The global prevalence of mental health disorders among runaway and homeless youth: A meta-analysis

A meta-analysis was performed to identify the pooled prevalence of mental health disorders (MHDs) among runaway and homeless youth (RHY). Relevant studies published between December 1, 1985, and October 1, 2023, were identified in the PubMed, Scopus, Web of Science, and Cochrane Library databases. A preliminary screening of 11,266 papers resulted in the inclusion of 101 studies. The pooled-prevalence estimates were obtained using a random-effects model. The findings showed varying lifetime prevalence rates of MHDs: 47% (conduct disorders and psychological distress), 43% (depression), 34% (major depressive disorders), 33% (post-traumatic stress disorder), 27% (personality disorders), 25% (attention-deficit/hyperactivity disorder), 23% (bipolar disorders), 22% (anxiety), 21% (oppositional defiant disorders), 15% (anorexia), 15% (adjustment disorders), 14% (dysthymia), 11% (schizophrenia), 9% (obsessive-compulsive disorders), and 8% (gambling disorder). The current prevalence rates were: 31% (depression), 23% (major depressive disorder), 23% (anxiety), 21% (post-traumatic stress disorder), 16% (attention-deficit/hyperactivity disorder), 15% (bipolar disorder), 13% (personality disorders), 13% (oppositional defiant disorders), 8% (schizophrenia), and 6% (obsessive-compulsive disorders). Regular screening and the implementation of evidence-based treatments and the promotion of integration and coordination between mental health services for adolescent minors and young adults with other service systems are recommended.

Understanding Homelessness Among Young People to Improve Outcomes

In the United States, an estimated 4.2 million young people experience homelessness during critical stages in their development-adolescence and emerging adulthood. While research on youth homelessness often emphasizes risk and vulnerability, the field must situate these issues within the developmental trajectories of adolescence and emerging adulthood to effectively prevent and end youth homelessness. This review uses the Risk Amplification and Abatement Model (RAAM) as a conceptual framework for contextualizing the landscape of youth homelessness research in the United States since 2010. An extension of ecological models of risk-taking, RAAM emphasizes both risk and resilience, positing that negative as well as positive socialization processes across interactions with family, peers, social services, and formal institutions affect key housing, health, and behavioral outcomes for youth experiencing homelessness. This review applies RAAM to our understanding of the causes and consequences of youth homelessness, recent interventions, and recommendations for future directions.

A Systematic Review of Systems Science Approaches to Understand and Address Domestic and Gender-Based Violence

Purpose

We aimed to synthesize insights from systems science approaches applied to domestic and gender-based violence.

Methods

We conducted a systematic review of systems science studies (systems thinking, group model-building, agent-based modeling [ABM], system dynamics [SD] modeling, social network analysis [SNA], and network analysis [NA]) applied to domestic or gender-based violence, including victimization, perpetration, prevention, and community responses. We used blinded review to identify papers meeting our inclusion criteria (i.e., peer-reviewed journal article or published book chapter that described a systems science approach to domestic or gender-based violence, broadly defined) and assessed the quality and transparency of each study.

Results

Our search yielded 1,841 studies, and 74 studies met our inclusion criteria (45 SNA, 12 NA, 8 ABM, and 3 SD). Although research aims varied across study types, the included studies highlighted social network influences on risks for domestic violence, clustering of risk factors and violence experiences, and potential targets for intervention. We assessed the quality of the included studies as moderate, though only a minority adhered to best practices in model development and dissemination, including stakeholder engagement and sharing of model code.

Conclusions

Systems science approaches for the study of domestic and gender-based violence have shed light on the complex processes that characterize domestic violence and its broader context. Future research in this area should include greater dialogue between different types of systems science approaches, consideration of peer and family influences in the same models, and expanded use of best practices, including continued engagement of community stakeholders.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10896-023-00578-8.

Systematic review: Rates of psychopathology, substance misuse, and neuropsychological dysfunction among transitional age youth experiencing homelessness

BACKGROUND AND OBJECTIVES

Transitional age youth experiencing homelessness (TAY-EH) bear a disproportionate burden of morbidity and mortality related to psychopathology, substance use disorders (SUD), and neuropsychological dysfunction. Prior reviews examining these conditions are now nearly a decade old, have focused on younger adolescent populations, or have utilized nonsystematic approaches. To our knowledge, no prior reviews have reported on all three of these domains in an integrated fashion. Here, we provide a contemporary, critical synthesis of the literature on the functioning of TAY-EH in North America within these three domains.

METHODS

Based upon PRISMA guidelines, a search of PubMed, Medline, and PsycInfo databases was conducted, including literature published between January 2015 and June 2021.

RESULTS

The initial search yielded 2024 citations; 104 underwent full text review and 32 met inclusion criteria, with a final aggregate sample size of 13,516. Studies revealed elevated rates of mood disorders, PTSD, anxiety disorders, and alcohol misuse. There is insufficient data to draw generalizable conclusions regarding neuropsychological functioning, other SUD, or other psychiatric diagnoses. No studies reported on co-occurrence of disorders among or between the domains of psychopathology, SUD, and neuropsychological dysfunction. Four studies used structured interviews for diagnoses, with the remainder relying upon brief screeners or self-report measures.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

To our knowledge, this is the first systematic review to provide integrated findings on psychopathology, SUD, and neuropsychological dysfunction among TAY-EH. Further research using structured, DSM-based tools is needed to characterize rates of single and co-occurring conditions to inform tailored treatment interventions.

Few Do and To Few: Disclosure of Suicidal Thoughts in Friendship Networks of Young Adults Experiencing Homelessness

Disclosure of one's suicidal thoughts is a pivotal but under-investigated mechanism for preventing suicide among young adults experiencing homelessness (YAEH). In a sample of 527 YAEH, we adopted a multi-level perspective to assess patterns and correlates of disclosure in their friendship networks. Less than one-third of YAEH disclosed their suicidal thoughts-half of them doing so during a suicidal crisis-and only disclosed to 21% of their friends. Multilevel modeling showed that YAEH who reported a history of unmet mental health needs were more likely to have disclosed to a friend, and friends who were sources of social support were most highly sought out for disclosures. Our findings highlight the need for cultivating safe environments that promote disclosures among YAEH.

Suicidal ideation among North Korean refugees in South Korea: Exploring the influence of social network characteristics by gender

Rates of death by suicide among North Korean refugees are three times higher than those among their host-country counterparts in South Korea. However, social and cultural factors predicting suicidality among North Korean refugees are not well known. Thus, we explored how social networks affect suicidal ideation in a sample of 405 North Korean refugees in South Korea using egocentric network data. Network diversity (number of different types of ties) was a protective factor for suicidal ideation among women. Having a help-providing and trustworthy church-based tie was a protective factor for women, whereas it was a risk factor for men. It is likely that women connected to people in diverse social contexts received more support to effectively deal with adversities. Because South Korean churches provide tailored worship services and financial aid to North Korean refugees, women might receive emotional comfort from church-based ties whom they can trust and receive help from, whereas men might become distressed about being financially dependent on others, which contradicts cultural expectations of a man's traditional role. Our findings have implications for mental health practitioners serving vulnerable populations, and highlight the importance of understanding the cultural context of social networks and gender in suicide research.

The role of suicide ideation in assessing near-term suicide risk: A machine learning approach

BACKGROUND

The majority of suicide attempters do not disclose suicide ideation (SI) prior to making an attempt. When reported, SI is nevertheless associated with increased risk of suicide. This paper implemented machine learning (ML) approaches to assess the degree to which current and lifetime SI affect the predictive validity of the Suicide Crisis Syndrome (SCS), an acute condition indicative of imminent risk, for near-term suicidal behaviors (SB ).

METHODS

In a sample of 591 high-risk inpatient participants, SCS and SI were respectively assessed using the Suicide Crisis Inventory (SCI) and the Columbia Suicide Severity Rating Scale (C-SSRS). Two ML predictive algorithms, Random Forest and XGBoost, were implemented and framed using optimism adjusted bootstrapping. Metrics collected included AUPRC, AUROC, classification accuracy, balanced accuracy, precision, recall, and brier score. AUROC metrics were compared by computing a z-score.

RESULTS

The combination of current SI and SCI showed slightly higher predictive validity for near-term SB as evidenced by AUROC metrics than the SCI alone, but the difference was not significant (p<0.05). Current SI scored the highest amongst a chi square distribution in regards to predictors of near-term SB.

CONCLUSION

The addition of SI to the SCS does not materially improve the model's predictive validity for near-term SB, suggesting that patient self-reported SI should not be a requirement for the diagnosis of SCS.

Gatekeeping beliefs, intent, and behavior among homeless youth

No research has explored the potential of homeless youth to serve as gatekeepers for suicide prevention purposes. This study described and examined associations between gatekeeping beliefs (i.e. preparedness and efficacy), intent-to-intervene, and gatekeeping behaviors (approach/referral behavior). In a sample of 139 homeless youth (aged 14-24), regression analysis was used to characterize associations between gatekeeper beliefs, intent, and behaviors. On average, participants engaged in gatekeeper behaviors with 1-2 people over the past 3 months. Gatekeeping beliefs and intent were positively associated with behaviors. Gatekeeper training that targets these attributes is a promising prevention strategy for homeless youth, but may require population-specific adaptation.

Firearm Violence Exposure and Suicidal Ideation Among Young Adults Experiencing Homelessness

PURPOSE

This study aimed to explore the association between direct exposure, indirect exposure, and perpetration of gun violence and suicidal ideation among young adults experiencing homelessness (YAEH).

METHODS

YAEH (n = 1,426) in seven cities across the U.S. were surveyed. Logistic regression analyses were conducted to examine the association between lifetime gun violence exposure and suicidal ideation in the past 12 months.

RESULTS

Forty-five percent (n = 641) of YAEH had experienced direct or indirect gun violence, whereas 17% (n = 247) had engaged in gun violence perpetration. Gun violence perpetration is associated with elevated suicidal ideation risk (odds ratio = 1.46; 95% confidence interval = 1.02-2.01) among YAEH.

CONCLUSIONS

A high percentage of YAEH were exposed to firearm violence. Cross-sector, multiagency collaborations are warranted to reduce firearm violence exposure among this vulnerable population. Homeless service providers should screen for gun violence exposure and suicide risk and target prevention efforts on YAEH with a history of gun violence perpetration.

Individual and Social Network Correlates of Sexual Health Communication Among Youth Experiencing Homelessness

Despite the potential for sexual health communication to be leveraged for HIV prevention among youth experiencing homelessness (YEH), there has yet to be a rigorous examination of individual and network or relational characteristics associated with sexual health communication in this group of young people. Cross-sectional survey and social network data from 1014 YEH aged 14-25 recruited in Los Angeles, California, were utilized to assess individual and network or relational characteristics associated with communication regarding condom use and HIV testing among YEH. Results suggest that social networks are key to understanding sexual health communication; YEH's engagement in sexual health communication was significantly related to the composition of their networks. To increase testing and decrease new HIV cases, a prudent strategy would be to train existing social network members (e.g., staff members, home-based peers, or partners) as agents of change in naturally occurring social networks of YEH.

Does the source matter? Social support and suicide attempts among homeless youth

The impact of social support on suicide is understudied among youth experiencing homelessness (YEH). This is problematic because assumptions about the protectiveness of relationships may not generalize to conflictive YEH environments. This study, which included 1047 YEH, used path modeling with a logistic regression estimator to examine associations between social support from family, home-based friends, and street-based friends and past-year suicide attempt. Social support from home-based friends but not family or street-based friends decreased suicide attempt risk. Moreover, social support from home-based friends moderated the association between depression and attempt risk. Targeted programming strengthening home-based-friend relationships represents a valuable endeavor.

Suicidal because I don't feel connected or vice versa? A longitudinal study of suicidal ideation and connectedness among child welfare youth

Suicide is a major public health problem among youth involved with the child welfare system. Although social connectedness rests at the core of many prevention approaches, we know little about this relationship over time in this vulnerable population. This study tested the hypotheses that inverse relationships would exist between connectedness in three social domains (i.e., caregiver, peers, and school) and suicidal ideation over time. The current study used baseline and 18-month follow-up data from 995 youth who participated in the National Survey of Child and Adolescent Well-Being (NSCAW II)-a nationally representative study of children and families investigated by a child welfare agency conducted from 2008 to 2011. A cross-lagged path model was used for the analysis. There were significant main effects of suicidal ideation at Time 1 on peer connectedness (β= -.17, p < .01) and caregiver connectedness (β= -.12, p < .05) at Time 2, but not on school connectedness (β= -.05, ns). There was no main effect of any of the connectedness variables at Time 1 on suicidal ideation at Time 2. Screening for suicidal ideation is important for managing immediate risk but our findings suggest that such ideation also foreshadows disconnectedness from their primary caregiver and peers in the future. These findings demonstrate that there is clinical value in engaging child-welfare-involved youth and their social systems about how their suicide-related experiences may affect vital social ties. Therefore, there may be merit to designing and exploring the effects of pilot programming focused on mitigating social distancing that suicide-related experiences engender.

But Everyone is Doing It (Sort of)! Perceived Sexual Risks in the Social Environment and the Impact on Homeless Youth Engagement in Concurrent Sexual Relationships

Although homeless youth are likely to engage in concurrent sexual relationships and doing so can accelerate HIV transmission, the issue of sexual concurrency (i.e., having sexual partnerships that overlap in time) has received scarce attention in this vulnerable population. The literature that exists tends to focus on individuals' characteristics that may be associated with concurrency and overlooks the influence of their social environment. Informed by the risk amplification and abatement model (RAAM), this study explored the association between pro-social and problematic social network connections, and sexual concurrency among homeless youth using drop-in center services (N = 841). Nearly 37% of youth engaged in concurrency. Partially consistent with the RAAM, regression analyses showed that affiliation with more problematic ties (i.e., having more network members who practice concurrency and unprotected sex) was associated with greater sexual concurrency. Programs addressing HIV risk among homeless youth in drop-in centers should consider the role youths' network composition may play in concurrency.

Suicidal Ideation and Behavior Among Youth Victims of Sex Trafficking in Kentuckiana

Background: Youth experiencing homelessness are at risk for sex trafficking and mental health concerns. Aims: More information is needed to elucidate the prevalence and characteristics of suicidal ideation and behavior among youth experiencing sex trafficking. Method: The present study examined suicidal ideation and behavior in a convenience sample of 128 youths experiencing homelessness aged 12-25 years in metropolitan Louisville, Kentucky, and southern Indiana. Participants were asked seven questions regarding suicidal ideation and attempts as part of an enhanced version of the 60-item Youth Experiences Survey (YES). Results: Approximately 53% of the sample reported experiencing suicidal ideation at some point in their lifetime and the odds of a youth experiencing homelessness who had experienced sex trafficking reporting suicidal ideation was 3.87 times higher than the odds of a youth experiencing homelessness who had not experienced sex trafficking. Additionally, of those who reported experiencing suicidal ideation, the majority (84.4%) reported they had attempted suicide in their lifetime. Limitations: This study relied on a convenience sample of youth receiving services in the Kentuckiana region and brief, self-report measures yielding categorical data. Conclusion: Programs servicing youth experiencing homelessness should require additional training and resources regarding the identification, screening, and assessment of youth who are at risk of or who have experienced sex trafficking in order to more quickly connect youth with much-needed, trauma-informed services.