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Gultekin L, Gilchrist C, Walker A, Hinebaugh A, Brush BL. Trauma-Disclosure, Meaning-Making, and Help-Seeking in Mothers Experiencing Homelessness: Results From a Trauma-Focused, Clinical Ethnographic Narrative Intervention. Violence Against Women 2024; 30:2877-2900. [PMID: 37128156 DOI: 10.1177/10778012231170860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Mothers experiencing homelessness are seldom asked about past trauma that may be causal to housing instability and poor health. There are also few validated trauma-focused interventions in family shelters. To address this gap, we tested the feasibility and acceptability of the trauma-focused clinical ethnographic narrative intervention (CENI-TF) in increasing mothers' trauma disclosure, appraisal of its meaning in their lives, and help-seeking behaviors. We also present the qualitative findings to contextualize the intervention. Findings are organized under three major domains and nine subthemes that capture participants' voices and experiences. The CENI-TF has the potential to promote help-seeking behaviors and interrupt recurring cycles of trauma and housing instability in this at-risk population.
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Affiliation(s)
- Laura Gultekin
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Andrea Walker
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Barbara L Brush
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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2
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Rahaman M, Das KC. Differentials in self-reported health status and healthcare utilization among homeless women during the antenatal period in urban settings: Does migration status matter? J Migr Health 2024; 10:100246. [PMID: 39169914 PMCID: PMC11338154 DOI: 10.1016/j.jmh.2024.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/01/2024] [Accepted: 07/13/2024] [Indexed: 08/23/2024] Open
Abstract
Background Limited studies have covered the nexus between homelessness, migration, and maternal health. However, most homeless women are migrants and have high-risk fertility behaviors. Therefore, the present study examines the variation in antenatal health and healthcare behavior among homeless women, focusing on migration status. Methods The present study employed a mixed-methods approach. A cross-sectional quantitative survey using Time and Location sampling (TLS) and face-to-face interviews was carried out for the quantitative component. Further, qualitative data was gathered through in-depth interviews using purposive sampling. Descriptive statistics, bivariate analysis with the Pearson chi-square test, and multivariate logistic models estimated qualitative results. Further, the thematic analysis presented qualitative findings. Results Out of 400 respondents, 76 % were migrants, and 57 % reported poor SRH. The likelihood of poor SRH was 1.07 times higher among migrants than non-migrants. A higher likelihood of poor SRH was found among beggars and ragpickers. Similarly, it was prevalent among the respondents who lived alone, mainly migrants. Almost 80 % of migrants reported experiencing depression. The unmet need for health visits was substantial among the study population (41 %), and it was found to be noteworthy among migrants (51 %). Several individual, socioeconomic, and structural factors were identified as barriers to healthcare utilization. Conclusion Poor antenatal health was substantial among homeless women, mainly migrants. Public and private healthcare visits were inadequate among homeless women who were migrants. Several individual, socioeconomic, and structural factors affected healthcare utilization. The study highlights the urgent need to introduce population-centric programs and policies to promote reproductive health among homeless women.
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Affiliation(s)
- Margubur Rahaman
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
- Research Associate, Govind Ballabh Pant Social Science Institute, Prayagraj, 211019, India
| | - Kailash Chandra Das
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
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Marea CX, Arno CA, McShane KS, Lozano A, Vanderpuije M, Robinson KN, Grace KT, Jeffers N. Navigating Homelessness Assistance While Pregnant: A Rapid Qualitative Research-to-Policy Collaboration in Washington, DC. Health Equity 2024; 8:325-337. [PMID: 39015221 PMCID: PMC11250836 DOI: 10.1089/heq.2023.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 07/18/2024] Open
Abstract
Background Homelessness during pregnancy contributes to adverse pregnancy and infant outcomes from birth through early childhood. Washington, DC, a microcosm of structural inequities in the United States, has persistent racial disparities in perinatal outcomes and housing insecurity. Methods Grounded in a reproductive justice framework, we explored the lived experience of navigating homelessness assistance while pregnant to inform recommendations for a collaborative policy and practice change effort. We conducted 20 individual interviews with DC residents who experienced homelessness during pregnancy. We analyzed the data using thematic analysis and an action-oriented approach. Results Our analysis resulted in three main recommendation areas for policy and practice change: (1) timely and meaningful access to safe and stable housing in pregnancy; (2) care coordination for services and referrals that support physical, mental, and social well-being; and (3) access to a living wage and affordable housing. Discussion Access to stable housing is critical to ensure that pregnant and parenting people can have and raise children in a safe and sustainable environment-key tenets of reproductive justice. Housing support must be meaningfully accessible, including service delivery that accommodates the complex social histories and competing demands that accompany housing insecurity. Health Equity Implications This study informed the development of strategic recommendations, catalyzed a new model for multisector collaboration, and influenced a system-wide practice change to expand access to robust housing supports for pregnant people. Policy and practice change require sustained leveraging of political will to promote economic justice and ensure that residents can achieve safe, sustainable, and affordable housing.
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Affiliation(s)
- Christina X. Marea
- School of Nursing, Georgetown University, Washington, District of Columbia, USA
| | - C. Anneta Arno
- Office of Health Equity, DC Department of Health, Washington, District of Columbia, USA
| | | | - Andrew Lozano
- Office of Health Equity, DC Department of Health, Washington, District of Columbia, USA
| | - Makeda Vanderpuije
- Office of Health Equity, DC Department of Health, Washington, District of Columbia, USA
| | | | | | - Noelene Jeffers
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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4
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Melchior M, Figueiredo N, Roversi A, Dubanchet A, Bui E, Vadell-Martínez J, Barbui C, Purgato M, Ayuso-Mateos JL, Mediavilla R, McDaid D, Park AL, Petri-Romão P, Kalisch R, Nicaise P, Lorant V, Sijbrandij M, Witteveen AB, Bryant R, Felez M, Underhill J, Pollice G, Tortelli A. Addressing mental health problems among persons without stable housing in the context of the COVID-19 pandemic: study protocol for a randomised trial. RESPOND - France. BMC Public Health 2023; 23:2275. [PMID: 37978577 PMCID: PMC10656934 DOI: 10.1186/s12889-023-17238-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/16/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had an impact on population-wide mental health and well-being. Although people experiencing socioeconomic disadvantage may be especially vulnerable, they experience barriers in accessing mental health care. To overcome these barriers, the World Health Organization (WHO) designed two scalable psychosocial interventions, namely the web-based Doing What Matters in Times of Stress (DWM) and the face-to-face Problem Management Plus (PM+), to help people manage stressful situations. Our study aims to test the effectiveness of a stepped-care program using DWM and PM + among individuals experiencing unstable housing in France - a majority of whom are migrant or have sought asylum. METHODS This is a randomised controlled trial to evaluate the effectiveness and cost effectiveness of a stepped-care program using DWM and PM + among persons with psychological distress and experiencing unstable housing, in comparison to enhanced care as usual (eCAU). Participants (N = 210) will be randomised to two parallel groups: eCAU or eCAU plus the stepped-care program. The main study outcomes are symptoms of depression and anxiety measured using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). DISCUSSION This randomised controlled trial will contribute to a better understanding of effective community-based scalable strategies that can help address the mental health needs of persons experiencing socioeconomic disadvantage, whose needs are high yet who frequently have limited access to mental health care services. TRIAL REGISTRATION this randomised trial has been registered at ClinicalTrials.gov under the number NCT05033210.
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Affiliation(s)
- Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France.
| | - Natasha Figueiredo
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Aurélia Roversi
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Alexandre Dubanchet
- CHU Caen, & Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", NeuroPresage Team, Cyceron, Caen, 14000, France
| | - Eric Bui
- CHU Caen, & Normandie Univ, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", NeuroPresage Team, Cyceron, Caen, 14000, France
| | - Julian Vadell-Martínez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Papoula Petri-Romão
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Pablo Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium
| | - Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Anke B Witteveen
- Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, VU University, Amsterdam, the Netherlands
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Mireia Felez
- Institut de recerca Sant Joan de Déu, Dr. Antoni Pujadas, Sant Boi de Llobregat (Barcelona), 4208830, Spain
| | | | - Giulia Pollice
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
| | - Andrea Tortelli
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, (IPLESP), Equipe de Recherche en Epidémiologie Sociale, Paris, F75012, France
- GHU Paris, Psychiatrie & Neurosciences - Pôle Psychiatrie Précarité, Paris, France
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5
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Carey N, Karwatzki E, Griffin V, Keville S. “Hell on Earth”: Single mothers’ experiences of temporary accommodation in London and its impact on their mental health. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2023. [DOI: 10.1080/13642537.2023.2175884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Nina Carey
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
| | - Emma Karwatzki
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
| | - Vanessa Griffin
- Child and Adolescent Mental Health Services, East London NHS Foundation Trust, London, UK
| | - Saskia Keville
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
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The perceived impact of homelessness on health during pregnancy and the postpartum period: A qualitative study carried out in the metropolitan area of Nantes, France. PLoS One 2023; 18:e0280273. [PMID: 36724156 PMCID: PMC9891509 DOI: 10.1371/journal.pone.0280273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/23/2022] [Indexed: 02/02/2023] Open
Abstract
The number of homeless people has been constantly increasing in Europe over recent years, as well as the proportion of women among the homeless population. Pregnancy can increase the risk of becoming homeless and, on the other hand, homelessness has been widely connected to adverse perinatal outcomes. The objective of this study was to describe the overall perceived impact of homelessness on health during pregnancy and the postpartum period, using a qualitative research approach to prioritize women's perspective. One-time semi structured interviews were conducted with 10 pregnant women and 10 women in the postpartum period experiencing homelessness in the metropolitan area of Nantes, as well as with six people from their social surroundings. A thematic analysis was performed to identify major themes and sub-themes. Homelessness was perceived as having an overall negative impact on all aspects of health (physical health, mental health, and social well-being) during pregnancy and the postpartum period. Stress and anxiety, food insecurity, social isolation, physical suffering, deterioration of chronic diseases, and pregnancy complications, were the main perceived consequences of homelessness on health. On the other hand, social support, and the "welcomeness" of healthcare professionals during pregnancy and the postpartum period were identified as capable of palliating those consequences. Finally, basic needs, such as having access to suitable housing, being independent, and being in good health, were identified by participants in the study as their main priorities. The results of this study, as well as those found by previous research, allowed us to identify possible axes in tackling homelessness and its complex consequences on health during pregnancy and the postpartum period. Housing and income assistance interventions, promoting social support and employment, outreach services enhancing collaborative networks among healthcare service providers, and integrating coordinated multidisciplinary approaches in primary care have shown to provide promising solutions to this issue.
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7
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Graf MDC, Dressel A, Schmitt M, Deal E, Pittman B, Lopez A, Kako P, Mkandawire-Valhmu L. 'I was broken in so many different ways': The intersection of complex factors impacting homeless and at-risk African American women's mental health and well-being. Int J Ment Health Nurs 2022; 31:167-178. [PMID: 34719091 DOI: 10.1111/inm.12946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
African American women are at higher risk of poor mental ill health compared with other racial and ethnic groups in the United States. For low-income and homeless African American populations, the risk of poor mental ill health is even higher. The purpose of our study was to learn what programmes at a long-term transitional living centre helped at-risk and homeless African American mothers to succeed on their own, in accordance with self-identified goals. We conducted ten focus group interviews with 39 graduates of a long-term transitional living centre located in a Midwestern city, and an individual interview with the founder of that centre (N = 40). Our study was informed by Black Feminist Thought, Life Course Theory, and an instrumental case study design. Thematic analysis was used to identify patterns in the qualitative data collected. Findings pertaining to mental health included impacts of adverse childhood experiences, lack of social networks, child placement in foster care, and implications on self-esteem and self-worth. Our findings demonstrate the need for healthcare providers to take into account the intersecting factors facing African American women experiencing homelessness undergirded by systemic racism, which impacts their mental health and well-being.
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Affiliation(s)
| | - Anne Dressel
- College of Nursing, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Marin Schmitt
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Emily Deal
- Joseph J. Zilber School of Public Health, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | | | - Alexa Lopez
- College of Nursing, University of Wisconsin Milwaukee, Milwaukee, WI, USA
| | - Penninah Kako
- College of Nursing, University of Wisconsin Milwaukee, Milwaukee, WI, USA
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Nyamathi AM, Gelberg L, Lee D, Arce N, Patten-Jones A, Yadav K, Goodwine M, Alikhani M, Yao M, Chang AH, Salem BE. Perceptions of Homeless Adults and Their Providers on Coping With the Impact of COVID-19 Pandemic on Mental Health, Substance Use, and Harm Reduction Services. Glob Qual Nurs Res 2022; 9:23333936221108712. [PMID: 35912133 PMCID: PMC9335488 DOI: 10.1177/23333936221108712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Adults experiencing homelessness experience a disproportionate burden of health disparities which has further exacerbated mental health, substance use, and coping during the COVID-19 pandemic. As limited data is available to understand the experience of adults experiencing homelessness and their health during this time, the purpose of this study was to explore how COVID-19 may have impacted their mental health, substance use, and ways of coping in this population. Using community-based participatory research, a community advisory board was established and remote individual interviews with 21 adults experiencing homelessness and 10 providers were conducted in Skid Row, Los Angeles. Using a qualitative, data analytic approach, the following major themes emerged: (1) Negative Impact of COVID-19 on Mental Health; (2) Negative Impact of COVID-19 on Limitation of Harm Reduction Services; and (3) Coping Strategies Utilized During the COVID-19 Pandemic. More research is needed to understand the impact of this pandemic on underserved communities.
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Affiliation(s)
| | - Lillian Gelberg
- David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Darlene Lee
- University of California, Irvine, California, USA
| | | | | | - Kartik Yadav
- University of California, Irvine, California, USA
| | | | | | - Maritas Yao
- University of California, Los Angeles, California, USA
| | - Alicia H Chang
- Los Angeles County Department of Public Health, California, USA
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Du X, Kim YK. Direct and Indirect Associations between Family Residential Mobility, Parent Functioning, and Adolescent Behavioral Health. JOURNAL OF CHILD AND FAMILY STUDIES 2021; 30:3055-3069. [PMID: 34664006 PMCID: PMC8515153 DOI: 10.1007/s10826-021-02129-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Residential mobility and caregiver social support are two key factors influencing adolescents' and their caregivers' health status. However, few studies have examined whether these factors vary across developmental periods. The present study therefore adopted a life course perspective to investigate the longitudinal effects of residential mobility and caregiver social support on a range of individual health outcomes (i.e., caregiver depression, adolescent internalizing problems, and adolescent externalizing problems) among families exposed to disadvantaged social and economic conditions. Data were obtained from the Longitudinal Studies in Child Abuse and Neglect, and 425 children and their caregivers who completed the age 12, 14, 16, and 18 interviews were included in this study. Structural equation modeling was conducted to test the measurement and structural models. The results showed that greater residential mobility was significantly associated with higher levels of caregiver depression, which in turn led to more adolescent internalizing and externalizing problems. Alternatively, higher levels of caregiver social support mitigated the levels of caregiver depression, which in turn resulted in fewer adolescent internalizing and externalizing problems. Highly mobile children and their caregivers were found to be vulnerable to several negative health outcomes and in high need of mental and behavioral health support and services. These findings inform important policy and practice implications on social support for mobile caregivers to address their children's behavioral problems.
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Affiliation(s)
- Xi Du
- School of Social Work, Louisiana State University, Baton Rouge, LA 70803 USA
| | - Youn Kyoung Kim
- School of Social Work, Louisiana State University, Baton Rouge, LA 70803 USA
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Frenoy P, Vandentorren S, Arnaud A, Vuillermoz C, Rico Berrocal R, Martin‐Fernandez J, Azria E, de Lauzon‐Guillain B, Bernard JY, Lioret S. Demographic, socioeconomic, and sociocultural factors associated with any breastfeeding in homeless mothers. MATERNAL & CHILD NUTRITION 2021; 17:e13167. [PMID: 33780138 PMCID: PMC8189215 DOI: 10.1111/mcn.13167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Abstract
In high-income countries, breastfeeding has been shown to be positively associated with socioeconomic position. However, less is known about breastfeeding practices and their associated factors among extremely disadvantaged populations. We aimed to assess the associations of cultural origins and socioeconomic factors with any breastfeeding initiation and duration in homeless families. We analyzed data from 456 children aged 6 months to 5 years from the cross-sectional ENFAMS survey, conducted in 2013 among a random sample of homeless families in shelters in the Greater Paris area. Data were collected by bilingual interviewers in 17 languages. Four nested multivariable robust Poisson regression models were run in a hierarchical framework to determine the factors associated with breastfeeding initiation and with any breastfeeding for 6 months or more. Most of the children (86.0%) had previously been or were currently being breastfed at the time of the survey; 58.9% were fed with breast milk ≥6 months. A higher maternal age and African origin were positively associated with breastfeeding ≥6 months, although the relation to the region of origin was moderated by education level. Migration to escape war, unrest or other violence and the child's birth in France were inversely associated with breastfeeding ≥6 months. Any breastfeeding by these homeless mothers seems influenced predominantly by their cultural origin and complicated by a difficult migration trajectory. The possible influence of poor material circumstances and cumulative hardship should encourage interventions targeted at homeless mothers that emphasize social/family support with a commitment to improving the family's living conditions.
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Affiliation(s)
| | - Stéphanie Vandentorren
- Santé Publique FranceFrench National Public Health AgencySaint‐MauriceFrance
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Department of Social EpidemiologyINSERM, Sorbonne UniversitéParisFrance
| | | | - Cécile Vuillermoz
- Institut Pierre Louis d'Épidémiologie et de Santé Publique, Department of Social EpidemiologyINSERM, Sorbonne UniversitéParisFrance
| | | | - Judith Martin‐Fernandez
- INSERM, Bordeaux Population Health Research Center, UMR 1219, CIC1401‐ECUniversity of Bordeaux, ISPEDBordeauxFrance
| | - Elie Azria
- Université de Paris, CRESS, INSERM, INRAEParisFrance
- Maternité Notre Dame de Bon Secours, Groupe Hospitalier Paris Saint JosephParisFrance
| | | | - Jonathan Y. Bernard
- Université de Paris, CRESS, INSERM, INRAEParisFrance
- Agency for Science, Technology and Research (A*STAR)Singapore Institute for Clinical Sciences (SICS)Singapore
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11
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Ayano G, Belete A, Duko B, Tsegay L, Dachew BA. Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people. BMJ Open 2021; 11:e040061. [PMID: 33622940 PMCID: PMC7907847 DOI: 10.1136/bmjopen-2020-040061] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the global prevalence estimates of depressive symptoms, dysthymia and major depressive disorders (MDDs) among homeless people. DESIGN Systematic review and meta-analysis. DATA SOURCES Databases including PubMed, Scopus and Web of Science were systematically searched up to February 2020 to identify relevant studies that have reported data on the prevalence of depressive symptoms, dysthymia and MDDs among homeless people. ELIGIBILITY CRITERIA Original epidemiological studies written in English that addressed the prevalence of depressive problems among homeless people. DATA EXTRACTION AND SYNTHESIS A random-effect meta-analysis was performed to pool the prevalence estimated from individual studies. Subgroup and sensitivity analyses were employed to compare the prevalence across the groups as well as to identify the source of heterogeneities. The Joanna Briggs Institute's quality assessment checklist was used to measure the study quality. Cochran's Q and the I2 test were used to assess heterogeneity between the studies. RESULTS Forty publications, including 17 215 participants, were included in the final analysis. This meta-analysis demonstrated considerably higher prevalence rates of depressive symptoms 46.72% (95% CI 37.77% to 55.90%), dysthymia 8.25% (95% CI 4.79% to 11.86%), as well as MDDs 26.24% (95% CI 21.02% to 32.22%) among homeless people. Our subgroup analysis showed that the prevalence of depressive symptoms was high among younger homeless people (<25 years of age), whereas the prevalence of MDD was high among older homeless people (>50 years of age) when compared with adults (25-50 years). CONCLUSION This review showed that nearly half, one-fourth and one-tenth of homeless people are suffering from depressive symptoms, dysthymia and MDDs, respectively, which are notably higher than the reported prevalence rates in the general population. The findings suggest the need for appropriate mental health prevention and treatment strategies for this population group.
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Affiliation(s)
- Getinet Ayano
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
- Department of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Asmare Belete
- Department of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Duko
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Light Tsegay
- Department of Psychiatry, Aksum University, Aksum, Ethiopia
| | - Berihun Assefa Dachew
- Department of Public Health, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
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Ayano G, Solomon M, Tsegay L, Yohannes K, Abraha M. A Systematic Review and Meta-Analysis of the Prevalence of Post-Traumatic Stress Disorder among Homeless People. Psychiatr Q 2020; 91:949-963. [PMID: 32415465 DOI: 10.1007/s11126-020-09746-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Post-traumatic stress disorder (PTSD) is common among homeless people and is associated with an increased risk of mortality from suicide, medical causes, and drug-related problems. However, there are no previous systematic review and meta-analysis studies that reported the consolidated magnitude of PTSD among homeless people. A literature search was conducted on PubMed, Embase, and Scopus to discover pertinent studies that determined the prevalence of PTSD among the homeless. Articles were evaluated by titles, abstracts, and full-text. Comprehensive meta-analysis software was used to conduct the meta-analysis. Subgroup and sensitivity analysis were performed and Cochran's Q- and the I2 test were used to assess heterogeneity. The evidence of publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots. From the total, 19 studies with 20,364 participants across seven countries were included in the final analysis. Our meta-analysis revealed that the pooled prevalence of PTSD among homeless people was 27.38% (95% CI; 21.95-33.57). In our subgroup analysis, we found that the prevalence of PTSD was considerably high as measured by the screening instrument (35.93%) than the diagnostic instrument (23.57% %). The prevalence of PTSD among homeless showed a significant variation by the location of the studies, the instruments used to measure PTSD as well as the quality of the included studies. This review showed that the pooled prevalence estimate of PTSD among homeless peoples was remarkably high (27.38%). Early screening and treatment of PTSD among homeless peoples are warranted to alleviate suffering.
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
- School of public health, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102, Australia.
| | - Melat Solomon
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Light Tsegay
- Department of Psychiatry, Aksum University, Aksum, Ethiopia
| | | | - Mebratu Abraha
- Department of Psychiatry, Paulo's millennium medical college, Addis Ababa, Ethiopia
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Mansor-Lefebvre S, Le Strat Y, Bernadou A, Vignier N, Guthmann JP, Arnaud A, Lévy-Bruhl D, Vandentorren S. Diphtheria-Tetanus-Polio, Measles-Mumps-Rubella, and Hepatitis B Vaccination Coverage and Associated Factors among Homeless Children in the Paris Region in 2013: Results from the ENFAMS Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2854. [PMID: 32326203 PMCID: PMC7216283 DOI: 10.3390/ijerph17082854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/03/2020] [Accepted: 04/18/2020] [Indexed: 12/20/2022]
Abstract
Background: The number of homeless families has increased considerably since the 1990s in France. We aimed to estimate the homeless children vaccination coverage (VC) for diphtheria, tetanus, polio, measles-mumps-rubella and hepatitis B and identify factors associated with insufficient VC according to birthplace. Methods: A cross-sectional survey was conducted among homeless shelter families in the greater Paris area. A nurse conducted face-to-face interviews and collected vaccination records. We analyzed factors associated with insufficient VC, stratified by birthplace and vaccine, using robust Poisson regression. Results: The study included 214 children born in France and 236 born outside France. VC in French-born homeless children was high (>90% at 24 months for most vaccinations) and similar to levels observed in the general population, whereas VC in those born outside France was low (<50% at 24 months for all vaccines). Factors significantly associated with insufficient VC among children born outside France were age, parents with French-language difficulties, and changing residence at least twice in the previous year. Children in contact with the healthcare system at least once in the previous year had significantly higher VC, irrespective of vaccine and birthplace. Conclusion: Special attention should be paid to homeless children born outside France, with recent European and French recommendations confirming the need for catch-up vaccination in children with undocumented VC.
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Affiliation(s)
- Samreen Mansor-Lefebvre
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (S.M.-L.); (Y.L.S.); (A.B.); (J.-P.G.); (D.L.-B.)
- Ecoles des Hautes Etudes en santé Publique, 35043 Rennes, France
| | - Yann Le Strat
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (S.M.-L.); (Y.L.S.); (A.B.); (J.-P.G.); (D.L.-B.)
| | - Anne Bernadou
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (S.M.-L.); (Y.L.S.); (A.B.); (J.-P.G.); (D.L.-B.)
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), 169 73 Solna, Sweden
| | - Nicolas Vignier
- Department of Social Epidemiology, Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), F75012 Paris, France;
- Department of Infectious Disease and Tropical Medicine, Groupe Hospitalier Sud Île de France, 77000 Melun, France
- Institut Convergences et Migration, 93300 Aubervilliers, France
| | - Jean-Paul Guthmann
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (S.M.-L.); (Y.L.S.); (A.B.); (J.-P.G.); (D.L.-B.)
| | | | - Daniel Lévy-Bruhl
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (S.M.-L.); (Y.L.S.); (A.B.); (J.-P.G.); (D.L.-B.)
| | - Stéphanie Vandentorren
- Santé Publique France, French National Public Health Agency, F-94415 Saint-Maurice, France; (S.M.-L.); (Y.L.S.); (A.B.); (J.-P.G.); (D.L.-B.)
- Department of Social Epidemiology, Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), F75012 Paris, France;
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