Previous Homelessness as a Risk Factor for Recovery from Serious Mental Illnesses

Utilization and Perceived Need for Mental Health Services Among Homeless Seniors

Homeless seniors confront distinct challenges regarding their mental health needs and service access. This study aims to illuminate the mental health landscape of homeless seniors by examining the prevalence of mental illness, utilization of mental health services, and perceived need for mental health care. The study comprises 177 homeless seniors in New York, NY. Findings indicate 10.2% experiencing depression, 10.2% schizophrenia, and 5.7% bipolar disorder. Despite high prevalence, there is a significant gap between diagnosed mental health conditions and service utilization, with only 50% of those with depression seeking care. Perceived need for mental health services emerges as a critical aspect of the study, with over half of those suffering from depression (61.1%; n = 11), PTSD (75%; n = 3), schizophrenia (77.8%; n = 14), and other mental illnesses (100%; n = 1) expressing a need for mental health care. Also, mental health conditions, loneliness, and levels of social support play significant roles in a need for mental health services.

The Effects of Traumatic Events on Mental Health Among Women Experiencing Homelessness: A Longitudinal Study

In this longitudinal study, we aim to evaluate the prevalence and impact of interpersonal and non-interpersonal traumatic events among women experiencing homelessness in Madrid (Spain) (N  =  136). The information was collected through a structured interview and standardized instruments at baseline and at a 12-month follow-up. The most prevalent events were physical assaults, intimate partner violence, and severe illnesses or accidents. Path analysis revealed that personal and non-interpersonal traumatic events had direct effects on mental health, but also had differential indirect effects. Greater efforts are needed to address the effects of various types of potentially traumatic events and to design effective trauma-informed interventions for women experiencing homelessness.

Periods of Homelessness Linked to Higher VACS Index Among HIV-Positive People Who Use Drugs

We sought to evaluate the impact of homelessness on HIV disease progression among people who use unregulated drugs (PWUD) living with HIV and test if this association was mediated by adherence to antiretroviral therapy (ART). We applied general linear mixed-effects modeling to estimate the longitudinal relationship between homelessness and the Veterans Aging Cohort Study (VACS) Index, a validated measure of HIV disease progression that predicts all-cause mortality, among a prospective cohort of PWUD. In a longitudinal model adjusted for ART adherence, homelessness was significantly associated with increased VACS Index scores and 16% of the association was mediated by ART adherence. These findings indicate that homelessness was a significant risk factor for HIV disease progression and this association was marginally mediated by ART adherence. Future studies are needed to quantify the other mechanisms (e.g., food insecurity, mental health) by which homelessness increases mortality risk among PWUD living with HIV.

[Associations of mental illness and homelessness: results of a secondary data analysis at a Berlin health center for the homeless]

Hintergrund

Wohnungslosigkeit ist Ausdruck und Folge einer komplexen Problemlage, die die medizinischen und sozialen Versorgungssysteme in Deutschland vor große Herausforderungen stellt. Etwa 3 Viertel der wohnungslosen Menschen leiden an psychischen Erkrankungen. Ziel dieser Studie war es, Assoziationen zwischen psychischen Erkrankungen und Wohnungslosigkeit zu untersuchen.

Material und Methoden

Es wurde eine Sekundärdatenanalyse von Patient*innendokumentationen eines Berliner Gesundheitszentrums für Obdachlose durchgeführt. In die explorative Studie eingeschlossen wurden Daten von 112 wohnungslosen Patient*innen, die dort zwischen den Jahren 2006 und 2020 versorgt wurden.

Ergebnisse

Bei 84,9 % der Patient*innen lagen psychische Erkrankungen bereits vor dem Beginn der Wohnungslosigkeit vor. Assoziiert mit einem frühen Beginn der Wohnungslosigkeit waren die Faktoren niedrige Schulbildung sowie Drogenabusus. Eine lange Dauer der Wohnungslosigkeit war mit den Faktoren Alkoholabusus sowie Haftaufenthalte assoziiert. Jede erneute Episode der Straßenobdachlosigkeit war mit einer durchschnittlichen Verlängerung der Dauer der Wohnungslosigkeit um 7,9 Monate assoziiert.

Diskussion

Da psychische Erkrankungen wichtige Einflussfaktoren für die Entstehung und Aufrechterhaltung von Wohnungslosigkeit sind, sollten vermehrt präventive Strategien sowie spezialisierte Angebote für diese vulnerable Gruppe geschaffen werden. Insbesondere wiederkehrende Episoden der Straßenobdachlosigkeit sollten so weit wie möglich verhindert werden. Der Zusammenhang zwischen Inhaftierungen und Wohnungslosigkeit legt nahe, dass eine intensivere Begleitung bei der Wiedereingliederung nach Haftentlassung erforderlich ist.

Risk and Resilience Factors for Youth Homelessness in Western Countries: A Systematic Review

OBJECTIVES

The experience of homelessness for young people can affect social, emotional, and physical development, resulting in poorer physical and mental health outcomes. To reduce rates of youth homelessness, a better understanding of both risk and resilience is needed to inform future intervention development. This article presents a systematic review of published research reporting risk or resilience factors related to homelessness among young people in Western countries.

METHODS

After thorough examination for inclusion criteria, 665 abstracts of peer-reviewed quantitative studies of risk or resilience factors for homelessness among young people (ages 0-25) that included an adequate comparison group (e.g., not homeless) were selected. After abstract and full-text screening, 16 articles were reviewed. A primary prevention framework was used to create an explanatory model for the onset of homelessness using risk and resilience factors.

RESULTS

Common risk factors for youth homelessness included difficulties with family, mental health or substance use problems, a history of problem behaviors, a history of foster care, homelessness as a child, and running away. Common protective factors included a supportive family, a college education, and high socioeconomic status. Findings were integrated into a provisional developmental model of youth homelessness risk. Clinical implications of the model for service development are discussed, and a model for monitoring homelessness risk and resilience factors is proposed.

CONCLUSIONS

Factors affecting homelessness risk among youths and adults differ, with family, foster care, and schooling playing a much more important role among youths. Findings highlight opportunities for youth homelessness prevention strategies and monitoring.

Multivariable modelling of factors associated with criminal convictions among people experiencing homelessness and serious mental illness: a multi-year study

People experiencing homelessness and serious mental illness exhibit high rates of criminal justice system involvement. Researchers have debated the causes of such involvement among people experiencing serious mental illness, including what services to prioritize. Some, for example, have emphasized mental illness while others have emphasized poverty. We examined factors associated with criminal convictions among people experiencing homelessness and serious mental illness recruited to the Vancouver At Home study. Participants were recruited between October 2009 and June 2011. Comprehensive administrative data were examined over the five-year period preceding study baseline to identify risk and protective factors associated with criminal convictions among participants (n = 425). Eight variables were independently associated with criminal convictions, some of which included drug dependence (RR = 1.53; P = 0.009), psychiatric hospitalization (RR = 1.44; P = 0.030), an irregular frequency of social assistance payments (compared to regular payments; 1.75; P < 0.001), and prior conviction (RR = 3.56; P < 0.001). Collectively, findings of the present study implicate poverty, social marginalization, crises involving mental illness, and the need for long-term recovery-oriented services that address these conditions to reduce criminal convictions among people experiencing homelessness and serious mental illness.

The Role of Stressful Life Events among Women Experiencing Homelessness: An Intragroup Analysis

The aim of this study is to examine stressful life events (SLEs) among homeless women and how SLEs were related to patterns and trajectories of homelessness. Specifically, the study aimed to replicate and build upon by Muñoz et al. (2005) by using cluster and discriminant analysis in a sample of 116 homeless women. The sample was classified based on SLEs, and the relationship between the resulting subgroups and sociodemographic characteristics, homeless trajectories, physical and mental health, and social support was examined. The results suggest that the three-cluster solution was theoretically and structurally meaningful: (a) the "Shorter homelessness trajectories and best health and mental health" subgroup was characterized by low levels of SLEs, a shorter homeless trajectory, lower prevalence of physical and mental health problems, and lower rates of alcohol and substances consumption; (b) the "Early onset of homelessness and poorer health and poorer mental health" subgroup was characterized by a higher prevalence of childhood and adolescence SLEs, an early onset of homelessness and greater chronification, mental health problems, and alcohol consumption; and (c) the "Chronic homelessness and poorest health and mental health" subgroup was mainly characterized by a higher prevalence of typically adulthood SLEs, as well as some SLEs that may be unique to women, a greater number of periods of homelessness, physical health problems, disabilities, and substance misuse. Increased knowledge about the different subgroups and trajectories of homeless women, as well as their specific characteristics and needs, will help us design social services and policies sensitive to all these differences.

Trauma and healing in the underserved populations of homelessness and corrections: Forgiveness Therapy as an added component to intervention

The purpose of this article is to begin applying the principles of the psychology of forgiveness to people who are without homes and people who are in prisons. A review of the literature shows trauma for both groups. When the trauma is caused by unjust treatment by others, then excessive anger can result, compromising one's psychological and physical health. We review the interventions that have been offered for those without homes and the imprisoned to examine which existing programmes address such anger. Forgiveness Therapy, although untried in these two settings, may be one beneficial approach for substantially reducing unhealthy anger. Forgiveness interventions have shown a cause-and-effect relationship between learning to forgive and overcoming psychological compromise such as strong resentment and clinical levels of anxiety and depression. The literature review here suggests that forgiveness therapy for those without homes and the imprisoned may be a new and important consideration for ameliorating anger and aiding in a changed life pattern.

Risk of mental ill-health among homeless women in Madrid (Spain)

Several studies have revealed that homeless people suffering from mental health problems are more vulnerable than homeless without those mental health problems. Nevertheless, there is a lack of evidence describing the real circumstances of homeless women. This paper explores the differences between homeless women at high risk of mental ill-health compared with those who do not present this risk. The sample consisted of a group of 120 homeless women in Madrid (Spain). For this study, we collected data on background information (trajectory of homelessness and stressful life events experienced) and current aspects (living conditions, physical health, and social support). The risk of mental ill-health has been measured by the short version of the General Health Questionnaire (GHQ-28). The results showed that homeless women with higher risk of mental ill-health had become homeless at a younger age, had experienced more stressful life events in their lives, had a poorer physical health, felt less happy, had less social support, and a greater feeling of loneliness when compared with homeless women who did not present risk of mental ill-health. Improving knowledge about the risk of mental ill-health among homeless women is essential for the design of specific psychological interventions within this population.

Patient Characteristics Predicting Abstinence in Substance Use Disorder Patients With Comorbid Mental Disorders

Objective: Patients with both a substance use disorder and comorbid mental disorder, or dual diagnosis, form a heterogeneous group with complex treatment needs. Dual diagnosis patients have worse treatment outcomes compared to patients with substance use disorders alone. There is a lack of research focusing on predictors of treatment outcome in dual diagnosis patients. The aim of this study was to identify patient characteristics associated with abstinence in dual diagnosis patients. Methods: In a cohort design, we examined associations between baseline demographic and clinical patient characteristics and abstinence at 14-month follow-up in 102 dual diagnosis patients undergoing treatment in an addiction-psychiatry service in Amsterdam. Immigration, employment, housing, age, emotion regulation, psychiatric symptoms, and frequency and nature of substance abuse were examined as possible predictors of abstinence. Patients were considered abstinent if they had refrained from any substance use in the 30 days prior to the follow-up assessment, as measured with the Timeline Follow Back method. Results: In a multiple logistic regression analysis corrected for treatment utilization, being a first- or second-generation immigrant was associated with lower odds of abstinence (OR = 5.13; 95% CI [1.63, 18.18]), as well as higher levels of depressive and anxiety symptoms at baseline (OR = 0.90; 95% CI [0.81, 0.99]). Gender, age, housing, employment, emotion regulation, frequency and nature of substance abuse, and the psychiatric symptoms positive symptoms, negative symptoms, and manic excitement and disorganization did not show a significant relationship with abstinence. Conclusions: The results indicate that being a first- or second-generation immigrant and experiencing more symptoms of depression and anxiety are predictive of non-abstinence. Attention for linguistic and cultural congruence of dual diagnosis treatments may enhance abstinence in immigrants. Additionally, addressing symptoms of depression and anxiety in dual diagnosis treatment may be beneficial for the maintenance of abstinence. More research is needed on factors influencing treatment success in dual diagnosis patients.

Correlates of loneliness in older persons living with HIV

Loneliness poses a significant risk for morbidity and mortality in the context of older adulthood. Research shows that older persons living with HIV (PLWH) often face increased and complex vulnerability in terms of physical and psychosocial needs which may promote loneliness. The current study sought to identify correlates of loneliness in a sample of 146 older PLWH (age ≥50) recruited from an outpatient HIV clinic in Atlanta, GA. Participants completed a survey on loneliness, depression, HIV-related stigma, social network size, HIV-disclosure status, disease burden, and demographics. HIV biomarkers were abstracted from electronic medical records. Participants were predominantly male (60%) and African American (86%). Twelve percent (n = 17) reported past homelessness/unstable housing. Multivariable modeling revealed that depression and HIV-related stigma explained 41% of the variance in loneliness, above and beyond the effects of past homelessness/unstable housing and disease burden (R ²= 0.41, F(7, 138) = 13.76, p < .001). Findings suggest that targeting HIV-related stigma and depression may reduce loneliness in older PLWH, but more studies are needed to elucidate causal pathways. A greater understanding of the mechanisms by which loneliness affects health among older PLWH could help better inform efforts to improve health in this patient population.

Intrapersonal and social-contextual factors related to psychological well-being among youth experiencing homelessness

Homeless youth are adolescents and young adults who do not have stable dwellings but instead live on the streets, in shelters, or in other unstable situations. Although researchers have begun examining well-being among this population, little is known about components of well-being that are relevant to homeless youth or which factors predict differences in well-being. This study examined psychological well-being and its associations with demographic characteristics, intrapersonal factors (mental health, optimism, and self-esteem), and social-contextual factors (social support, sense of community, and empowerment) among 100 youth experiencing homelessness. All of the intrapersonal and social-contextual variables were associated with well-being at the bivariate level. In the full regression model, only self-esteem and psychological distress remained significant. Findings inform future research and program development at homeless service centers.

Predictors of Mental Health Recovery in Homeless Adults with Mental Illness

For people with mental illness, experiences of homelessness can complicate mental health recovery processes. This study used longitudinal data from a randomized controlled trial of housing first (HF) to examine predictors of recovery among homeless people with mental illness. Findings showed that health and community predictors were most strongly associated with mental health recovery. Receipt of HF did not have any effect on changes in recovery scores at follow-up. Overall, the findings suggest that interventions aimed at preventing chronic homelessness, strengthening social networks and community involvement, and providing case management services will facilitate mental health recovery.

On the Frontlines: Perspectives of Providers Working With Homeless Women

Homeless service providers (HSPs) are on the frontlines of caring for the most vulnerable populations to help them navigate out of homelessness and access health and social services. The purpose of this qualitative study was to understand, from the perspectives of HSPs ( N = 19; age range, 27-58 years; SD = 10.37), their account and experiences in working with homeless women (HW), and opportunities for intervention development and integration. Five focus groups were conducted with HSPs in Central City East, Los Angeles. Five main themes emerged which included (a) seeking to establish a therapeutic relationship, (b) internal and external drivers of change, (c) navigating systems, (d) targeted outreach, and (e) program design recommendations. Within these themes, individual- and structural-level characteristics emerged. To better equip HW, HSPs' perspectives need to be considered in future interventions to aid women traverse homelessness.

How Feasible is Multiple Time Point Web-Based Data Collection with Individuals Experiencing Street Homelessness?

Three barriers investigators often encounter when conducting longitudinal work with homeless or other marginalized populations are difficulty tracking participants, high rates of no-shows for follow-up interviews, and high rates of loss to follow-up. Recent research has shown that homeless populations have substantial access to information technologies, including mobile devices and computers. These technologies have the potential both to make longitudinal data collection with homeless populations easier and to minimize some of these methodological challenges. This pilot study's purpose was to test whether individuals who were homeless and sleeping on the streets-the "street homeless"-would answer questions remotely through a web-based data collection system at regular "follow-up" intervals. We attempted to simulate longitudinal data collection in a condensed time period. Participants (N = 21) completed an in-person baseline interview. Each participant was given a remotely reloadable gift card. Subsequently, weekly for 8 weeks, participants were sent an email with a link to a SurveyMonkey questionnaire. Participants were given 48 h to complete each questionnaire. Data were collected about life on the streets, service use, community inclusion, substance use, and high-risk sexual behaviors. Ten dollars was remotely loaded onto each participant's gift card when they completed the questionnaire within the completion window. A substantial number of participants (67% of the total sample and 86% of the adjusted sample) completed at least seven out of the eight follow-up questionnaires. Most questionnaires were completed at public libraries, but several were completed at other types of locations (social service agencies, places of employment, relative/friend/acquaintance's domiciles, or via mobile phone). Although some of the questions were quite sensitive, very few participants skipped any questions. The only variables associated with questionnaire completion were frequency of computer use and education-both positive associations. This pilot study suggests that collecting longitudinal data online may be feasible with a subpopulation of persons experiencing homelessness. We suspect that participant follow-up rates using web-based data collection methods have the potential to exceed follow-up rates using traditional in-person interviews. If this population of persons experiencing street homelessness can be successful with this method of data collection, perhaps other disenfranchised, difficult-to-track, or difficult-to-reach populations could be followed using web-based data collection methods. Local governments are striving to decrease the "digital divide," providing free or greatly discounted wi-fi connectivity as well as mobile computer lab access to low-income geographic areas. These actions, in combination with increased smart phone ownership, may permit vulnerable populations to connect and communicate with investigators.

A Longitudinal Study of Predictors of Housing Stability, Housing Quality, and Mental Health Functioning Among Single Homeless Individuals Staying in Emergency Shelters

The current study examined risk and resilience factors at multiple levels that affect homeless individuals' ability to exit homelessness and achieve housing stability. It also examined the relationship between housing status, housing quality and mental health functioning. The methodology is a longitudinal study of single homeless individuals staying in emergency shelters in a medium-sized Canadian city who were followed for a 2 year period. Data were collected from participants at a baseline interview when they were homeless and at a 2-year follow-up. There were 329 participants interviewed at baseline and 197 (59.9%) participants interviewed at follow-up. Results from a structural equation modelling analysis found that having interpersonal and community resources were predictive of achieving housing stability. Specifically, having a larger social support network, access to subsidized housing, and greater income was related to achieving housing stability. On the other hand, having a substance use problem was a risk factor associated with a failure to achieving housing stability. Being female, feeling personally empowered, having housing that is perceived of being of higher quality were directly predictive of mental health functioning at follow-up. Findings are discussed in the context of previous research and their policy implications.