Originally published on Time.

Months of such uncertainty can have real consequences. In order to keep a roof over their heads, families may compromise on food, energy and health care bills, experts say. “These things not only take a physical toll, but they take a mental health toll,” says Dr. Megan Sandel, an associate professor of pediatrics at the Boston University School of Medicine.

In a 2018 study published in the journal Pediatrics surveying more than 22,000 U.S. families, Sandel and other researchers found that those who had recently been behind on rent faced quadruple rates of food insecurity, twice the rate of maternal depression, and higher rates of child hospitalizations and developmental delays compared to those with stable housing. During the current recession and unemployment crisis, researchers think two or three times as many people may be feeling those effects. Indeed, recent studies have found that three times as many Americans are experiencing depression during the COVID-19 pandemic than beforehand.

“It’s no longer just a low-income family problem,” says Sandel. “This is something that is hitting more and more middle-income families.” And like so many other effects of the coronavirus pandemic, housing insecurity disproportionately affects households of color, with Black and Hispanic households reporting far higher rates of missed rent payments compared to white households, according to early June reports from the U.S. Census Bureau.

These conditions can have long-term consequences for young children especially. Developmental delays caused by persistent childhood stresses can have enormous effects along the course of a person’s life, reducing their likelihood to graduate high school or their lifetime earning potential. “This is a critical window of time,” Sandel says. “Being able to have that stable, decent, affordable home that allows kids to reach their potential is a public health emergency.”