it. These should be treated as distinct policy issues.”
“We plan to continue investigating the scale, variation, and health consequences of energy insecurity. Our hope is that this work helps policymakers prioritize expanding energy assistance programs to meet demand and so households can both afford their homes and safely power them.”
The study, “Energy Insecurity and Mental Health Symptoms in US Adults,” was authored by Michelle Graff and Ther W. Aung.
