Depressive symptoms and patterns of drug use among street youth

A systematic review and meta-analysis of health, functional, and cognitive outcomes in young people who use methamphetamine

Methamphetamine use typically starts in adolescence, and early onset is associated with worse outcomes. Yet, health, functional, and cognitive outcomes associated with methamphetamine use in young people are not well understood. The aim of this study was to comprehensively assess the evidence on health, functional, and cognitive outcomes in young people (10-25 years-old) who use methamphetamine. Sixty-six studies were included. The strongest association observed was with conduct disorder, with young people who use methamphetamine some 13 times more likely to meet conduct disorder criteria than controls. They were also more likely to have justice system involvement and to perpetrate violence against others. Educational problems were consistently associated with youth methamphetamine use. The cognitive domain most reliably implicated was inhibitory control. Key limitations in the literature were identified, including heterogenous measurement of exposure and outcomes, lack of adequate controls, and limited longitudinal evidence. Outcomes identified in the present review - suggesting complex and clinically significant behavioural issues in this population - are informative for the development of future research and targeted treatments.

Alcohol, tobacco and drug use among adults experiencing homelessness in Accra, Ghana: A cross-sectional study of risk levels and associated factors

BACKGROUND

Substance use contributes to poor health and increases the risk of mortality in the homeless population. This study assessed the prevalence and risk levels of substance use and associated factors among adults experiencing homelessness in Accra, Ghana.

METHODS

305 adults currently experiencing sheltered and unsheltered homelessness in Accra aged ≥ 18 years were recruited. The World Health Organization's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess substance use risk levels. Association of high-risk substance use with sociodemographic, migration, homelessness, and health characteristics were assessed using logistic regression.

RESULTS

Nearly three-quarters (71%, n = 216) of the sample had ever used a substance, almost all of whom engaged in ASSIST-defined moderate-risk (55%) or high-risk (40%) use. Survivors of physical or emotional violence (AOR = 3.54; 95% confidence interval [CI] 1.89-6.65, p<.001) and sexual violence (AOR = 3.94; 95%CI 1.85-8.39, p<.001) had significantly higher odds of engaging in high-risk substance use, particularly alcohol, cocaine, and cannabis. The likelihood of engaging in high-risk substance use was higher for men than women (AOR = 4.09; 95%CI 2.06-8.12, p<.001) but lower for those in the middle-income group compared to low-income (AOR = 3.94; 95%CI 1.85-8.39, p<.001).

CONCLUSIONS

Risky substance use was common among adults experiencing homelessness in Accra, and strongly associated with violent victimisation, gender, and income levels. The findings highlight the urgent need for effective and targeted preventive and health-risk reduction strategies to address risky substance use in the homeless population in Accra and similar cities within Ghana and sub-Sahara Africa with a high burden of homelessness.

Evaluation of General Health Status of Persons Living in Socio-Economically Disadvantaged Neighborhoods in a Large European Metropolitan City

Background: Living in socio-economically disadvantaged neighborhoods can predispose persons to numerous health conditions. The purpose of this study was to report the general health conditions of persons living in disadvantaged neighborhoods in Rome, Italy, a large European metropolitan city. Participants were reached through the mobile facilities of the primary care services of the Dicastery for the Charity Services, Vatican City. Methods: People living in disadvantaged neighborhoods were reached with mobile medical units by doctors, nurses, and paramedics. Demographic characteristics, degree of social integration, housing conditions, and history of smoking and/or alcohol use were investigated. Unstructured interviews and general health assessments were performed to investigate common acute and/or chronic diseases, and history of positivity to COVID-19. Basic health parameters were measured; data were collected and analyzed. Results: Over a 10-month period, 436 individuals aged 18–95 years were enrolled in the study. Most lived in dormitories, whereas a few lived in unsheltered settings. Most participants (76%) were unemployed. Smoking and drinking habits were comparable to the general population. The most common pathological conditions were cardiovascular diseases in 103 subjects (23.39%), diabetes in 65 (14.9%), followed by musculoskeletal system disorders (11.7%), eye diseases (10.5%), psychiatric conditions such as anxiety and depression (9.2%), and chronic respiratory conditions (8.7%). Conclusions: Subjects in our sample showed several pathologic conditions that may be related to their living conditions, thus encouraging the development of more efficient and effective strategies for a population-tailored diagnosis and treatment.

Prevalence and Correlates of Illicit Substance Use Among Young Adults Experiencing Homelessness in Seven Cities Across the United States

Background

Young adults experiencing homelessness (YAEH) engage in substantially higher substance use rates than housed young adults. This current study builds on previous research by investigating the prevalence of and salient correlates of illicit substance use across a seven-city sample.

Methods

This study used the Homeless Youth Risk and Resiliency Survey (HYRRS) dataset, n=1426 Young adults experiencing homelessness to study patterns and correlates of illicit substance use.

Results

Multivariate logistic regression analyses were used to assess correlates of substance use. Study site, age, gender identity, sexual orientation, history of suicidal ideation, use of specific substances, and trading sex for drugs were associated with five types of illicit substance use (ecstasy, cocaine, crack, methamphetamine, and injection drug use).

Conclusion

Findings indicate that substance use interventions for YAEH must be multifaceted, addressing illicit and multiple substance use, along with the myriad factors associated with substance use among this at-risk group.

Ketamine use in relation to depressive symptoms among high school seniors

BACKGROUND AND OBJECTIVES

Ketamine is efficacious in treating treatment-resistant depression in medical settings and the drug was approved for such use by the US Federal Drug Administration in 2019. However, little is known about how use outside of medical settings relates to depression. We determined whether recreational ketamine use, relative to the use of other drugs, is related to the current experience of depression among adolescents.

METHODS

We examined data from the 2016 to 2019 Monitoring the Future nationally representative survey of high school seniors in the United States (N = 15,673). We determined how past-year drug use and frequency of past-year drug use were associated with students reporting a high level of current depressive symptoms relative to other students.

RESULTS

Ketamine use was associated with highest risk for a high level of depression (aPR = 1.55, 95% confidence interval [CI]: 1.24-1.94), followed by use of cannabis (aPR = 1.29, 95% CI: 1.19-1.39), and nonmedical use of tranquilizers (aPR = 1.22, 95% CI: 1.04-1.44) and amphetamine (aPR = 1.17, 95% CI: 1.01-1.34). Alcohol use was associated with decreased risk (aPR = 0.92, 95% CI: 0.85-0.99). With respect to frequency of past-year use, more frequent use of ketamine and cannabis was associated with increased risk for a high level of depression in a dose-response-like manner, with past-year use of ketamine and cannabis ≥10 times associated with increased risk for depression by 70% and 40%, respectively.

DISCUSSION AND CONCLUSIONS

Past-year recreational ketamine use is a risk factor for reporting current depression than most other drugs.

SCIENTIFIC SIGNIFICANCE

This was the first study to compare the risk of use of various drugs in relation to depression.

Bullying at School and on the Street: Risk Factors and Outcomes Among Homeless Youth

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.

Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people

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.

Suspected Nonfatal Drug-Related Overdoses Among Youth in the US: 2016-2019

BACKGROUND AND OBJECTIVES

During the current drug overdose crisis, the United States is experiencing a significant number of overdose deaths, hospitalizations, and emergency department visits. Given the vulnerability of young persons to substance use, it is important to assess how this crisis affects the nation's youth. In this study, we investigate trends in suspected nonfatal drug-related overdoses (all-drugs, opioids, heroin, and stimulants) among youth using syndromic surveillance data from 2016 to 2019.

METHODS

A retrospective analysis of emergency department syndromic surveillance data were used to detect quarterly trends in suspected drug overdoses from April 2016 through September 2019 among youth aged 0 to 10, 11 to 14, and 15 to 24 years. Syndrome definitions were developed using chief complaint free-text and discharge diagnosis codes to identify overdoses involving all-drugs, opioids, heroin, and stimulants. Pearson χ² tests detected quarter-to-quarter changes, and joinpoint regression analysis assessed trends over time.

RESULTS

On average, there was a 2.0% increase for youth aged 0 to 10 years and a 2.3% increase for youth aged 11 to 14 years for suspected all-drug overdoses. Suspected heroin overdoses decreased by an average of 3.3% per quarter for youth aged 15 to 24 years. Among all age groups, suspected stimulant overdoses increased across the study period, 3.3% for 0 to 10-year-olds, 4.0% for 11- to 14-year-olds, and 2.3% for 15- to 24-year-olds.

CONCLUSIONS

Suspected stimulant-involved drug overdoses appear to be rising among youth. These findings could inform targeted interventions, such as stimulant-focused prevention, and comprehensive approaches, including school-based prevention and other strategies to lower morbidity and mortality.

Argyrophilic nucleolar organizer regions in oral mucosa cells of crack and cocaine users: a cross-sectional study

The objective of this study was to analyze and compare the presence of argyrophilic nucleolar organizer regions (AgNORs) in exfoliated cells obtained from the buccal mucosa among crack and cocaine users and non-users by the AgNOR staining technique. Seventy-three males ≥ 18 years were categorized into two groups: 38 crack and/or cocaine users and 35 non-user volunteers. They were interviewed and responded a questionnaire regarding general health and drug addiction. Exfoliative cytology specimens were collected from the clinically intact buccal mucosa, and cytological preparations were fixed and stained by AgNOR technique. The mean number of AgNORs (p = 0.02) and the percentage of epithelial cells with more than 3 (p = 0.01) and 4 (p = 0.04) AgNORs/nucleus were significantly higher in the non-user group. In conclusion, the frequency and diversity of substances present in the drugs-cocaine, crack, and alcohol-consumed by the volunteers of this study may have influenced the number of AgNORs and the response to damage and consequent effect on protein synthesis.

Short Message Service Surveying With Homeless Youth: Findings From a 30-Day Study of Sleeping Arrangements and Well-Being

Little is known about the location and consistency of sleeping arrangements among youth experiencing homelessness (YEH) and how this is linked to their well-being. This study addresses this gap using ecological momentary assessment (EMA) via short message service (SMS) surveying with 150 YEH over 30 days, to examine how various sleeping arrangements are associated with depression, marijuana use, support received, and service utilization. Results revealed that the average number of consecutive days youth stayed at any particular location varied considerably. Youth who stayed more frequently with a friend/partner or in a transitional living facility (TLF) reported fewer days of being depressed, whereas staying with a friend/ partner was associated with using marijuana more frequently. Finally, youth staying with a friend/partner, stranger, or TLF reported using services on fewer days. Because sleeping arrangements change almost daily, on average, this has important public health implications for agencies finding permanent housing for YEH.

Identifying and managing infectious disease syndemics in patients with HIV

PURPOSE OF REVIEW

We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics.

RECENT FINDINGS

Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach.

SUMMARY

HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.

"This Research Is Cool": Engaging Youth Experiencing Homelessness in Research on Reproductive and Sexual Health

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.

The consequences of regular methamphetamine use in Tehran: qualitative content analysis

BACKGROUND

In recent years, methamphetamine use has increased noticeably in Iran, and this can make harmful consequences for the health of individuals and society. Therefore, the study aimed to investigate the consequences of regular methamphetamine use in Tehran.

METHODS

This study was conducted based on a conventional content analysis approach. Data were collected through observation and in-depth interviews with 20 regular adult users of methamphetamine in Tehran (including 15 males and 5 females). Participants were selected using snowball sampling and purposeful sampling, which continued until data saturation. Guba and Lincoln's criteria were used to assess the strength of the study.

RESULTS

The extraction of the codes resulted in three main categories: (1)the short-term consequences, consisting of the sub-categories of individual and social consequences, (2) the long-term consequences, consisting of the sub-categories of psychological and physical consequences, high-risk behaviors, severely decayed memory and changes in the eating pattern, and (3) hallucinations and delusions including the sub-categories of visual and auditory hallucinations, persecutory delusions and delusion of having supernatural power.

CONCLUSION

Regular methamphetamine use may have serious adverse effects on the overall health of individuals. It is therefore highly recommended that educational programs must implement with the use of methamphetamine in the high- risk groups in order to raise awareness and change attitudes about the short and long term consequences. is highly recommended.

Childhood Disadvantage, Social and Psychological Stress, and Substance Use Among Homeless Youth: A Life Stress Framework

We used a life stress framework to examine linkages between distal or primary stressors (e.g., child abuse) and proximal or secondary stressors (e.g., street victimization) and their association with substance use among 150 youth experiencing homelessness in the Midwestern United States. Results revealed that numerous primary stressors such as number of times youth ran from home and number of foster care placements were associated with secondary stressors, such as anxiety, total duration of homelessness, and street victimization. Only street physical victimization (e.g., been beaten up since leaving home) was associated with greater substance use. Our findings provide a more holistic picture of both distal and proximal life stressors that these young people experience and reveal the complexity of issues that service providers must acknowledge when working with this population.

Risk and Protective Factors for Substance Use Among Youth Experiencing Homelessness

BACKGROUND

Though research finds that youth experiencing homelessness (YEH) have high rates of substance use, which can lead to numerous long-term negative health effects, less is known about both risk and protective factors for substance use. Moreover, even less is known about whether these factors differ for lesbian, gay and bisexual (LGB) youth compared to non-LGB youth. In the current study, we compared risk and protective factors for binge drinking, marijuana use, and illicit drug use (i.e. substance use) among heterosexual and sexual minority YEH.

METHODS

The sample included 322 young people experiencing homelessness in the Midwestern United States and who were between 16 and 26 years of age. Almost one-half of our sample were female (N = 146; 45%) and 68 youth (21%) identified as LGB.

RESULTS

Youth who experienced more child physical abuse, ran away from home more frequently, and those who had a parent(s) with drug problems were more likely to have reported binge drinking in the past 30 days. Additionally, having parents with drug problems was associated with the use of marijuana and illicit drugs. Conversely, having higher parental monitoring while growing up reduced the likelihood of using marijuana and illicit drugs. Tests for interactions revealed that while self-efficacy had no relationship with the probability of binge drinking for heterosexual youth, as self-efficacy increased, the probability of binge drinking declined drastically for sexual minority youth suggesting this protective mechanism operates differently for these two groups of youth. Additionally, tests of interactions showed that the probability of binge drinking among heterosexual and sexual minority youth also varied by child sexual abuse and street sexual victimization.

CONCLUSION

Study results have implications for service providers who serve YEH.

Association between cumulating substances use and cumulating several school, violence and mental health difficulties in early adolescents

Multiple substances (alcohol, tobacco, cannabis and other illicit drugs (OID)) have been frequently used in early adolescents maybe due to school, violence and mental-health difficulties. We investigated the associations between substance-use patterns and related difficulties among 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed a questionnaire including socioeconomic features, school, violence and mental-health difficulties (school grade repetition, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms and suicide attempt; cumulated number noted SVMD_score) and the time of their first occurrence during the life course. Data were analyzed using logistic and negative binomial regression models. Alcohol, tobacco, cannabis and OID use affected 35.2, 11.2, 5.6 and 2.8% of the subjects respectively. The risk of using tobacco only, alcohol and tobacco, alcohol plus tobacco and cannabis, or all alcohol, tobacco, cannabis and OID strongly increased with the SVMD_score (socioeconomic features-adjusted odds ratio reaching 85). The risk began in early years in middle schools and then steadily increased, more markedly for elevated SVMD_score. Exposure to several SVMDs may be a transmission vector towards the substance use, starting mostly with alcohol/tobacco, and then shifting to cannabis/OID. These findings help to understand substance-use risk patterns and identify at-risk adolescents.

Understanding Daily Depression, Drinking, and Marijuana Use among Homeless Youth using Short Message Service Surveying

We used short message service surveying (SMS) with 150 homeless youth to examine the time ordering of feeling depressed with drinking alcohol, using marijuana, and using substances with friends. Multilevel binary logistic regression results revealed that youth who were depressed earlier in the day were more likely to drink alcohol later that day. Among depressed youth, heterosexual youth were less likely to drink alcohol than lesbian, gay, and bisexual (LGB) youth. Depressed youth had increased odds of using marijuana by a factor of 1.6, while heterosexual youth, compared to LGB youth, were 80% less likely to use marijuana. Females were 82% less likely and heterosexual youth 75% less likely to use substances with friends compared to males and LGB youth, respectively. These findings improve upon prior retrospective studies by using SMS to understand time ordering between feeling depressed and substance use in the same day.

Prevalence and Correlates of Depressive Symptomology among Young Adults Who Use Prescription Opioids Non-medically

Non-medical prescription opioid (NMPO) use and depression frequently co-occur and are mutually reinforcing in adults, yet NMPO use and depression in younger populations has been under-studied. We examined the prevalence and correlates of depressive symptomology among NMPO-using young adults. The Rhode Island Young Adult Prescription Drug Study (RAPiDS) recruited young adults in Rhode Island who reported past 30-day NMPO use. We administered the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and used modified Poisson regression to identify the independent correlates of depressive symptomology (CES-D 10 score ≥10). Over half (59.8%, n = 119) screened positive for depressive symptomology. In modified Poisson regression analysis, diagnostic history of depressive disorder and childhood verbal abuse were associated with depressive symptomology. Participants with depressive symptomology were more likely to report using prescription opioids non-medically to feel less depressed or anxious, to avoid withdrawal symptoms, and as a substitute when other drugs are not available. Among young adult NMPO users, depressive symptomology is prevalent and associated with distinct motivations for engaging in NMPO use and represents a potential subgroup for intervention. Improving guidelines with tools such as screening for depressive symptomology among young adult NMPO users may help prevent NMPO-related harms.

Associations of childhood maltreatment with subsequent illicit drug use among Chinese adolescents: The moderating role of the child's sex

Adolescence is a critical period for the onset of illicit drug use. This study aimed to estimate the prevalence of illicit drug use among Chinese adolescents, to assess the associations between different forms of childhood maltreatment and subsequent illicit drug use and to test whether the child's sex plays a moderating role in the associations. A secondary analysis was made of cross-sectional data collected from 10th to 12th graders from China who were sampled in the 2015 School-based Chinese Adolescents Health Survey. A total of 59,518 questionnaires were included in the final analysis. The prevalence estimates and logistic regression analyses were weighted to account for the complex survey design. If the interaction term (between childhood maltreatment and sex) was significantly associated with illicit drug use, we would perform stratification analyses across sex. Of the total sample, 45.2% were boys, and the mean (SD) age was 17.0 (0.9) years. The results of stratification analyses demonstrated that among boys, physical abuse and sexual abuse were independently associated with an increased risk of use during their lifetime of MDMA, methamphetamine, ketamine, and mephedrone; among girls, only emotional abuse and sexual abuse were associated with MDMA use, methamphetamine use, ketamine use, and mephedrone use.

Food insufficiency is associated with depression among street-involved youth in a Canadian setting

OBJECTIVE

Food insufficiency, defined by the experience of hunger, is known to be prevalent and a source of health-related harm among-street involved youth, but little is known about its relationship with depression in this population. Therefore, we sought to assess the association between food insufficiency and symptoms of depression among a cohort of street-involved youth.

DESIGN

Multivariable logistic regression was used to assess the relationship between food insufficiency, defined as being hungry but not having enough money to buy food, and depression as measured by the Center for Epidemiological Studies Depression (CES-D) scale.

SETTING

Data from April 2006 to November 2013 were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use illicit drugs in Vancouver, Canada.

SUBJECTS

There were 1066 street-involved youth enrolled in the study, including 340 (31·9 %) females.

RESULTS

Of 1066 youth enrolled in the study, 724 (67·9 %) reported some food insufficiency and 565 (53·0 %) met criteria for depression. Compared with youth who did not report food insufficiency, those who reported often experiencing food insufficiency had a higher likelihood of reporting depression (adjusted OR=2·52; 95 % CI 1·74, 3·67), as did those who reported sometimes experiencing food insufficiency (adjusted OR=1·99; 95 % CI 1·47, 2·70).

CONCLUSIONS

Food insufficiency was prevalent and associated in a dose-dependent trend with symptoms of depression among street-involved youth in our setting. Findings highlight the need to address the nutritional and mental health needs of youth and identify pathways by which food insufficiency may contribute to depression among vulnerable populations.

Examining the Feasibility of Ecological Momentary Assessment Using Short Message Service Surveying with Homeless Youth: Lessons Learned

We assessed the feasibility of ecological momentary assessment using short message service (SMS) surveying with 150 homeless youth. We found that on average, participants completed 18.8 days of texts, but 30% of youth (N = 44) had texting data on 28 or more days. The average number of texts answered per day was 8.49 (of a possible 11). Forty-three percent of days had answers to all 11 texts sent that day, and 69.4% of days had answers to eight or more texts. We found significant differences in response rates by phone type. Seventy-three percent of youth reported that responding to our texts was very easy or somewhat easy and 69% endorsed the response option "just enough," regarding the number of texts sent per day. The 30-day texting period was deemed "about right" by 74% of youth. Details of using SMS with homeless youth are provided, and results indicate that this data collection technique is feasible with this population.

Role of Social Environmental Protective Factors on Anxiety and Depressive Symptoms Among Midwestern Homeless Youth

We employ a social stress framework, which examines the influence of multiple stressors (e.g., physical abuse, foster care placement) on an individual's ability to function (e.g., mental well-being), to longitudinally examine the effects of stressful life events on mental health and the role of the social environment in this process among 150 homeless youth. Results revealed that numerous stressors, such as physical abuse and running away from home more frequently, were associated with greater depressive symptoms and elevated anxiety. Having mentors and family and friends from home that youth can rely on resulted in more positive social support, which subsequently lowered the risk for depressive symptoms and anxiety at wave 2.

Nonmedical prescription opioid use and illegal drug use: initiation trajectory and related risks among people who use illegal drugs in Vancouver, Canada

Objective

We investigated the prevalence of and risk factors associated with initiating nonmedical prescription opioid use (NMPOU) before and after illegal drugs using data from two linked cohort studies of street youth and adults who use illegal drugs in Vancouver, Canada. All participants who attended a study visit between 2013 and 2016 were eligible for the primary analyses.

Results

Among 512 youth and 833 adult participants, the prevalence of NMPOU was extremely high (88% among street youth; 90% among adults), and over one-third of those who reported engaging in NMPOU had initiated NMPOU before illegal drug use (vs. transitioning from illegal drugs to NMPOU). Participants who reported either transitioning to or from NMPOU had higher risk profiles, particularly related to substance use, when compared with those who reported never engaging in NMPOU. Sub-analyses restricted to only those who engaged in NMPOU found few statistically significant differences between those who initiated NMPOU prior to illegal drugs versus those who initiated illegal drugs prior to NMPOU. Findings suggest that among people who use illegal drugs, early NMPOU trajectories do not appear to critically shape future patterns and practices.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3152-9) contains supplementary material, which is available to authorized users.

The Relative Influence of Injunctive and Descriptive Social Norms on Methamphetamine, Heroin, and Injection Drug Use Among Homeless Youths: The Impact of Different Referent Groups

The current study assessed the relative influence of both injunctive and descriptive norms in the context of different referent groups (i.e., family, street peers, home-based peers, and staff members) on past 30-day methamphetamine, heroin, and injection drug use behaviors of homeless youth. Cross-sectional data ( N = 911) were collected from three drop-in centers in Los Angeles, California. The study consisted of two parts: a social network interview and a computerized self-administered survey. Multivariate logistic regression models examined the association of objection to drug use from referent groups (injunctive norms; that is, street-based peers, home-based peers, relatives, staff members) and drug use of referent groups (descriptive norms) with youths’ substance use behaviors. Multivariate results indicated that the role of injunctive and descriptive norms varied across the three substance use behaviors and by referent group. Findings indicate the need to carefully consider the diversity of homeless youths’ networks in designing substance use interventions.

Relations between mental health diagnoses, mental health treatment, and substance use in homeless youth

BACKGROUND

Youth experiencing homelessness have elevated rates of mental illness and substance use compared to the general population. However, the extent to which underlying mental health issues may contribute to substance use as a way to manage symptoms and whether mental health treatment may reduce risk for substance use is unclear. This paper investigated these relations in a community sample of homeless youth.

METHODS

Youth ages 13-24 (N=416) were interviewed as part of a community count and survey of homeless youth in Houston, Texas. A path analysis examined relations among lifetime diagnoses of ADHD, bipolar disorder, and depression; past-month marijuana, alcohol, and synthetic marijuana use, and hypothesized mediators of past-year mental health treatment and perceived unmet need for treatment.

RESULTS

Rates of prior mental disorder diagnoses were high, with extensive comorbidity across the three diagnoses (n=114, 27.3% had all three diagnoses). Relations varied by diagnoses and substances. ADHD was positively related to current marijuana use (β=0.55 (0.16), p<0.001), a relation that mental health treatment did not mediate. Depression was positively related to synthetic marijuana use through unmet need (β=0.25 (0.09), p=0.004) and to alcohol use through unmet need (β=0.20 (0.10), p=0.04) CONCLUSIONS: This study provides new information about relations between prior mental health diagnoses and substance use in homeless youth. Findings support the need to consider prior mental disorder diagnoses in relation to current substance use and to assess for whether youth perceive they have unmet needs for mental health treatment.

Using Cell Phones for Data Collection: Benefits, Outcomes, and Intervention Possibilities with Homeless Youth

While many homeless youth use cell phones to stay socially connected, and maintaining positive social ties can contribute to pathways out of homelessness, little is known about how using cell phones for data collection can improve these young people's lives. We conducted baseline and follow-up interviews with 150 homeless youth as well as provided them with a cell phone for 30 days to gather daily data using short message service (SMS) surveying. This paper examines youths' opinions about study participation and how they used the cell phone. Results revealed that youth liked participating in the study because the SMS texting portion, for example, made them feel that someone still cared about them, prompted them to self-reflect on their life, and allowed them to make a difference (e.g. educating the public about homelessness). Despite numerous benefits of study participation, improvements that youth discussed for future studies included changing the format of our text questions to allow for explanations and the use of higher quality phones. In terms of study phone usage, youth reported using the phone to schedule appointments, contact employers, and to keep in touch with family and friends. Finally, we highlight ways in which cell phones via SMS could be used with homeless youth to provide informational resources along with educational and employment opportunities, all of which are important intervention strategies in improving life situations for this population.

Depressive Symptoms and their Association With Adverse Environmental Factors and Substance Use in Runaway and Homeless Youths

We used diathesis-stress and stress-sensitization models to determine whether family maltreatment, street-related traumatic events, stressful life events, and substance use were associated with depressive symptoms in runaway and homeless youths (RHY) in Los Angeles. Greater severity of depressive symptoms was significantly related to family maltreatment, being exposed to more traumatic stressors during homelessness, and current substance use compared to no substance use. Family maltreatment was also found to moderate the relationship between traumatic stressors and depressive symptoms. Importantly, cumulative exposure to the investigated risk factors at varying levels was associated with more severe depressive symptoms. Using a trauma-informed approach to screen for RHY at risk of depression may pave the way for secondary prevention of major depression in RHY.

Stimulants and Cannabis Use Among a Marginalized Population in British Columbia, Canada: Role of Trauma and Incarceration

High rates of substance use, especially cannabis and stimulant use, have been associated with homelessness, exposure to trauma, and involvement with the criminal justice system. This study explored differences in substance use (cannabis vs. stimulants) and associations with trauma and incarceration among a homeless population. Data were derived from the BC Health of the Homeless Study (BCHOHS), carried out in three cities in British Columbia, Canada. Measures included sociodemographic information, the Maudsley Addiction Profile (MAP), the Childhood Trauma Questionnaire (CTQ), and the Mini International Neuropsychiatric Interview (MINI) Plus. Stimulant users were more likely to be female (43%), using multiple substances (3.2), and engaging in survival sex (14%). Cannabis users had higher rates of lifetime psychotic disorders (32%). Among the incarcerated, cannabis users had been subjected to greater emotional neglect (p < .05) and one in two cannabis users had a history of lifetime depressive disorders (p < .05). Childhood physical abuse and Caucasian ethnicity were also associated with greater crack cocaine use. One explanation for the results is that a history of childhood abuse may lead to a developmental cascade of depressive symptoms and other psychopathology, increasing the chances of cannabis dependence and the development of psychosis.

Health, perceived quality of life and health services use among homeless illicit drug users

INTRODUCTION

Drug misuse has been identified as a significant problem in homeless populations. This study examines aspects of physical and mental health, perceived quality of life and health service use among homeless illicit drug users and compares these to non-drug users.

METHODS

Participants were recruited through health clinics across Dublin. A questionnaire assessed participants' drug use, health and well-being, health behaviours and use of health services. Descriptive statistics are presented for the entire cohort and drug users separately. Logistic regression analysis was used to examine the relationship between drug use and (i) multimorbidity, (ii) anxiety and/or depression, (iii) perceived quality of life and (iv) use of health services.

RESULTS

Of 105 participants recruited, 35 (33%) were current drug users. Current and previous drug users were significantly more likely to have multimorbidity than those who had never taken drugs (OR 4.86, 95% CI 1.00-23.66). There was no significant difference between drug users and non-drug users in the prevalence of anxiety and/or depression. Drug users were five times more likely than non-drug users to have a low perceived quality of life (OR 5.2, 95% CI 1.7-16.0). Health service utilization was high, although some services were used less by drug users (e.g., dentist and psychiatric outpatient services) while others were used more often (e.g., phoneline services and day care centres).

CONCLUSION

This study highlights the high levels of drug use in this population and the negative impact of drug use on health and perceived quality of life of a homeless population in Dublin.

Depression and sexual risk behaviours among people who inject drugs: a gender-based analysis

Background Although many people who inject drugs (PID) contend with comorbidities, including high rates of mental illness, limited attention has been given to the differences in comorbidities among men and women or the potential links between psychiatric disorders and HIV risk behaviours. We sought to longitudinally examine associations between depression and HIV-related sexual risk behaviours among PID, stratified by gender.

METHODS

Data were derived from a prospective cohort of PID in Vancouver, Canada between December 2005 and November 2009. Using generalised estimating equations, we examined the relationship between depressive symptoms and two types of sexual HIV risk behaviours: engaging in unprotected sex; and having multiple sexual partners. All analyses were stratified by self-reported gender.

RESULTS

Overall, 1017 PID participated in this study, including 331 (32.5%) women. At baseline, women reported significantly higher depressive symptoms than men (P<0.001). In multivariate generalised estimating equations analyses, after adjustment for potential social, demographic and behavioural confounders, more severe depressive symptomology remained independently associated with engaging in unprotected sex [adjusted odds ratio (AOR)=1.62, 95% confidence interval (CI): 1.18-2.23] and having multiple sexual partners (AOR=1.54, 95% CI: 1.09-2.19) among women, but was only marginally associated with having multiple sexual partners among men (AOR=1.18, 95% CI: 0.98-1.41).

CONCLUSIONS

These findings call for improved integration of psychiatric screening and treatment services within existing public health initiatives designed for PID, particularly for women. Efforts are also needed to address sexual risk-taking among female PID contending with clinically significant depression.

Bidirectional Influence: A Longitudinal Analysis of Size of Drug Network and Depression Among Inner-City Residents in Baltimore, Maryland

BACKGROUND

The prevalence of depression among drug users is high. It has been recognized that drug use behaviors can be influenced and spread through social networks.

OBJECTIVES

We investigated the directional relationship between social network factors and depressive symptoms among a sample of inner-city residents in Baltimore, MD.

METHODS

We performed a longitudinal study of four-wave data collected from a network-based HIV/STI prevention intervention for women and network members, consisting of both men and women. Our primary outcome and exposure were depression using CESD scale and social network characteristics, respectively. Linear-mixed model with clustering adjustment was used to account for both repeated measurement and network design.

RESULTS

Of the 746 participants, those who had high levels of depression tended to be female, less educated, homeless, smokers, and did not have a main partner. In the univariate longitudinal model, larger size of drug network was significantly associated with depression (OR = 1.38, p < .001). This relationship held after controlling for age, gender, homeless in the past 6 months, college education, having a main partner, cigarette smoking, perceived health, and social support network (aOR = 1.19, p = .001). In the univariate mixed model using depression to predict size of drug network, the data suggested that depression was associated with larger size of drug network (coef. = 1.23, p < .001) and the same relation held in multivariate model (adjusted coef. = 1.08, p = .001).

CONCLUSIONS

The results suggest that larger size of drug network is a risk factor for depression, and vice versa. Further intervention strategies to reduce depression should address social networks factors.

Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population

OBJECTIVE

To assess the association between lifetime crack cocaine use and psychiatric (post-traumatic stress disorder, current depression, current dysthymia, generalized anxiety disorder, panic disorder with agoraphobia, social phobia, as well as SRQ scores and suicide risk) and substance-use disorders (tobacco, alcohol, cannabis, cocaine, amphetamine, inhalants, sedatives, hallucinogens and opioids) in youth in the general population of the city of Pelotas, RS.

METHOD

This was a cross-sectional population-based study, involving 1560 participants between 18 and 24 ears old. Lifetime substance use and abuse were investigated using the ASSIST inventory. Psychiatric comorbidities were assessed using the Mini-International Neuropsychiatric Interview and symptoms of common mental disorders were evaluated with the Self-Reported Questionnaire (SRQ).

RESULTS

The prevalence of lifetime crack cocaine use in the sample was 2.5%. Its use was associated with total SRW scores and the presence of post-traumatic stress disorder, antisocial personality disorder and suicide risk in the final regression model. Tobacco, alcohol, cannabis, cocaine, amphetamine and cocaine dependence were also associated with lifetime use of crack cocaine.

DISCUSSION

Youth with a history of crack cocaine use had a higher prevalence of psychiatric conditions such as post-traumatic stress disorder, as well as an increased risk of tobacco, alcohol, cannabis, cocaine, amphetamine and inhalant use and dependence.

The effect of victimization, mental health, and protective factors on crime and illicit drug use among homeless young adults

Although research has found high rates of child maltreatment, widespread victimization, and other negative outcomes among homeless youth and young adults, resiliency among this population has largely been understudied. Specifically, a gap remains in terms of how protective factors such as self-efficacy, low deviant beliefs, and religiosity operate among homeless youth and young adults. The purpose of this study is to examine the relationship between various forms of victimization, mental health, and protective factors with property and violent crime and illicit drug use among homeless young adults. Results from regression analyses indicate that running away from home more frequently, experiencing more physical victimization on the street, higher levels of self-efficacy, and more deviant beliefs were associated with greater property crime. Significant correlates of violent crime included being male, running away from home more frequently, greater sexual and physical victimization on the street, higher levels of self-efficacy, and more deviant beliefs. Finally, being male, running away more frequently from home, greater child physical abuse and partner victimization, and more deviant beliefs were all associated with greater illicit drug use. Self-efficacy was positively related to both property and violent crime, suggesting that it may not operate for homeless young adults in the same manner as it does for normative populations.

Socioeconomic inequities patterns of multi-morbidity in early adolescence

BACKGROUND

Multi-morbidity such as cumulating mental health, behavioral, and school difficulties (consumptions of alcohol, tobacco, cannabis, and hard drugs, obesity, depressive symptoms, suicide attempts, involvement in violence, and low school performance) is common in early adolescence and can be favored by a number of socioeconomic factors (gender, age, nationality, family structure, parents' education, father' occupation, and income). This study assessed the concurrent roles of various socioeconomic factors in multi-morbidity defined as cumulated number of difficulties (CD) which has been partially documented.

METHODS

Adolescents from middle schools in north-eastern France (N = 1,559) completed a questionnaire measuring socioeconomic characteristics and mental health, behavioral, and school difficulties. Data were analyzed using logistic regression models.

RESULTS

Alcohol use affected 35.2% of subjects, tobacco use 11.2%, cannabis use 5.6%, hard drugs use 2.8%, obesity 10.6%, depressive symptoms 13.3%, suicide attempts 9.9%, involvement in violence 10.3%, and low school performance 8.2%. Insufficient income and non-intact families impacted most mental health, behavioral, and school difficulties with adjusted odds ratios (ORa) between 1.51 and 3.72. Being immigrant impacted illicit drugs use and low school performance (ORa 2.31-4.14); low parents' education depressive symptoms (1.42) and school performance (3.32); and manual-worker/inactive offspring low school performance (2.56-3.05). Multi-morbidity was very common: CD0 44.1%, CD1 30.8%, CD2-3 18.4%, and CD ≥ 4 6.7%. Insufficient income, divorced/separated parents, reconstructed families, and single parents played impressive roles with strong ORa gradients (reaching 4.86) from CD1 to CD ≥ 4. Being European immigrant, low parents' education, and low fathers' occupations had significant gender-age-adjusted odds ratios for CD2-3 and CD ≥ 4, but these became non-significant when adjusted for all socioeconomic factors. Older adolescents had higher risks for multi-morbidity which did not change when adjusting for all socioeconomic factors.

CONCLUSIONS

Multi-morbidity including a wide range of mental health, behavioral, and school difficulties was common in early adolescence. Insufficient income and non-intact families played impressive roles. Being immigrant, low parents' education, and low fathers' occupations also played strong roles but these were explained by insufficient income and non-intact families. Prevention against multi-morbidity should be designed to help adolescents to solve their difficulties, especially among adolescents with socioeconomic difficulties.

Psychopathology in young people experiencing homelessness: a systematic review

Understanding mental health issues faced by young homeless persons is instrumental to the development of successful targeted interventions. No systematic review of recent published literature on psychopathology in this group has been completed. We conducted a systematic review of published research examining the prevalence of psychiatric problems among young homeless people. We examined the temporal relationship between homelessness and psychopathology. We collated 46 articles according to the PRISMA Statement. All studies that used a full psychiatric assessment consistently reported a prevalence of any psychiatric disorder from 48% to 98%. Although there was a lack of longitudinal studies of the temporal relationship between psychiatric disorders and homelessness, findings suggested a reciprocal link. Supporting young people at risk for homelessness could reduce homelessness incidence and improve mental health.

Childhood sexual abuse and risk for initiating injection drug use: a prospective cohort study

OBJECTIVE

This study examined whether childhood sexual abuse predicts initiation of injection drug use in a prospective cohort of youth.

METHOD

From October 2005 to November 2010, data were collected from the At Risk Youth Study (ARYS), a prospective cohort study of street-involved youth in Vancouver, Canada. Inclusion criteria were age 14-26 years, no lifetime drug injection, and non-injection drug use in the month preceding enrollment. Participants were interviewed at baseline and semiannually thereafter. Cox regression was employed to identify risk factors for initiating injection.

RESULTS

Among 395 injection-naïve youth, 81 (20.5%) reported childhood sexual abuse. During a median follow-up of 15.9 months (total follow-up 606.6 person-years), 45 (11.4%) youth initiated injection drug use, resulting in an incidence density of 7.4 per 100 person-years. In univariate analyses, childhood sexual abuse was associated with increased risk of initiating injection (unadjusted hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.29-4.38; p=0.006), an effect that persisted in multivariate analysis despite adjustment for gender, age, aboriginal ancestry and recent non-injection drug use (adjusted HR, 2.71; 95% CI, 1.42-5.20; p=0.003).

CONCLUSION

Childhood sexual abuse places drug users at risk for initiating injection. Addiction treatment programs should incorporate services for survivors of childhood maltreatment.