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Adams CS, Roach CA, Berini CR, Cooper NA, Kahle RW, Player MS, Diaz VA. Health Needs Assessment of Unhoused Youth in Charleston, South Carolina. FAMILY & COMMUNITY HEALTH 2024; 47:280-287. [PMID: 39158174 DOI: 10.1097/fch.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
BACKGROUND Over 35 000 youth experience homelessness on any given night in the United States (US). Unhoused youth experience unique physical and mental health challenges and face barriers in every social determinant of health (SDoH), which may be amplified in the LGBTQ+ population. OBJECTIVE The objective of this study was to define characteristics of the unhoused youth population and their utilization of healthcare to inform programs to meet their needs. METHODS Secondary analysis of data from the College of Charleston's YOUth Count survey was conducted, focusing on health-related characteristics, challenges, healthcare utilization, and SDoH of youth aged 18 to 25 experiencing homelessness in Charleston, SC. RESULTS Almost three-quarters of respondents (74.6%) reported mental health challenges and 35% reported physical health challenges. A significantly higher proportion of those who engaged in survival sex were LGBTQ+ . More than half (68.4%) visited the emergency department (ED) and 29.3% were admitted to the hospital in the past 12 months. Housing status, safety, food insecurity, sexual orientation, prior foster care, and survival sex were all significantly associated with ED utilization. Housing status and survival sex were significantly associated with hospital admission. CONCLUSIONS Addressing SDoH is essential to improving health outcomes and healthcare utilization among unhoused youth, particularly in the LGBTQ+ population.
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Affiliation(s)
- Cristin S Adams
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina (Dr Adams, Mss Berini and Cooper, and Drs Player and Diaz); Department of Family Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina (Dr Roach); and Kahle Strategic Insights, Charleston, South Carolina (Dr Kahle)
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Ermita KC, Rosenthal DM. Exploring Mental Health Services for Youth Experiencing Homelessness in East Asian Pacific Regions: A Systematic Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:864. [PMID: 39062313 PMCID: PMC11275148 DOI: 10.3390/children11070864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/30/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Youth experiencing homelessness (YEH) in East Asian Pacific (EAP) regions represent one of the most at-risk populations due to cultural and geographical factors. Effective mental health interventions, primarily researched in Western contexts, may not fully apply to YEH in EAP. Their lack of stable shelter, disrupted social networks, and limited access to mental health services elevate their susceptibility to adverse mental health, making urgent interventions essential to address their needs. OBJECTIVE The objective of this study is to explore and systematically search the types of mental health services and interventions available for YEH in EAP and their impact on overall quality of life and wellbeing. METHODS Electronic databases (e.g., Medline, PsycINFO, PubMed, Scopus) were systematically searched (publication dates between 1 January 1990 and 13 May 2023), as well as additional online resources specific to homelessness. Articles were screened, and a critical appraisal assessed the quality of the included studies. RESULTS Eight studies with different interventions were identified in Indonesia (n = 2), Malaysia (n = 1), South Korea (n = 3), and the Philippines (n = 1). These were thematically clustered into six categories: art, cognitive behavioural therapy, life skills education, resilience enhancement, family strengthening, and government interventions/services. CONCLUSIONS This review highlights effective mental health interventions' positive impact on YEH mental health outcomes and quality of life in EAP, stressing the urgent need to implement socio-culturally sensitive services. Future research should address knowledge gaps through comprehensive studies covering diverse EAP regions and populations, prioritising socio-culturally specific psychological measures.
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Affiliation(s)
- Kimberley Cortez Ermita
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK;
| | - Diana Margot Rosenthal
- UCL Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK;
- UCL Collaborative Centre for Inclusion Health, University College London, London WC1E 7HB, UK
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY 10003, USA
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Armoon B, Mohammadi R, Griffiths MD. The Global Prevalence of Non-suicidal Self-injury, Suicide Behaviors, and Associated Risk Factors Among Runaway and Homeless Youth: A Meta-analysis. Community Ment Health J 2024; 60:919-944. [PMID: 38451378 DOI: 10.1007/s10597-024-01245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
A meta-analysis was performed to determine pooled prevalence of non-suicidal self-injury (NSSI), suicide behaviors (including ideation, attempts), and associated risk factors among runaway and homeless youth (RHY). The databases PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant studies published from January 1995 to May 2023. Initially, 8465 papers were screened, resulting in 69 included studies. The results showed that among RHY, lifetime prevalence rates were 42% for NSSI, 38% for suicidal ideation, and 27% for suicide attempts. Lifetime prevalence of NSSI and suicide behaviors was higher among adolescent minors (aged 12-17 years) compared to young adults (aged 18-24 years). Also, NSSI and suicide behaviors were associated with having a childhood history of physical and sexual abuse. Developing an impactful community-based suicide prevention campaign tailored for RHY appears warranted. Peer groups and mentorship programs would provide invaluable support for young individuals, as supportive friendships protect against NSSI.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
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Lamontagne SJ, Zabala PK, Zarate CA, Ballard ED. Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks. Neurosci Biobehav Rev 2023; 153:105361. [PMID: 37595649 PMCID: PMC10592047 DOI: 10.1016/j.neubiorev.2023.105361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/22/2023] [Accepted: 08/12/2023] [Indexed: 08/20/2023]
Abstract
Although suicide is a leading cause of preventable death worldwide, current prevention efforts have failed to substantively mitigate suicide risk. Suicide research has traditionally relied on subjective reports that may not accurately differentiate those at high versus minimal risk. This narrative review supports the inclusion of objective task-based measures in suicide research to complement existing subjective batteries. The article: 1) outlines risk factors proposed by contemporary theories of suicide and highlights recent empirical findings supporting these theories; 2) discusses ongoing challenges associated with current risk assessment tools and their ability to accurately evaluate risk factors; and 3) analyzes objective laboratory measures that can be implemented alongside traditional measures to enhance the precision of risk assessment. To illustrate the potential of these methods to improve our understanding of suicide risk, the article reviews how acute stress responses in a laboratory setting can be modeled, given that stress is a major precipitant for suicidal behavior. More precise risk assessment strategies can emerge if objective measures are implemented in conjunction with traditional subjective measures.
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Affiliation(s)
- Steven J Lamontagne
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Paloma K Zabala
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, Division of Intramural Research Programs, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Kim HR, Moon SH. Predictors for runaway behavior in adolescents in South Korea: national data from a comprehensive survey of adolescents. Front Psychiatry 2023; 14:1195378. [PMID: 37663596 PMCID: PMC10469315 DOI: 10.3389/fpsyt.2023.1195378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Background Runaway behavior is reported to impede the growth, mental health development, and social adjustment of adolescents. Exposure to harmful media causes problematic behaviors in adolescents, sometimes inducing them to run away from home. Methods This study examined the factors influencing adolescents' runaway behavior. Utilizing the data of 11,354 adolescents from the Survey of Media Usage and Harmful Environment among Adolescents, a hierarchical logistic regression analysis was conducted using the SPSS 24.0 program. Results The significant predictors of runaway behavior were the grade of the adolescent, deviant behaviors (drinking, smoking), autonomous control ability, relationship with family, and harmful media (p < 0.001). This regression model explained 13.1% of the variance in runaway behavior. A significant outcome of this study is that harmful media was identified as one of the factors affecting adolescents' runaway behavior. Adjusted OR and 95% CI of harmful media was 1.23 (1.10-1.38). Conclusion This study showed that individual, family, social factors, and harmful media influence adolescents' runaway behavior. The results emphasize the importance of health teachers and the need for early intervention programs, for the identification and prevention of risk factors for adolescents' runaway behavior.
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Affiliation(s)
- Hyung Ran Kim
- Department of Health Insurance Review and Assessment Service, Kwangju Christian Hospital, Gwangju, Republic of Korea
| | - So-Hyun Moon
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Republic of Korea
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Yohannes K, Gezahegn M, Birhanie M, Simachew Y, Moges A, Ayano G, Toitole KK, Mokona H, Abebe L. Suicidality and homelessness: prevalence and associated factors of suicidal behaviour among homeless young adults in Southern Ethiopia. BMC Psychol 2023; 11:121. [PMID: 37072864 PMCID: PMC10111304 DOI: 10.1186/s40359-023-01162-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Research indicates that homelessness is associated with an increased risk of suicide. While street homelessness is a global problem, it is a disproportionately serious concern in low- and middle-income countries such as Ethiopia. Despite their high risk of suicidal thoughts and attempts, there has been limited research on this subject among homeless young people in Ethiopia. Therefore, we assessed the prevalence and factors contributing to suicidal behaviour among homeless young people in the southern region of this country. METHODS We conducted a community-based cross-sectional study from 15 June to 15 August 2020 involving 798 homeless young adults in four southern Ethiopian towns and cities. The Suicide Behaviour Questionnaire-Revised (SBQ-R) was used to assess suicidal behaviour. Data were coded and entered into Epi-Data version 7 and analysed using SPSS version 20. We conducted a multivariable logistic regression analysis to identify factors associated with suicidal behaviour. Variables with a p-value of < 0.05 were considered statistically significant. An adjusted odds ratio with a 95% confidence interval was determined to indicate the association's strength. RESULTS The overall prevalence of suicidal behaviour among young homeless individuals was 38.2% (95% CI: 34.8%, 41.5%). The lifetime prevalence of suicidal ideation, planning and attempt was 10.7% (95% CI: 8.6-12.9%), 5.1% (95% CI: 3.6-6.6%) and 3% (95% CI: 1.9-4.3%), respectively. A longer duration of homelessness (1-2 years) (AOR = 2.244, 95% CI: 1.447-3.481), stressful life events (AOR = 1.655, 95% CI: 1.132-2.418) and the stigma associated with homelessness (AOR = 1.629, 95% CI: 1.149-1.505) were significantly associated with suicidal behaviour. CONCLUSION The results of our study indicate that suicide is a serious public health problem among homeless young people in southern Ethiopia. We have found associations between suicidal behaviour and stressful events, homelessness lasting for one to two years and stigma. Our study suggests that policymakers and programme planners need to develop a strategy for preventing, detecting and managing suicidal behaviour among street-dwelling homeless young adults, a vulnerable and understudied population. A community-based suicide prevention campaign is also essential for street-dwelling homeless young people in Ethiopia.
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Affiliation(s)
- Kalkidan Yohannes
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Melkamu Gezahegn
- Department of Sociology, Institute of Behavioural science, Dilla University, Dilla, Ethiopia
| | - Mekonnen Birhanie
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Yilkal Simachew
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Awoke Moges
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
- School of Population Health, Curtin University, Perth, WA, Australia
| | | | - Hirbaye Mokona
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
- Department of Psychiatry, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lulu Abebe
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Rhoades H, Petry L, Schrager SM, Goldbach J. Couch-Surfing and Mental Health Outcomes among Sexual Minority Adolescents. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2022; 33:186-197. [PMID: 38911355 PMCID: PMC11189619 DOI: 10.1080/10530789.2022.2141869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/20/2022] [Indexed: 06/25/2024]
Abstract
Background Sexual minority youth are at more than twice the risk of experiencing homelessness than their peers and both sexual minority youth and youth experiencing homelessness have disproportionate risk for mental health disorder symptoms. Couch-surfing is a common form of homelessness experienced by youth, but research on the relationship between couch-surfing and mental health outcomes, especially among sexual minority adolescents (SMA), is limited. Methods Utilizing a sample of 2,558 SMA (14-17 years old) recruited via social media and respondent-driven sampling, this study explores the relationship between different forms of homelessness (exclusive couch-surfing vs. multiple types of homelessness) and symptoms of depression, anxiety, suicidal ideation, and suicide attempt. Results Nearly 21% of participants experienced any homelessness in their lifetime, with 14% reporting exclusive couch-surfing. All forms of homelessness were associated with large increases in symptoms of anxiety, depression, suicidal ideation and suicide attempt. Conclusion Homelessness - primarily couch-surfing - is a common experience for SMA in this sample. All forms of homelessness - including exclusive couch-surfing - were associated with large increases in depression, anxiety, suicidal ideation, and suicide attempt, emphasizing the importance of services that are available to couch-surfing young people and responsive to the needs of sexual minority adolescents.
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Affiliation(s)
- Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Laura Petry
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Sheree M Schrager
- California State University, Dominguez Hills, Carson, California, USA
| | - Jeremy Goldbach
- The Brown School, Washington University in St Louis, St. Louis, Missouri, USA
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Sakai-Bizmark R, Kumamaru H, Estevez D, Bedel LEM, Marr EH, Mena LA, Kaplan MS. Association between suicide attempt and previous healthcare utilization among homeless youth. Suicide Life Threat Behav 2022; 52:994-1001. [PMID: 35765815 DOI: 10.1111/sltb.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/14/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to examine the association between prior emergency department (ED) visit or hospitalization and subsequent suicide attempt among homeless youth aged 10-17 years old. METHODS With New York statewide databases, a case-control design was conducted. Cases and controls were homeless patients with an ED visit or hospitalization due to suicide attempt (cases) or appendicitis (controls) between April and December. We examined ED and inpatient records for 90 days prior to the visit for suicide attempt or appendicitis. The primary exposure variable was prior healthcare utilization for any reason other than the following four reasons: mental health disorder, substance use, self-harm, and other injuries. Multivariable logistic regression models, with year fixed effect and hospital random effect, were used. RESULTS A total of 335 cases and 742 controls were identified. Cases had lower odds of prior healthcare utilization for any reason other than the four reasons listed above. (adjusted Odds Ratio [aOR]: 0.53, p-value = 0.03). CONCLUSIONS The association between prior healthcare utilization and decreased risk of suicide attempt among homeless youth may be due to comprehensive care provided during healthcare utilization. It may also reflect the presence of a social network that provided a protective effect.
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Affiliation(s)
- Rie Sakai-Bizmark
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.,Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA.,David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Lauren E M Bedel
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.,Network for Excellence in Health Innovation (NEHI), Boston, Massachusetts, USA
| | - Emily H Marr
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Laurie A Mena
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Mark S Kaplan
- The Luskin School of Public Affairs, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Straka K, Blacketer AR, Martinez RL, Glover A, Winiarski DA, Karnik NS, Schueller SM, Zalta AK. Rates and correlates of well-being among youth experiencing homelessness. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3746-3759. [PMID: 35460583 PMCID: PMC9464689 DOI: 10.1002/jcop.22869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Mental health concerns have been well studied among youth experiencing homelessness, yet few studies have explored factors that contribute to well-being in this population. The current cross-sectional study examined rates and correlates of well-being among youth experiencing homelessness. This is a descriptive, secondary analysis of the baseline data from a clinical intervention study. Ninety-nine youth (aged 16-25) who were experiencing homelessness were recruited in Chicago. Approximately 40% of the sample reported average or above average well-being relative to existing benchmarks. Having medical insurance, a mobile phone, and a history of more severe childhood trauma were unique cross-sectional predictors of worse well-being (all ps < 0.034). A significant portion of our sample experienced well-being. Having access to certain resources may be counterintuitive indicators of poorer well-being among youth experiencing homelessness, perhaps because they are indicators of greater need or increased social comparison among these youth.
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Affiliation(s)
- Kelci Straka
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Alexis R. Blacketer
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Ramona L. Martinez
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Angela Glover
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Dominika A. Winiarski
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Niranjan S. Karnik
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Stephen M. Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Alyson K. Zalta
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
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Lurgain JG, Eyber C. Understanding female adolescent 'runaways' and the implications of their decisions in Tigray, northern Ethiopia. CHILD ABUSE & NEGLECT 2022; 129:104125. [PMID: 31416600 DOI: 10.1016/j.chiabu.2019.104125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 06/19/2019] [Accepted: 07/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study aimed to understand the main factors influencing the decision of adolescent girls to run away from home in Tigray, northern Ethiopia, and to explore the social and cultural construction of female adolescent runaways in this region. METHOD In-depth qualitative interviews with seven runaway adolescent girls and six women married at an early age (11-16 years old) were conducted in Wukro and Mekelle in Tigray to investigate why the girls escaped from home and how communities responded to these decisions. RESULTS Findings suggest that the immediate trigger that led all the young participants to run away was to escape an arranged marriage, except in one 'romantic' elopement case. Individual and structural factors, such as child maltreatment and educational aspirations, and new family law respectively, also contributed to the decision to escape. CONCLUSION Adolescent runaways seem to be ignored or normalized within the community in Tigray and, in particular, by its public institutions. This may explain why there are limited services for runaway girls, such as shelters and other forms of support. This lack of social protection structures has left these girls unprotected and exposed to a range of risks, such as early and unwanted pregnancies, labor exploitation, dropping out of school, and transactional sex. To date, this phenomenon of adolescent runaways has remained an invisible issue in Tigray as runaway girls are counted under general migration figures. Further research is needed to explore how this phenomenon is categorized at policy level in order to address runaway girls' needs as defined by them.
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Affiliation(s)
- Jone G Lurgain
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.
| | - Carola Eyber
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Ferguson M, Peled M, Saewyc EM. Health and Healthcare Service Use: The Experiences of Runaway Trans Adolescents Compared to their Peers. JOURNAL OF HOMOSEXUALITY 2022; 69:821-835. [PMID: 33891528 DOI: 10.1080/00918369.2021.1892404] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study is the first trans-inclusive exploration of the relation between running away from home, health, and access to healthcare and supportive figures as a function of gender among adolescents. Secondary data analysis of the 2013 BC Adolescent Health Survey found that trans adolescents were 4.25 times as likely as males, and 3.0 times as likely as females, to have run away. Logistic regressions indicated that runaway adolescents of all genders had greater odds of reporting poor or fair overall health (OR: 2.9) and mental health (OR: 4.5), and of foregoing needed physical (OR: 4.8) and mental health care (OR: 4.5) compared to adolescents who had not run away. The relation between running away and health was exacerbated among trans adolescents. Trans and female youth were also less likely than males to report receiving helpful support. Findings highlight the importance of offering trans-affirming services and care to mitigate harms associated with running away from home.
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Affiliation(s)
- Max Ferguson
- MAP Centre for Urban Health Solutions, St Michael's Hospital, London, UK
| | - Maya Peled
- McCreary Centre Society, Vancouver, Canada
| | - Elizabeth M Saewyc
- McCreary Centre Society, Vancouver, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
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Lifetime prevalence of suicidal attempt among homeless individuals in North America: a meta-analysis. J Affect Disord 2021; 287:341-349. [PMID: 33813254 DOI: 10.1016/j.jad.2021.03.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/10/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Homelessness is a compelling public health problem, and homeless individuals are at increased risk for attempting suicide. However, the reported lifetime prevalence of suicidal attempt among homeless individuals in North America varied considerably. Therefore, this meta-analysis aimed to estimate the pooled lifetime prevalence of suicidal attempt among homeless individuals in North America and explore factors that may moderate this estimation. METHODS The protocol was registered in PROSPERO database (CRD42018102593). A systematic literature search was conducted in the electronic databases of PubMed, Embase, Web of Science, PsycINFO, and Google Scholar. Observational studies exploring the lifetime prevalence of suicidal attempt among homeless individuals in North America were included. Heterogeneity across studies was evaluated using the Cochran Q test and quantified using the I2 statistic. Subgroup analyses were performed to identify possible sources of heterogeneity. RESULTS Twenty-two eligible studies with a total of 9,727 homeless individuals were included, of which 2,986 reported having attempted suicide in their lifetime. A high degree of heterogeneity (I2=96.4%, P<0.001) was observed, and the pooled lifetime prevalence was 31.83% (95% confidence interval: 26.87%-36.99%). Subgroup analyses showed that the heterogeneity was quite low when estimating the pooled lifetime prevalence of suicidal attempt among heterosexual (I2=0.0, P=0.401) and non-heterosexual homeless individuals (I2=0.0, P=0.405). LIMITATIONS All eligible studies were exclusively conducted in the US and Canada. CONCLUSIONS Nearly three tenths of homeless individuals in North America have attempted suicide in their lifetime, and the differences in sexual orientation might have contributed to the heterogeneity.
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Tyler KA, Schmitz RM. Bullying at School and on the Street: Risk Factors and Outcomes Among Homeless Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP4768-NP4787. [PMID: 30141722 DOI: 10.1177/0886260518794024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Though rates of bullying among general population youth are high, there is elevated prevalence among certain subgroups, in particular sexual minority homeless youth. Enduring bullying can have devastating consequences, including poor mental health, revictimization, and substance abuse. The current study compares risk factors (i.e., sexual orientation, gender, and child abuse) for being bullied both at school and on the street among homeless youth. We also examine the associations of both contexts of bullying (i.e., at school and on the street) with physical and sexual victimization while on the street, with illicit drug use. From July 2014 to October 2015, we interviewed 150 homeless youth aged 16 to 22 years in shelters and on the streets from two Midwestern cities. Our sample was 51% female and 22% identified as lesbian, gay, or bisexual (LGB). Results revealed that LGB youth experienced more frequent bullying at school and were more likely to have ever used one or more illicit drugs at least a few times compared with heterosexual youth. Moreover, youth who experienced more child abuse prior to leaving home were also victimized more often at school (school bullying) and on the street (street bullying). Young people who experienced more sexual and physical street victimization were more likely to report illicit drug use compared with those who had fewer street victimization experiences. Overall, youth who experience victimization in one context (i.e., home) are at heightened risk for being bullied in additional contexts (i.e., school). These findings have important policy and service intervention implications, such that service providers should attend to homeless youth's multiple social contexts of victimization and the potential for youth's illicit drug use as a coping mechanism.
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Zhang J, Wu Q, Slesnick N. Social Problem-Solving and Suicidal Ideation Among Homeless Youth Receiving a Cognitive Therapy Intervention: A Moderated Mediation Analysis. Behav Ther 2021; 52:552-563. [PMID: 33990233 PMCID: PMC8663281 DOI: 10.1016/j.beth.2020.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 06/01/2020] [Accepted: 07/16/2020] [Indexed: 11/18/2022]
Abstract
Despite the high prevalence of suicidal ideation and attempts among homeless youth, little research has examined how suicide prevention interventions influence suicide-related risk and protective factors, and ultimately produce positive outcome in suicidality in this population. Drawing on the Diathesis-Stress Model and the Interpersonal Theory of Suicide, the current study examined whether participation in Cognitive Therapy for Suicide Prevention (CTSP) moderated the mediation link between social problem-solving, perceived burdensomeness and thwarted belongingness, and suicidal ideation among a sample of homeless youth experiencing suicidal ideation. Social problem-solving refers to a set of cognitive, emotional, and behavioral coping responses in the face of stressful situations, and it is identified as a potent protective factor in alleviating perceived burdensomeness and thwarted belongingness, and reducing suicidal ideation. Participants included 150 homeless youth (M age = 20.99, range = 18-24; 41% female) who were randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Treatment as Usual (TAU) (n = 75) or Treatment as Usual alone (n = 75). Participants were assessed at baseline, 3, 6, and 9 months post-baseline. Findings showed that perceived burdensomeness mediated the association of social problem-solving with suicidal ideation only among youth participating in the CTSP condition. These findings provide evidence to support the promising effects of CTSP in enhancing the protective effects of social problem-solving on suicidal ideation through the mediating effects of perceived burdensomeness. Findings also have implications for improving intervention effectiveness with a community-based population at high risk of suicide.
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Affiliation(s)
- Jing Zhang
- School of Lifespan Development and Educational Sciences, Kent State University.
| | - Qiong Wu
- College of Human Sciences, Florida State University
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Begun S, Weber A, Spring J, Arora SRA, Frey C, Fortin A. "This Research Is Cool": Engaging Youth Experiencing Homelessness in Research on Reproductive and Sexual Health. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:271-281. [PMID: 32631161 DOI: 10.1080/19371918.2020.1791296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Youth experiencing homelessness face myriad barriers and inequities regarding their reproductive and sexual health and rights. Moreover, homeless youth are often characterized as "disaffiliated" and depicted as difficult to engage in research. This study qualitatively explored homeless youths' attitudes, beliefs, and needs regarding reproductive and sexual health, and sought their perspectives on being involved in research on such topics, which are often thought of as "taboo" or sensitive. Youth were enthusiastic about openly discussing such issues, which they deemed as highly relevant to their daily lives. Youth identified that how they were engaged in such research, and having opportunities for longer-term contributions to such efforts, were both important and exciting to them. Future social work and public health research efforts should seek to further disrupt narratives of homeless youth as "disaffiliated" and difficult to engage, and in doing so, develop more creative, participatory, and youth-led opportunities for including this group in reproductive and sexual health research.
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Affiliation(s)
- Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Ariel Weber
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Joshua Spring
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Simran R A Arora
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Cressida Frey
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Alicia Fortin
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
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Cutuli JJ, Treglia D, Herbers JE. Adolescent Homelessness and Associated Features: Prevalence and Risk Across Eight States. Child Psychiatry Hum Dev 2020; 51:48-58. [PMID: 31270658 DOI: 10.1007/s10578-019-00909-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study utilizes data from the Youth Risk Behavior Survey to estimate the prevalence of adolescent homelessness and relations to five indicators of poor functioning among students attending public high school in eight states. About 3.27% of students experienced homelessness, and nearly 7% of teens who identified as lesbian, gay, or bisexual (LGB) experienced homelessness. Homelessness was related to higher rates of sexual/dating violence as well as having been bullied and feeling unsafe at school. Homelessness and LGB identification predicted higher rates of more-severe problems with alcohol, hard drug use, poor grades, suicidality, and risky sexual behavior, controlling for other factors. There was no interaction effect between homelessness and LGB status, suggesting that these risks are additive.
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Affiliation(s)
- J J Cutuli
- Department of Psychology, Rutgers University - Camden, 311 N Fifth Street, Rm 308, Camden, NJ, 08243, USA.
| | - Dan Treglia
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Janette E Herbers
- Department of Psychological and Brain Sciences, Villanova University, Villanova, PA, USA
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LGBTIQ+ Homelessness: A Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16152677. [PMID: 31357432 PMCID: PMC6695950 DOI: 10.3390/ijerph16152677] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/19/2022]
Abstract
Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ+) people’s experiences of homelessness is an under-explored area of housing and homelessness studies, despite this group making up 20–40% of homeless populations. Despite this, much of the existing literature focuses on specific elements of LGBTIQ+ homelessness, and often does not consider the intersections of these elements, instead placing them into individual siloes. Our approach is an intersectional one; this paper identifies the key themes in the existing research, and analyses how these themes interact to reinforce the discrimination and stigma faced by LGBTIQ+ people who experience homelessness. This intersectional-systems thinking approach to LGBTIQ+ homelessness can be used to develop well-informed, culturally sensitive support programmes.
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Barker B, Hadland SE, Dong H, Shannon K, Kerr T, DeBeck K. Increased burden of suicidality among young street-involved sex workers who use drugs in Vancouver, Canada. J Public Health (Oxf) 2019; 41:e152-e157. [PMID: 30007367 PMCID: PMC6636686 DOI: 10.1093/pubmed/fdy119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 04/16/2018] [Accepted: 06/14/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The risks of suicidality among street-involved youth who use drugs and engage in sex work are not well described. This study sought to evaluate if street-involved youth who engage in sex work were at an elevated risk for attempting suicide. METHODS Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth who use drugs in Vancouver, Canada. Multivariable generalized estimating equation analyses were employed to examine whether youth who engaged in sex work were at elevated risk of attempting suicide, controlling for possible confounders. RESULTS Between September 2005 and May 2015, 1210 youth were recruited into the cohort, of whom, 173 (14.3%) reported recently attempting suicide at some point during the study period. In multivariable analysis, youth who engaged in sex work were significantly more likely to report a recent suicide attempt (adjusted odds ratio = 1.93; 95% confidence interval: 1.28-2.91). CONCLUSIONS Street-involved youth who engage in sex work were observed to be at a significantly higher risk for suicidality. Systematic discrimination and unaddressed trauma may contribute to the observed increased burden of suicidality among this population. Interventions that support the mental health and well-being of street-involved youth who engage in sex work are urgently needed.
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Affiliation(s)
- Brittany Barker
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Room 270 - 2357 Main Mall, H. R. MacMillan Building, Vancouver, BC, Canada
| | - Scott E Hadland
- Department of Pediatrics, Boston Medical Center, 850 Harrison Ave., Boston, MA, USA
- Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall, Room 322, Boston, MA, USA
| | - Huiru Dong
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, Canada
| | - Kate Shannon
- Division of AIDS, Department of Medicine, University of British Columbia, #667-1081 Burrard Street, Vancouver, BC, Canada
- Gender and Sexual Health Initiative, St. Paul’s Hospital, #608-1081 Burrard St., Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, Canada
- Division of AIDS, Department of Medicine, University of British Columbia, #667-1081 Burrard Street, Vancouver, BC, Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe St., Vancouver, BC, Canada
- School of Public Policy, Simon Fraser University, SFU Harbour Centre, 515 West Hastings Street, Vancouver, BC, Canada
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McCann E, Brown M. Homelessness among youth who identify as LGBTQ+: A systematic review. J Clin Nurs 2019; 28:2061-2072. [PMID: 30786099 DOI: 10.1111/jocn.14818] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/29/2019] [Accepted: 02/09/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore homelessness among lesbian, gay, bisexual, transgender, queer/questioning plus (LGBTQ+) youth and to identify their support and care requirements. BACKGROUND LGBTQ+ youth face many health and societal challenges including issues related to homelessness. DESIGN A systematic review of qualitative, quantitative and mixed methods studies. METHODS A search of relevant electronic databases was carried out and included the dates August 2008-August 2018 and limited to academic journals and peer-reviewed empirical studies written in English. Included studies specifically addressed the homeless experiences of youth aged 13-24 years old who identified as LGBTQ+. The PRISMA checklist was used in the review. A quality assessment instrument was used to review all of the selected papers and narrative methods utilised in the synthesis of the research evidence. RESULTS The search resulted in 319 papers, and after applying distinct inclusion criteria, a total of 14 papers were considered suitable for the systematic review. Following analysis, the four main themes identified were stigma, discrimination and exclusion; mental health issues and substance use; sexual risks and vulnerability; and interventions and supports. CONCLUSION LGBTQ+ homeless youth is a major public health concern that has significant consequences for a young person's physical and psychosocial well-being. RELEVANCE TO CLINICAL PRACTICE Practitioners need to be aware of the specific health and support requirements of LGBTQ+ youth in relation to homelessness. Inclusive and holistic care plans should exist that are fully responsive to the distinct needs of this group guided by definitive policies and sound clinical research. The implications for future nursing practice are presented and discussed.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, Trinity College, University of Dublin, Dublin, Ireland
| | - Michael Brown
- School of Nursing and Midwifery, Queen's University Belfast, UK
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Holliday SB, Edelen MO, Tucker JS. Family Functioning and Predictors of Runaway Behavior Among At-Risk Youth. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2017; 34:247-258. [PMID: 28496291 PMCID: PMC5421563 DOI: 10.1007/s10560-016-0459-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Adolescent runaway behavior is associated with a host of negative outcomes in young adulthood. Therefore, it is important to understand the factors that predict running away in youth. METHODS Longitudinal data from 111 at-risk families were used to identify proximal predictors of runaway behavior over a 12-week period. On average, youth were 14.96 years old, and 45% were female. Ten percent of youth ran away during the 12-week follow-up period. RESULTS In bivariate analyses, running away was predicted by poorer youth- and parent-rated family functioning, past runaway behavior, and other problem behaviors (e.g., substance use, delinquency), but not poorer perceived academic functioning. Results of a hierarchical logistic regression revealed a relationship between youth-rated family functioning and runaway behavior. However, this effect became non-significant after accounting for past runaway behavior and other problem behaviors, both of which remained significant predictors in the multivariable model. CONCLUSION These findings suggest that youth who run away may be engaged in a more pervasive pattern of problematic behavior, and that screening and prevention programs need to address the cycle of adolescent defiant behavior associated with running away. Recommendations for clinical practice with this at-risk population are discussed.
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Oppong Asante K, Meyer-Weitz A. Prevalence and predictors of suicidal ideations and attempts among homeless children and adolescents in Ghana. J Child Adolesc Ment Health 2017; 29:27-37. [PMID: 28403747 DOI: 10.2989/17280583.2017.1287708] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to determine the prevalence and risk factors associated with suicidal ideations and attempts among a sample of homeless street children and adolescents found in Accra, Ghana. METHODS A cross-sectional survey of a convenience sample of 227 (122 male and 105 female) homeless youth was conducted in Ghana. An interviewer-administered questionnaire was used to collect data due to a low level of literacy among the study population. Bivariate and multivariate logistic regressions were fitted to analyse the data. RESULTS The results indicated that 26.4% and 26.0% of the participants had attempted suicide and reported suicidal ideations respectively. The multivariate logistic regression showed that smoking, past and present use of alcohol, use of marijuana, and engagement in prostitution, were associated with suicidal ideations and suicide attempts. Suicidal ideations were associated with having been physically beaten, robbed, and assaulted with a weapon; while a suicide attempt was predicted by having been robbed and physically beaten. CONCLUSION This study increased our understanding of the determinants of suicidal ideations and attempts among homeless youth. These findings suggest urgency to up-skill mental health workers to assess for risk factors and offer pathways to care for this vulnerable group.
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Affiliation(s)
- Kwaku Oppong Asante
- a Department of Psychology , University of KwaZulu-Natal , Durban , South Africa.,b Institute for Psychosocial Research in Child and Adolescent Wellbeing , Accra , Ghana.,c Department of Psychology , University of Ghana , Accra , Ghana
| | - Anna Meyer-Weitz
- a Department of Psychology , University of KwaZulu-Natal , Durban , South Africa
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Hsieh E. Voices of the Homeless: An Emic Approach to the Experiences of Health Disparities Faced by People Who Are Homeless. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:328-340. [PMID: 27093127 DOI: 10.1080/19371918.2015.1137512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
People who are homeless are particularly vulnerable to health disparities. Rather than using population statistics to highlight the prevalence or severity of the suffering of people who are homeless, 28 undergraduate students each conducted an in-depth interview with an individual who relied on a local homeless shelter to cope with everyday life. The interview explored the participants' health concerns and strategies for health management. Due to equipment failure and incomplete recording, only 16 interviews are included in this study. The author adopted thematic analysis while focused on preserving the richness of the interactions between the participants who are homeless and the undergraduate students. The author's goal is to provide emic, intimate insights about the struggles and challenges faced by the people who are homeless. The author concluded the study by situating the findings in the larger literature of health disparities experienced by people who are homeless.
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Affiliation(s)
- Elaine Hsieh
- a Department of Communication , University of Oklahoma , Norman , Oklahoma, USA
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24
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Wong CF, Clark LF, Marlotte L. The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth. JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:831-854. [PMID: 25392379 DOI: 10.1177/0886260514556770] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This study investigates the relative impact of trauma experiences that occurred prior to and since becoming homeless on depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and self-injurious behaviors among a sample of homeless youth (N = 389). Youth (aged 13 to 25) who had been homeless or precariously housed in the past year completed a survey about housing history, experiences of violence and victimization, mental health, and service utilization. In addition to examining the impact associated with specific trauma types, we also considered the effect of "early-on" poly-victimization (i.e., cumulative number of reported traumas prior to homelessness) and the influence of a compound sexual trauma variable created to represent earlier complex trauma. This created-variable has values ranging from no reported trauma, single trauma, multiple non-sexual traumas, and multiple traumas that co-occurred with sexual abuse. Multivariate analyses revealed that specific traumatic experiences prior to homelessness, including sexual abuse, emotional abuse/neglect, and adverse home environment, predicted greater mental health symptoms. Poly-victimization did not add to the prediction of mental health symptoms after the inclusion of specific traumas. Results with early compound sexual trauma revealed significant differences between lower-order trauma exposures and multiple-trauma exposures. Specifically, experience of multiple traumas that co-occurred with sexual trauma was significantly more detrimental in predicting PTSD symptoms than multiple traumas of non-sexual nature. Findings support the utility of an alternate/novel conceptualization of complex trauma, and support the need to carefully evaluate complex traumatic experiences that occurred prior to homelessness, which can impact the design and implementation of mental health care and services for homeless youth.
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Affiliation(s)
- Carolyn F Wong
- University of Southern California, Los Angeles, CA, USA Children's Hospital Los Angeles, CA, USA
| | - Leslie F Clark
- University of Southern California, Los Angeles, CA, USA Children's Hospital Los Angeles, CA, USA
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25
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Law BMF, Shek DTL. A 6-year Longitudinal Study of Self-harm and Suicidal Behaviors among Chinese Adolescents in Hong Kong. J Pediatr Adolesc Gynecol 2016; 29:S38-48. [PMID: 26461529 DOI: 10.1016/j.jpag.2015.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To examine the trajectories of self-harm and suicidal behaviors among Chinese adolescents in Hong Kong and to investigate the related predictors, including gender, family nonintactness, economic disadvantage, positive youth development, and family functioning. DESIGN We used quantitative data from a large sample of adolescent participants. Participants initially joined this study when they were in grade 7 (wave 1), and they were followed from grade 8 (wave 2) to grade 12 (wave 6). SETTING, PARTICIPANTS, AND INTERVENTIONS The participants consisted of 2023 grade 12 students from 28 secondary schools in Hong Kong. A multistage cluster random sampling method was adopted. MAIN OUTCOME MEASURES Self-harm and suicidal behaviors. RESULTS The trajectories of self-harm and suicidal behaviors in general declined from grade 7 to grade 12. Regarding the effect of gender, whereas adolescent girls showed a higher prevalence for self-harm and suicidal behaviors at baseline and other waves, adolescent boys showed a pronounced decline in self-harm rates. Adolescents from nonintact families were more likely to self-harm or engage in suicidal behaviors at wave 6. Economic disadvantage at wave 4 predicted higher suicidal behavior among adolescents but not self-harm at wave 6. Regarding positive youth development, several protective factors that include cognitive-behavioral competencies, prosocial attributes, general positive youth development qualities, and positive identity could help reduce self-harm and suicidal behaviors at different time points. Regarding the role of family functioning, more family conflicts predicted higher suicidality in adolescence (self-harm and suicidal behaviors), and family communication affected self-harming behaviors at wave 6. CONCLUSION The trajectories of self-harm and suicidal behaviors decline from early to late adolescence among Chinese adolescents. Positive youth development and constructive family functioning are critical to help reduce suicidal behaviors. Regarding increased risk, more attention should be paid to adolescent girls and adolescents from nonintact and economic disadvantaged families.
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Affiliation(s)
- Ben M F Law
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, P.R. China.
| | - Daniel T L Shek
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, P.R. China; Centre for Innovative Programmes for Adolescents and Families, The Hong Kong Polytechnic University, Hong Kong, P.R. China; School of Social Development, East China Normal University, Shanghai, P.R. China; Kiang Wu Nursing College of Macau, Macau, P.R. China; Division of Adolescent Medicine, Department of Pediatrics, Kentucky Children's Hospital, University of Kentucky College of Medicine, Lexington, Kentucky
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26
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Leone FT, Carlsen KH, Folan P, Latzka K, Munzer A, Neptune E, Pakhale S, Sachs DPL, Samet J, Upson D, White A. An Official American Thoracic Society Research Statement: Current Understanding and Future Research Needs in Tobacco Control and Treatment. Am J Respir Crit Care Med 2015; 192:e22-41. [PMID: 26230245 DOI: 10.1164/rccm.201506-1081st] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Since the mid-20th century, the scientific community has substantially improved its understanding of the worldwide tobacco epidemic. Although significant progress has been made, the sheer enormity and scope of the global problem put it on track to take a billion lives this century. Curbing the epidemic will require maximizing the impact of proven tools as well as the development of new, breakthrough methods to help interrupt the spread of nicotine addiction and reduce the downstream morbidity. METHODS Members of the Tobacco Action Committee of the American Thoracic Society queried bibliographic databases, including Medline, Embase, and the Cochrane Collaborative, to identify primary sources and reviews relevant to the epidemic. Exploded search terms were used to identify evidence, including tobacco, addiction, smoking, cigarettes, nicotine, and smoking cessation. Evidence was consolidated into three thematic areas: (1) determinants of risk, (2) maternal-fetal exposure, and (3) current tobacco users. Expert panel consensus regarding current gaps in understanding and recommendations for future research priorities was generated through iterative discussion. RESULTS Although much has been accomplished, significant gaps in understanding remain. Implementation often lags well behind insight. This report identifies a number of investigative opportunities for significantly reducing the toll of tobacco use, including: (1) the need for novel, nonlinear models of population-based disease control; (2) refinement of "real-world" models of clinical intervention in trial design; and (3) understanding of mechanisms by which intrauterine smoke exposure may lead to persistent, tobacco-related chronic disease. DISCUSSION In the coming era of tobacco research, pooled talent from multiple disciplines will be required to further illuminate the complex social, environmental and biological codeterminants of tobacco dependence.
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27
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Brown C. Naomi Nichols: Youth Work: An Institutional Ethnography of Youth Homelessness. J Youth Adolesc 2015. [DOI: 10.1007/s10964-015-0279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mutumba M, Harper GW. Mental health and support among young key populations: an ecological approach to understanding and intervention. J Int AIDS Soc 2015; 18:19429. [PMID: 25724505 PMCID: PMC4344542 DOI: 10.7448/ias.18.2.19429] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 12/11/2014] [Accepted: 01/02/2015] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The patterning of the HIV epidemic within young key populations (YKPs) highlights disproportionate burden by mental disorders in these populations. The mental wellbeing of YKPs is closely associated with biological predispositions and psychosocial factors related to YKPs' sexual and gender identities and socio-economic status. The purpose of this paper is to highlight sources of risk and resilience, as well as identify treatment and supports for mental health disorders (MHDs) among YKPs. DISCUSSION This paper utilizes Bronfenbrenner's Bioecological Systems Theory and the Social Stress Model to explore the risk and protective factors for MHDs across YKPs' ecological systems, and identify current gaps in treatment and support for MHDs among these youth. We emphasize the fluidity and intersections across these categorizations which reinforce the vulnerability of these populations, the lack of concrete data to inform mental health interventions among YKPs, and the need to ground YKP interventions and programmes with human rights principles stipulated in the convention on the rights of a child. CONCLUSIONS We put forth recommendations for future research and strategies to address the mental wellbeing of YKPs, including the need for integrated interventions that address the multiplicity of risk factors inherent in the multiple group membership, rather than single-focus interventions whilst addressing the unique needs or challenges of YKPs.
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Affiliation(s)
- Massy Mutumba
- Center for Sexuality and Health Disparities, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Joint Clinical Research Center, Kampala, Uganda;
| | - Gary W Harper
- Center for Sexuality and Health Disparities, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
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Keuroghlian AS, Shtasel D, Bassuk EL. Out on the street: a public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2015; 84:66-72. [PMID: 24826829 DOI: 10.1037/h0098852] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A disproportionate number of lesbian, gay, bisexual, and transgender (LGBT) youth experience homelessness each year in the United States. LGBT youth who are homeless have particularly high rates of mental health and substance use problems, suicidal acts, violent victimization, and a range of HIV risk behaviors. Given the intense needs of LGBT youth experiencing homelessness, it is imperative to understand their unique experiences and develop responsive practices and policies. The range and severity of health risks vary across subgroups of all homeless LGBT youth, and because the population is nonhomogeneous, their particular needs must be identified and addressed. Thus, the purpose of this article is to review the causes of homelessness among LGBT youth, discuss the mental health and victimization risks faced by this population, address differences among homeless LGBT subgoups, and recommend effective interventions and best practices. The authors conclude by discussing promising future research and public policy directions.
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Affiliation(s)
| | - Derri Shtasel
- Department of Psychiatry, Massachusetts General Hospital
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31
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Ronald E. Hallett: Educational Experiences of Hidden Homeless Teenagers: Living Doubled-Up. J Youth Adolesc 2013. [DOI: 10.1007/s10964-013-0070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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