Life shocks and homelessness

Housing hardship and maternal mental health among renter households with young children

Maternal mental health is crucial to healthy family functioning and child well-being. Housing hardship may increase risk for mood disorders among mothers of young children in renter households. The present study used latent class analysis to investigate manifestations of housing hardship during the postpartum year in a sample of renter mothers in the United States (N = 2,329), as well as whether housing hardship types were associated with subsequent maternal depression and anxiety. The majority of mothers were relatively stably housed ("Stable"), one in six made do with governmental rental assistance ("Rent-Assisted"), and more than one in ten struggled to afford or maintain stable housing ("Cost-Burdened" or "Housing Insecure"). The most severe housing hardship was associated with the greatest depression risk, whereas the best determinant of anxiety risk was whether rent was paid each month; mothers whose rent was paid with government assistance did not differ on anxiety risk compared to those who paid their rent independently. Findings suggest that different types of housing hardship are linked with distinct mental health sequelae. Widely available housing assistance may reduce cost burden and prevent displacement, with the potential to reduce mental disorder among low-income mothers of young children.

The Affordable Rental Housing Crisis and Population Health Equity: a Multidimensional and Multilevel Framework

The US is facing a severe affordable rental housing crisis that contributes to multiple forms of housing insecurity including homelessness, crowded and poor quality housing conditions, unstable housing arrangements, and cost burdens. A considerable body of evidence finds that housing insecurity is an important determinant of health. However, the existing literature may fall short of conceptualizing and measuring the full impact of housing insecurity on population health and on racial health equity. In this paper, we seek to expand the conceptualization of housing as a determinant of population health equity by considering housing insecurity as a manifestation of structural racism that intersects with other manifestations and impacts of structural racism to affect, not only the health of housing insecure individuals, but also the health of the networks and communities in which these individuals live. First, we situate the current housing crisis within larger systems of structural racism. We extend prior work documenting the confluence of ways that racist policies and practices have created unequal burdens of housing insecurity to also discuss the ways that the meanings and impacts of housing insecurity may be shaped by racism. Next, we consider how the health impacts of this unequal burden of housing insecurity can extend beyond individual households to affect networks and communities. Ultimately, we provide a multilevel framework that can inform research, policy, and practice to address housing and health equity.

Stressful Life Events and Risk of Homelessness After Active Duty: An Assessment of Risk and Resilience Among Servicemembers

OBJECTIVES

The transition from military to civilian life may present increased exposure to various stressful life events (SLEs) that can increase the risk of homelessness (eg, loss of employment, dissolution of romantic relationships). We assessed the extent to which exposure to SLEs occurring proximal to US Army soldier transitions out of active duty was associated with risk of homelessness.

METHODS

A total of 16 589 respondents who were no longer on active duty but participated while on active duty during 2011-2014 baseline surveys completed follow-up surveys during 2016-2018 and 2018-2019. The follow-up surveys assessed SLEs and homelessness occurring in the past 12 months. We used modified Poisson regression models to evaluate how much differential SLE exposure and effects explained the aggregate association of a risk index with homelessness among a sample of 6837 respondents, weighted to represent the full sample.

RESULTS

More than half (n = 3510, 52.8%) of respondents reported experiencing any SLEs in the past 12 months. Most (60.5%) of the difference in prevalence of homelessness among respondents defined as being at high risk of homelessness (vs lower risk) was explained by differential exposure to, and/or effects of, these SLEs. Personal betrayal by a loved one and economic problems played the largest roles in adjusted risk differences (0.045 and 0.074, respectively).

CONCLUSIONS

Homelessness might be reduced by gearing interventions toward soldiers at high risk of homelessness who are transitioning out of active duty to reduce exposure to and effects of modifiable SLEs on experiencing homelessness.

Mechanisms Linking High Residential Mobility to Decreased Contraceptive Use: The Importance of Method Availability

While research has demonstrated that high residential mobility has negative consequences for an array of outcomes, particularly among women and young adults, the mechanisms underlying these associations are unclear. The consequences of high residential mobility may be comprised solely of a series of short-term disruptions surrounding individual moves, or there may also be long-term, cumulative effects from repeated moves. High residential mobility may diminish access to resources as individuals move to different neighborhoods, impose a cognitive burden that impairs their ability to plan ahead, or decrease the relative power they have in their relationships to limit exposure to risk behaviors. We adjudicate between these possibilities by predicting the effects of high residential mobility on sexual intercourse and contraceptive use, the proximate determinants of pregnancy, during women's transition to adulthood. Using 2.5 years of monthly address data for 882 respondents in the Relationship Dynamics and Social Life study-a random sample of young women in Genesee County, Michigan-we find that high residential mobility is associated with long-term decreases in contraceptive use. These long-term consequences are independent of the short-term effects of individual moves and attributable to diminished contraceptive access. We disentangle the effects of home-leaving, which is distinct from subsequent moves.

Informal supports, housing insecurity, and adolescent outcomes: Implications for promoting resilience

Adolescents in low-income, marginalized families are vulnerable to behavior problems that impede healthy functioning and threaten long-term well-being. Informal supports may fill an important gap for these households as they navigate financial and social stressors. Instrumental support from social networks and neighborhood cohesion may promote family stability and youth well-being; further, these informal supports may promote resilience to housing insecurity, which is linked with a range of adverse adolescent outcomes. The present study utilized data from a large sample of at-risk families with children (N = 2425) to investigate whether instrumental support and neighborhood cohesion predicted adolescent behavior problems over 10 years and whether these links were mediated by housing insecurity. Results of structural equation modeling with latent variables showed direct links from instrumental support to anxious/depressed behaviors and from neighborhood cohesion to aggressive behaviors, as well as an indirect link from instrumental support to aggressive behavior via housing insecurity. Findings suggest informal supports are an important source of resilience for low-income families who may be excluded from or are reluctant to engage with formal social systems. Further, stable, connected communities with highly embedded social networks can promote housing stability and youth well-being in a virtuous cycle.

A photoelicitation exploration on formally homeless people experience with Universal Credit: System error and 'the government don't care'

This article explores the impact of Universal Credit (UC) on a group of formerly homeless people who were forcibly made to experience a system of full of errors and government that, in their view, did not care. The experience of a marginalised and vulnerable group with complex needs allows one to consider the impacts of welfare reforms on vulnerable people. The research was conducted with formerly homeless contacted via organisations that support people who experienced homelessness in Brighton, Southeast of the UK. Five people (32 years and older) participated. Qualitative data were obtained in photo-elicitation interviews and were thematically analysed. Findings were that they faced a system of error as well as experiencing a sense the government did not care about their situation. The participants expressed their views on how the UC process made them 'struggle' and caused them to have to 'use food banks', and argued that the staff did not know the policy. The system is singled out as the cause of UC claimants' destitution. For the participants, policymakers' negligence, contempt, and detachment were not hard to understand. The article provides implications for practice and research.

Quantifying the intersection of disability and homelessness in Massachusetts public schools in 2018-2019

BACKGROUND

Homelessness has a major impact on the educational and health trajectories of children. Youth with disabilities may be especially vulnerable to experiencing homelessness, but little epidemiological work has been done to characterize dual disparity. Our goal was to describe the relationship between homelessness and disability among students (age 3-21) receiving public education in Massachusetts in 2018-2019. We evaluated the proportion of students with and without disabilities experiencing homelessness by county and school district.

METHODS

We used publicly available data from the United States and Massachusetts Department's of Education. These data used the McKinney Vento Homelessness Assistance Act definition of homelessness which is a lack of fixed, adequate, and regular housing, and disability was determined by the presence of an individualized education program or individualized family service plan. We calculated percentages of students with and without disabilities experiencing homelessness at the state, county, and district level and calculated and mapped risk of homelessness comparing students and without disability. We also determined the occurrence of disability among those experiencing homelessness.

RESULTS

In Massachusetts public schools, 3.5% of students with disabilities experienced homelessness compared with 2.4% of students without disabilities (relative risk 1.50, 95% CI: 1.47, 1.53). A greater proportion of students with disabilities experienced homelessness compared with students without disabilities in all counties. In sum, 24.8% of students experiencing homelessness had a reported disability.

CONCLUSIONS

In Massachusetts public schools, a greater proportion of students with disabilities experience homelessness compared with students without disabilities, and disability is common among students experiencing homelessness. We hypothesize potential mechanisms, such as the financial cost of disability, that may lead to this finding. Findings support the need for additional funding and interventions for school districts and communities to better serve vulnerable students with disabilities experiencing homelessness.

Acute care utilization and housing hardships in American children

Millions of families in the United States are economically vulnerable: one shock can lead to hardship. We use data from the Fragile Families and Child Wellbeing Study to examine the association between acute healthcare utilization - emergency room visits or hospitalizations - and subsequent housing hardships, such as being evicted for financial reasons. Further, we explore whether this association differs by who in the family utilized the care and whether perceived social support protects against hardship when these experiences occur. Using lagged dependent variable regression models, we find that families that visited the emergency room or were hospitalized, regardless if it was a child or parent with this experience, were five percentage points more likely to experience any housing hardship than families that did not use acute care. Among families in which a child utilized acute care, perceived social support buffered the impact of using acute care. That perceived social support is associated with a lower likelihood of housing hardship among families that experienced acute care utilization for a child, but not parent, suggests that social support may be able to offset the challenges arising from children's, but not adults', use of acute care. In the face of economic precarity, informal safety nets may be insufficient to reduce the impact of acute care utilization on housing hardships.

Striving for Structure and Stability in Cincinnati's Family Homeless Shelters: A Community-Based Participatory Research Approach

Experiencing homelessness negatively impacts child health, development, and emotional-behavioral functioning, but there is limited knowledge regarding specific service priorities, as articulated by families themselves, to prevent or address these adverse sequelae. Thus, to elicit the service needs perspective of families in shelter and to translate these findings into real-world action, we undertook a community-based participatory research effort using Group-Level Assessment, a focus group methodology. An action-based participatory needs assessment called a Group-Level Assessment (GLA) was conducted in collaboration with parents currently experiencing homelessness. A total of 53 parents from 3 Cincinnati homeless shelters participated by responding to 17 to 20 open-ended prompts regarding their child's medical, developmental, learning, social, and behavioral needs. Using GLA methodology, we found that the needs expressed by families residing in shelters coalesced around the following themes: job and housing stability, education and skill development, emotional support, and improving shelter life. The GLA findings were then shared with shelter and community leaders, leading to a number of policy and practice enhancements in the shelters. This study demonstrates the power of the GLA approach to affect community action as a direct result of priorities generated by families experiencing homelessness.

The Concentrated Geography of Eviction

Preventing eviction is a tractable, efficient way to reduce homelessness. Doing so requires understanding the precise geography of eviction. Drawing on over 660,000 eviction records across 17 cities, this study finds the geography of evictions to be durable across time. Rather than occurring when the status quo is disrupted, through gentrification or other modes of neighborhood change, eviction is itself the status quo in some pockets of American cities. Increasing the magnification, the study shows that a few buildings are responsible for an outsized share of cities' eviction rates. Focusing on three cities-Cleveland, Ohio, Fayetteville, North Carolina, and Tucson, Arizona-it finds that the 100 most-evicting parcels account for over one in six evictions in Cleveland and two in five evictions in Fayetteville and Tucson. Policymakers looking to prevent homelessness can use the diagnostic tools developed in this study to precisely target high-evicting neighborhoods and buildings.

The life course of homeless female Veterans: Qualitative study findings

Introduction: Homelessness among Veterans is a significant problem in the United States, and female Veterans, one of the fastest-growing groups in the homeless population, are four times more likely to become homeless than their male peers. The purpose of this article is to share findings of a qualitative study that examined the life course that created a pathway into homelessness for 14 female Veterans in the United States. Methods: Data were collected using a life history grid and semi-structured interview guide in two 90-minute face-to-face interviews with each participant. Qualitative content analysis of the interview transcripts was conducted to identify major themes across the lifespans of study participants. Results: Six major themes shared by the participants emerged: traumatic experiences across the lifespan, entering the military to escape circumstances, racism, gender-related discrimination and sexism, difficulty transitioning from military to Veteran status, and positive childhood experiences and proud moments during military service. Discussion: The findings suggest a range of policy, housing and service needs. The study demonstrates the unique experiences of female Veterans that require gender-specific responses. The female Veterans in this study experienced exposure to multiple traumatic events pre-military, during service, and post service. Female Veterans’ increased risk of becoming homeless indicates the need for practitioners to address mental health, substance use, re-integration stability, and other health care needs and use trauma-informed interventions to ensure high-quality care. Practitioners also need to be well-versed in military and Veteran culture to provide the linkages to care and support systems required by these Veterans.

When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers

People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases. In the year before shelter entry and the year following shelter exit, 39.3 percent and 43.3 percent, respectively, of first-time adult shelter users had an ED visit or hospitalization. Hospital visits-particularly ED visits-began to increase several months before shelter entry and declined over several months after shelter exit, with spikes in ED visits and hospitalizations in the days immediately before shelter entry and following shelter exit. We recommend cross-system collaborations to better understand and address the co-occurring health and housing needs of vulnerable populations.

Forty Years of Research on Predictors of Homelessness

Homelessness is a chronic public health issue in the U.S. This paper reviews the endurance and evolution of individual, youth, and family homelessness over the past 40-plus years. Thematic findings detail research on predictors of homelessness among adolescents, runaway youth, veterans, older adults, sheltered families, and female-headed families. Results provide a summary of contributors to homelessness, including issues related to family instability, unemployment and poverty, mental illness, substance use, unstable living arrangements, child maltreatment, social support, crime, and violence. Findings highlight key and persistent predictors of homelessness found across decades, as well as more recently identified and nuanced precursors to individual or family displacement. The goal of this work was to summarize what is known about predictors of homelessness to inform targeted research, practice, and policies.

Socioeconomic inequalities in mental health in Australia: Explaining life shock exposure

BACKGROUND

Recent research suggests that there exists a strong link between life shocks and mental health. However, research on the distributional aspects of these shocks on mental health status is limited. In the health inequality literature no Australian studies have examined this relationship.

OBJECTIVE

This study examines the distributional impact of life shocks (negative life events and financial hardships) on mental health inequality among different socioeconomic groups in a longitudinal setting in Australia.

METHODS

This study analysed the data of 13,496 individuals from the Household, Income and Labour Dynamics in Australia (HILDA) survey, waves 12-17 (2012-2017). Using concentration index and Blinder-Oaxaca approaches, the study decomposed socioeconomic inequalities in mental health and changes in inequalities in mental health over the study period. The study used frailty indices to capture the severity of life shocks experienced by an individual.

RESULTS

The results suggest that exposure to just one life shock will result in a greater risk of mental disorder in the most disadvantaged socioeconomic groups. The results also indicate that 24.7%-40.5% of pro-rich socioeconomic mental health inequality are due to life shocks. Financial hardship shocks contributes to 21.6%-35.4% of inequality compared with 2.3%-5.4% inequality generated by negative life event shocks across waves.

CONCLUSIONS

Lower SES groups experience more life shocks than higher SES groups and in turn generate higher socioeconomic mental health inequality. Policies aimed at reducing socioeconomic inequality in mental health should account for these shocks when designing interventions.

"It Wasn't Just One Thing": A Qualitative Study of Newly Homeless Emergency Department Patients

OBJECTIVES

Emergency departments (EDs) frequently care for patients who are homeless or unstably housed. One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions.

METHODS

We conducted in-depth, one-on-one qualitative interviews with ED patients who had become homeless within the past 6 months. Using a semistructured interview guide, we asked patients about their pathways into homelessness and what might have prevented them from becoming homeless. Interviews were digitally recorded and professionally transcribed. Transcripts were coded line by line by multiple investigators who then met as a group to discuss and refine codes in an iterative fashion.

RESULTS

Interviews were completed with 31 patients. Mean interview length was 42 minutes. Four main themes emerged: 1) unique stories yet common social and health contributors to homelessness, 2) personal agency versus larger structural forces, 3) limitations in help from family or friends, and 4) homelessness was not expected.

CONCLUSIONS

These findings demonstrate gaps in current homeless prevention services and can help inform future interventions for unstably housed and homeless ED patients. More immediately, the findings provide rich, unique context to the lives of a vulnerable patient population commonly seen in EDs.

Effects of individual risk and state housing factors on adverse outcomes in a national sample of youth transitioning out of foster care

INTRODUCTION

Compared to their peers, youth who leave the foster care system without permanency experience greater risks for adverse young adult outcomes, including homelessness, incarceration, substance abuse, and early child birth. Extant literature focuses on individual-level factors related to adversity. In this study, we estimated the impact of state and individual-level risk and protective factors on adverse 19-year-old outcomes among a cohort of U.S. transition age youth.

METHODS

We used multilevel modeling to analyze prospective, longitudinal data from two waves of the National Youth in Transitions Database (N = 7449). These data were linked to the Adoption and Foster Care Reporting System, the Administration for Children and Families budget expenditures, and the American Community Survey for the period from 2011 to 2013.

RESULTS

Approximately 30% of the variation in each of the 19-year-old outcomes could be attributed to state-level effects. Residence in a state that spent above average of CFCIP budget on housing supports reduced the risk of homelessness and incarceration. Living in a state with a higher proportion of housing-burdened low-income renters significantly increased the risk of substance abuse and child birth. Individual-level risks were significant: racial/ethnic minority, male gender, past risk history, placement instability, child behavioral problems, residence in group home or runaway. Remaining in foster care at age 19 reduced the odds of homelessness, incarceration, and substance abuse.

CONCLUSION

Macro factors, including financial support for transition-age youth, and broader housing market characteristics, have a bearing on young adult outcomes, and raise policy questions across social and human service sectors.

Health Care Utilization and Expenditures of Homeless Family Members Before and After Emergency Housing

OBJECTIVES

To describe longitudinal health service utilization and expenditures for homeless family members before and after entering an emergency shelter.

METHODS

We linked Massachusetts emergency housing assistance data with Medicaid claims between July 2008 and June 2015, constructing episodes of health care 12 months before and 12 months after families entered a shelter. We modeled emergency department visits, hospital admissions, and expenditures over the 24-month period separately for children and adults.

RESULTS

Emergency department visits, hospital admissions, and expenditures rose steadily before shelter entry and declined gradually afterward, ending, in most cases, near the starting point. Infants, pregnant women, and individuals with depression, anxiety, or substance use disorder had significantly higher rates of all outcomes. Many children's emergency department visits were potentially preventable.

CONCLUSIONS

Increased service utilization and expenditures begin months before families become homeless and are potentially preventable with early intervention. Infants are at greater risk. Public Health Implications. Early identification and intervention to prevent homeless episodes, focusing on family members with behavioral health disorders, who are pregnant, or who have young children, may save money and improve family health.

The role of residential mobility in reproducing socioeconomic stratification during the transition to adulthood

OBJECTIVE

This study assesses whether frequency of residential mobility plays a role in the reproduction of socioeconomic inequality during the transition to adulthood based on two criteria: (1) selection – is there socioeconomic sorting into residential trajectories? – and (2) lack of moderation – is this sorting irreducible to other life events that prompt moves (e.g., changes in employment status)?

METHODS

I use two and a half years of monthly address data from the Relationship Dynamics and Social Life data set, a sample of 18- and 19-year-old young women in a Michigan county. As an improvement upon previous measures of residential mobility, I use group-based trajectory analysis to categorize young women into residential trajectory groups. I then conduct a series of nested logistic regressions to predict membership in residential trajectory groups and a decomposition analysis to determine whether rapid movers are exposed to more life events (e.g., entering/exiting employment) or are simply more sensitive to moving in the face of life events compared to gradual movers.

RESULTS

Rapid moving is associated with low socioeconomic status. Rapid movers experience similar family formation, employment, and academic changes as gradual movers but are more likely to move when faced with these life events.

CONCLUSIONS

High residential mobility is a phenomenon among early home-leavers as part of an accelerated and underfunded transition to adulthood rather than a reflection of the upward socioeconomic mobility of college students.

CONTRIBUTION

High residential mobility is not simply a neutral or normative aspect of the transition to adulthood but rather part of the process of reproducing socioeconomic stratification.

The Impact of Housing Instability on Child Maltreatment: A Causal Investigation

More than a half million children are confirmed as victims of maltreatment by the child welfare system each year. Children from unstably housed families are over-represented in child mal-treatment reports, and a growing body of evidence links housing problems to maltreatment and Child Protective Services (CPS); investigation. The present study applies two propensity score analysis approaches-greedy matching and propensity score weighting-to data from the Fragile Families and Child Well-being Study to move toward a causal explanation of child mal-treatment behaviors among mothers in low-income households. Utilizing two separate methods to correct for overt selection bias, the present study finds that housing instability leads to a small increase in maltreatment behaviors, yet this small positive net impact on child maltreatment does not fully explain the over-representation of unstably housed families in the child welfare system. Families experiencing housing problems likely have a range of needs that require earlier, targeted intervention to mitigate consequences of poverty, domestic violence, and maternal depression. Child welfare services should invest resources in housing assistance programs in-house as well as through partnerships with local public housing authorities to stabilize families, reduce housing-related strain on caregivers, and promote family preservation.

A Theory of Mental Health and Optimal Service Delivery for Homeless Children

Homeless children are a vulnerable group with high risk for developing mental health disorders. The pathways to disorders among homeless children have not been fully elucidated, with significant logistical and measurement issues challenging accurate and thorough assessment of need. The environments of homeless children are uniquely chaotic, marked by frequent moves, family structure changes, household and neighborhood disorder, parenting distress, and lack of continuous services. Despite high rates of service use, mental health outcomes remain poor. This paper reviews the literature on homeless children's mental health, as well as prior theoretical explorations. Finally, the paper proposes a theoretical model that explains elevated rates of mental health problems among homeless children as consequences of harmful stress reactions triggered by chronic household instability along with repeated service disruptions. This model draws upon existing conceptual frameworks of child development, family poverty, health services utilization, and the biology of stress to clarify the role of environmental chaos in the development of child emotional and behavioral problems. Potential strategies to mitigate the risk for mental health disorders among homeless children and future research directions are discussed.

Children with disabilities and trajectories of parents' unsecured debt across the life course

Prior research shows that having a child with a disability is economically burdensome for parents but we know little about whether this burden extends to unsecured debt. In this study, we examine the link between having a child with a disability that manifests between birth and age 4 and subsequent trajectories in unsecured household debt. We have three key findings. First, we find that having a child with an early-life disabling health condition is associated with a substantial increase in indebtedness in the years immediately following the child's birth, and that this association persists net of a range of potential confounders. Second, we find that parents do not quickly repay this debt, such that parents of a child with a disabling health condition have different trajectories of unsecured debt across the life course than do parents of children without a disabling health condition. Third, we find that the association between early-life child disability and debt is stronger for more severe conditions, such as those that require ongoing medical treatment. The results of this study are informative for understanding an important aspect of economic functioning-indebtedness-for parents of children with disabilities, as well as the causes and correlates of rising unsecured debt in the U.S.

Understanding how low-socioeconomic status households cope with health shocks: An analysis of multi-sector linked data

Low-socioeconomic status (SES) households have little income or wealth to buffer against the negative impacts of an adverse health event (health shock) among adult household members. However, these households may employ a variety of other coping strategies such as receiving help from family, friends, and social services. Administrative data from a non-profit food distribution center, electronic medical record (EMR) data from a safety-net healthcare system, and publicly available residential appraisal data were linked to provide insight into these coping strategies. Three broad types of coping strategies were examined: changes in household structure, residential mobility, and utilization of social services. Of 3,235 households, 20.2% had at least one adult member who experienced a health shock. These households were more likely to gain additional adult household members and employed household members, were more likely to move residence and to move distances greater than one mile, and were less likely to visit the food distribution center after the shock.

Effects of maternal depression on family food insecurity

We use data from the Early Childhood Longitudinal Study-Birth Cohort to estimate the effects of maternal depression, a condition that is fairly common and can be severe, on food insecurity, a hardship that has increased substantially in the U.S. Using various model specifications, we find convincing evidence that severe maternal depression increases the likelihood that young children experience food insecurity by 23-79%, with estimates depending on model specification and measures of depression and food insecurity. For household food insecurity, the corresponding estimates are 11-69%. We also find that maternal depression increases reliance on several types of public programs, suggesting that the programs play a buffering role.

Residential Instability Among Low-Income Families: A Concept Analysis

Residential instability is relatively common among low-income families and is associated with a host of negative outcomes, especially for children and adolescents. Psychiatric nurses, especially those in the advanced practice role, observe the consequences of residential instability within the clinical setting. Yet, to-date, the concept is somewhat vague and its essential meaning and definition remain unclear. The aim of this paper is to develop a definition of residential instability using Wilson's method of concept analysis. An overview of historical perspectives is included. The paper concludes with recommendations for future research and application within clinical practice.

Residential patterns in older homeless adults: Results of a cluster analysis

Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. They may have different life trajectories and reside in different environments than do younger homeless adults. Although the environmental risks associated with homelessness are substantial, the environments in which older homeless individuals live have not been well characterized. We classified living environments and identified associated factors in a sample of older homeless adults. From July 2013 to June 2014, we recruited a community-based sample of 350 homeless men and women aged fifty and older in Oakland, California. We administered structured interviews including assessments of health, history of homelessness, social support, and life course. Participants used a recall procedure to describe where they stayed in the prior six months. We performed cluster analysis to classify residential venues and used multinomial logistic regression to identify individual factors prior to the onset of homelessness as well as the duration of unstable housing associated with living in them. We generated four residential groups describing those who were unsheltered (n = 162), cohabited unstably with friends and family (n = 57), resided in multiple institutional settings (shelters, jails, transitional housing) (n = 88), or lived primarily in rental housing (recently homeless) (n = 43). Compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Cohabiters and renters were significantly more likely to be women and have experienced a shorter duration of homelessness. Cohabiters were significantly more likely than unsheltered participants to have experienced abuse prior to losing stable housing. Pre-homeless social support appears to protect against street homelessness while low levels of social support may increase the risk for becoming homeless immediately after losing rental housing. Our findings may enable targeted interventions for those with different manifestations of homelessness.

Maternal depression as a risk factor for children's inadequate housing conditions

Depression among mothers with young children is an important public health issue that not only has implications for their own well-being, but can also potentially affect their children's health and developmental trajectories. This study explored the extent to which maternal depression is a risk factor for inadequate housing conditions related to utilities, a noteworthy risk factor for poor child health. Using data on 2965 mothers and children from a national urban cohort of U.S. births in 1998-2000, we estimated multivariate logistic regression models of associations between maternal depression during the postpartum year and a U.S. Department of Housing and Urban Development (HUD) measure of severely inadequate housing due to heating issues, as well as a broader measure of energy insecurity that encompasses various types of utility problems. We also considered outcomes that incorporated housing instability and food insecurity in conjunction with housing inadequacy. Mothers who experienced depression had about 60% higher odds of experiencing severely inadequate housing due to heat (OR: 1.57) and 70% higher odds of experiencing energy insecurity (OR: 1.69) compared to mothers who did not experience depression. Maternal depression was even more strongly associated with multiple hardships in the forms of housing inadequacy plus housing instability and/or food insecurity than it was with housing inadequacy. This study provides robust evidence that maternal depression is a risk factor for inadequate housing and multiple hardships during a critical period of children's development. The findings suggest that policy efforts should not occur in mental health, housing, and food security silos.

Maternal depression as a risk factor for children's inadequate housing conditions

Depression among mothers with young children is an important public health issue that not only has implications for their own well-being, but can also potentially affect their children's health and developmental trajectories. This study explored the extent to which maternal depression is a risk factor for inadequate housing conditions related to utilities, a noteworthy risk factor for poor child health. Using data on 2965 mothers and children from a national urban cohort of U.S. births in 1998-2000, we estimated multivariate logistic regression models of associations between maternal depression during the postpartum year and a U.S. Department of Housing and Urban Development (HUD) measure of severely inadequate housing due to heating issues, as well as a broader measure of energy insecurity that encompasses various types of utility problems. We also considered outcomes that incorporated housing instability and food insecurity in conjunction with housing inadequacy. Mothers who experienced depression had about 60% higher odds of experiencing severely inadequate housing due to heat (OR: 1.57) and 70% higher odds of experiencing energy insecurity (OR: 1.69) compared to mothers who did not experience depression. Maternal depression was even more strongly associated with multiple hardships in the forms of housing inadequacy plus housing instability and/or food insecurity than it was with housing inadequacy. This study provides robust evidence that maternal depression is a risk factor for inadequate housing and multiple hardships during a critical period of children's development. The findings suggest that policy efforts should not occur in mental health, housing, and food security silos.

Child Support Receipt, Mobility, and Housing Quality

This study uses administrative records for the state of Wisconsin as well as Zillow Real Estate data on median house values to examine the associations between the regularity of child support receipt on moves and changes in housing values following moves. Our sample consists of 13 329 custodial mothers with new orders from 2002 to 2006. Across several measures of child support and specifications of moves, regular receipt is negatively associated with any moves and with more than one move a year, holding constant the value of the child support received. In models examining associations between regularity and changes in housing quality after a move, an additional month of child support within 25 per cent of the order amount is associated with an $890 increase in housing value. These results imply that policy-makers concerned with housing stability consider both the regularity and absolute value of child support when considering family well-being.

Effects of infant health on family food insecurity: evidence from two U.S. birth cohort studies

Extremely little is known about the effects of health on food insecurity despite strong associations between the two and a theoretical basis for this avenue of inquiry. This study uses data from two national birth cohort studies in the U.S., the Early Childhood Longitudinal Study-Birth Cohort (N = ∼9400) from 2001 to 2003 and the Fragile Families and Child Wellbeing Study (N = 2458) from 1998 to 2003, to estimate the effects of poor infant health on child and household food insecurity and explore the potential buffering effects of public programs that provide food, healthcare, and cash assistance. We address the issue of causality by defining poor infant health as an unexpected shock and conducting relevant specification tests. We find convincing evidence that poor infant health does not affect food insecurity but that it greatly increases reliance on cash assistance for low-income individuals with disabilities, which appears to be playing a buffering role.

Maternal depression as a risk factor for family homelessness

OBJECTIVES

We estimated the effects of maternal depression during the postpartum year, which is often an unexpected event, on subsequent homelessness and risk of homelessness in a national sample of urban, mostly low-income mothers.

METHODS

We used logistic regression models to estimate associations between maternal depression during the postpartum year and both homelessness and risk of homelessness 2 to 3 years later, controlling for maternal and family history of depression, prenatal housing problems, and other covariates. Risk factors for homelessness included experiencing evictions or frequent moves and moving in with family or friends and not paying rent.

RESULTS

We found robust associations between maternal depression during the postpartum year and subsequent homelessness and risk of homelessness, even among mothers who had no history of mental illness, whose own mothers did not have a history of depressive symptoms, and who had no previous housing problems.

CONCLUSIONS

This study provides robust evidence that maternal mental illness places families with young children at risk for homelessness, contributes to the scant literature elucidating directional and causal links between mental illness and homelessness, and contributes to a stagnant but important literature on family homelessness.