Factors in the psychological adjustment of homeless adolescent males: the role of coping style

The quality of psychosocial health and psychosocial illness among women with and without shelter homes: a cross-sectional study

BACKGROUND

Existing research on the psychosocial wellbeing of sheltered women is primarily from Western contexts, with limited studies from collectivistic cultures like Pakistan. This study aims to compare the psychosocial health and illness of sheltered women in Pakistan with those of women living with their families.

METHODS

A total of 184 sheltered women and 207 women from the general population from four Pakistani cities participated in this study. Data were collected using two validated instruments: the Psychosocial Health Evaluator and the Sukoon Psychosocial Illness Scale. The study employed independent sample t-tests, simple linear regression and Pearson correlation.

RESULTS

The study revealed significant differences between women residing in shelters and those in the general population. Sheltered women exhibited lower levels of psychosocial health and higher levels of psychosocial illness. Emotional, sexual, spiritual, and social health were notably lower among sheltered women. Sheltered women also reported elevated levels of psychosocial problems, including emotional, social, and professional difficulties. Additionally, the length of stay in shelters was negatively correlated with psychosocial health and positively correlated with psychosocial illness, while education showed a positive correlation with psychosocial health.

CONCLUSION

The current research highlights the psychosocial vulnerability of women residing in shelter homes. Government, non-governmental organizations, and mental health professionals are advised to work together to uplift the psychosocial health of women residing in Pakistani shelter homes. Appointments of psychological counselors in shelter homes are highly recommended in this regard.

Religion, spirituality, and pediatric mental health: a scoping review of research on religion and spirituality in the Journal of the American Academy of Child and Adolescent Psychiatry from 2000 to 2023

Introduction

Religion and spirituality (R/S) serve as sources of meaning-making and coping for many individuals and families. While research on the relationship between R/S and mental health has been ongoing, their role in pediatric mental health is poorly understood. The objective of this study is to assess research trends and predominant themes of R/S in child and adolescent psychiatric research in articles published in the Journal of the American Association of Child and Adolescent Psychiatry (JAACAP). This provides a rough measure of the relative importance of these topics to academic psychiatrists and researchers in the field and identifies gaps for future research.

Methods

All research and review articles published in JAACAP between 2000-2023 with a focus on R/S themes were retrieved, screened, and appraised for content and extent of focus on R/S (major, minor, incidental). Included articles were assessed for R/S variables and predominant themes.

Results

Thirty-two (32) research articles published between 2000-2023 contained sufficient R/S content for inclusion in our study. Only 4 articles had R/S as their major focus. Our analysis suggested a decline in publications with R/S content over the last 24 years. The R/S variables and measurement tools were heterogenous, with religious attendance and religious affiliation being the most frequently measured variables. The predominant themes include the relationships between R/S and psychopathology, suicide, utilization of services, conceptualization of illness, trauma, identity, and coping.

Discussion

Despite the significance attributed to R/S by many youths and families and the increasing academic interest in the intersection between R/S and health, a significant gap exists in our understanding of R/S vis-à-vis child and adolescent mental health. This gap may be further compounded by the limited attention offered to R/S factors and variables in academic psychiatric activities. JAACAP, a global leading academic platform, may advance this discourse by inviting and encouraging publications addressing R/S variables. This may inform diagnostic, preventive, and interventive clinical work with children and their families.

Assessing psychosocial distress associated with homelessness in Ghana: A springboard for interventional policy design

This study investigated the causes of homelessness in Ghana and associated psychosocial distress. A sample of 86 homeless participants listed perceived causes of their homelessness and completed measures of psychosocial distress, and 97 non-homeless participants completed the same measures psychosocial distress. Causes of homelessness among the participants included poverty (30.1%), migration (10.4%), unemployment (2.2%), parental demise (2.2%), parental neglect (0.5%), and parental divorce (0.5%). Multivariate analysis revealed higher psychosocial distress among the homeless than the non-homeless. Homeless females reported higher levels of stress and suicidality than their male counterparts. The study demonstrates the need for timely and effective implementation of interventions such as provision of affordable housing, financial assistance, job-creation, and skill training for the homeless directly related to known causes of homelessness and accounting for gender differences.

Coping, Social Support, and Suicide Attempts Among Homeless Adolescents

Abstract. Background: Homeless youth are a population at risk for suicidal behavior. Despite growing knowledge about risk factors, protective factors against suicidal behavior among this population are still poorly understood. Aims: To explore differences in coping and social support between homeless adolescents who attempted suicide and those who did not. Method: In total, 76 homeless adolescents from eight different shelters provided information about their suicidal behaviors over the previous year and filled out coping and social support questionnaires. Results: Homeless adolescents who had not attempted suicide perceived more social support (tangible assistance and guidance). Conversely, youth who had attempted suicide reported using more nonproductive strategies of coping (tension reduction, keep to self, and self-blame). Tangible assistance and tension reduction were found to be the strongest predictors. Limitations: As most of these youth were not homeless for a long time, care should be taken in generalizing these results to adolescents with longer histories of homelessness. Conclusion: Productive coping does not seem to constitute a sufficient personal resource to protect homeless adolescents from suicide attempts. Nonproductive coping could, however, be considered a serious risk factor. Consequently, promoting homeless youths' ability to find environmental resources, especially tangible assistance, could be the most valuable approach.

My Own Best Friend: Homeless Youths' Hesitance to Seek Help and Strategies for Coping Independently after Distressing and Traumatic Experiences

Although homeless youth face extreme adversities, they are often hesitant to seek help from formal and informal supports. The current study qualitatively explored homeless youths' reasons for coping independently and their strategies for doing so. Youth accessing services (N = 145) in three U.S. cities were interviewed about their rationales for not seeking help from others regarding distressing experiences. Analyses illustrated specific barriers to help seeking that prompted homeless youth to cope on their own by utilizing soothing, avoidant, aggressive, and introspective coping strategies. Implications for outreaching to those least likely to seek help are discussed.

Health problems among street children seeking care in the Center for Social and Preventive Medicine in Egypt

BACKGROUND

In Egypt, around 1 million children are on the streets. Street children's health is an issue that is not well researched. The objective of the current study was to determine the health problems of a targeted group of street children seeking medical care and to generate a hypothesis about the positive/negative role of street children care organizations.

METHODS

A cross-sectional study was done on 2169 street children who sought medical care at El-Basma clinic at the Center for Social and Preventive Medicine in Cairo University Children Hospital from January 2011 to July 2014.

RESULTS

Respiratory illnesses and skin problems were the most prevalent conditions, affecting 485 (22.4%) and 359 (16.6%) of the patients, respectively. Psychological issues and trauma were significantly higher among the adolescent group. Respiratory and gastrointestinal problems were significantly higher among children aged less than 2 years. Genital and cardiac problems were significantly higher among those referred from organizations whereas trauma was significantly higher among those coming directly from the streets. A significant proportion of children at the extremes of the studied age spectrum were coming directly from the streets. Sexually transmitted infections were rare problems.

CONCLUSIONS

Respiratory and skin diseases were the major morbidity problems among street children, especially adolescent males. Organizations afforded opportunities for access to different health care services.

Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review

In this meta-analytic and narrative review, we examine several overarching issues related to the study of coping, emotion regulation, and internalizing and externalizing symptoms of psychopathology in childhood and adolescence, including the conceptualization and measurement of these constructs. We report a quantitative meta-analysis of 212 studies (N = 80,850 participants) that measured the associations between coping and emotion regulation with symptoms of internalizing and externalizing psychopathology. Within the meta-analysis we address the association of broad domains of coping and emotion regulation (e.g., total coping, emotion regulation), intermediate factors of coping and emotion regulation (e.g., primary control coping, secondary control coping), and specific coping and emotion regulation strategies (e.g., emotional expression, cognitive reappraisal) with internalizing and externalizing symptoms. For cross-sectional studies, which made up the majority of studies included, we examine 3 potential moderators: age, measure quality, and single versus multiple informants. Finally, we separately consider findings from longitudinal studies as these provide stronger tests of the effects. After accounting for publication bias, findings indicate that the broad domain of emotion regulation and adaptive coping and the factors of primary control coping and secondary control coping are related to lower levels of symptoms of psychopathology. Further, the domain of maladaptive coping, the factor of disengagement coping, and the strategies of emotional suppression, avoidance, and denial are related to higher levels of symptoms of psychopathology. Finally, we offer a critique of the current state of the field and outline an agenda for future research. (PsycINFO Database Record

Gender Differences in the Path From Sexual Victimization to HIV Risk Behavior Among Homeless Youth

Experiencing sexual victimization prior to becoming homeless is common among homeless youth and is associated with increased HIV risk behavior. This study examined mediating variables that underlie this association, adding to the understanding of gender differences in these paths. Participants were homeless youth in Los Angeles recruited through service access centers who completed a computerized self-administered interview in English or Spanish using an iPad. Findings indicate a high presence of sexual victimization across both genders. Female participants experienced posttraumatic stress disorder and subsequent engagement with exchange sex, whereas male participants were primarily involved in substance use risk pathways. Results indicate paths in the association between sexual victimization and HIV risk behavior differ between male and female homeless youth. Gender-specific, mental-health-informed interventions targeting sexual risk reduction are warranted.

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.

An Exploratory Factor Analysis of Coping Styles and Relationship to Depression Among a Sample of Homeless Youth

The extent to which measures of coping adequately capture the ways that homeless youth cope with challenges, and the influence these coping styles have on mental health outcomes, is largely absent from the literature. This study tests the factor structure of the Coping Scale using Exploratory Factor Analysis (EFA) and then investigates the relationship between coping styles and depression using hierarchical logistic regression with data from 201 homeless youth. Results of the EFA indicate a 3-factor structure of coping, which includes active, avoidant, and social coping styles. Results of the hierarchical logistic regression show that homeless youth who engage in greater avoidant coping are at increased risk of meeting criteria for major depressive disorder. Findings provide insight into the utility of a preliminary tool for assessing homeless youths' coping styles. Such assessment may identify malleable risk factors that could be addressed by service providers to help prevent mental health problems.

Gender, coping strategies, homelessness stressors, and income generation among homeless young adults in three cities

This study examined gender differences among homeless young adults' coping strategies and homelessness stressors as they relate to legal (e.g., full-time employment, selling personal possessions, selling blood/plasma) and illegal economic activity (e.g., selling drugs, theft, prostitution). A sample of 601 homeless young adults was recruited from 3 cities (Los Angeles, CA [n = 200], Austin, TX [n = 200], and Denver, CO [n = 201]) to participate in semi-structured interviews from March 2010 to July 2011. Risk and resilience correlates of legal and illegal economic activity were analyzed using six Ordinary Least Squares regression models with the full sample and with the female and male sub-samples. In the full sample, three variables (i.e., avoidant coping, problem-focused coping, and mania) were associated with legal income generation whereas eight variables (i.e., social coping, age, arrest history, transience, peer substance use, antisocial personality disorder [ASPD], substance use disorder [SUD], and major depressive episode [MDE]) were associated with illegal economic activity. In the female sub-sample, three variables (i.e., problem-focused coping, race/ethnicity, and transience) were correlated with legal income generation whereas six variables (i.e., problem-focused coping, social coping, age, arrest history, peer substance use, and ASPD) were correlated with illegal economic activity. Among males, the model depicting legal income generation was not significant yet seven variables (i.e., social coping, age, transience, peer substance use, ASPD, SUD, and MDE) were associated with illegal economic activity. Understanding gender differences in coping strategies and economic activity might help customize interventions aimed at safe and legal income generation for this population.

The health diagnoses of homeless adolescents: a systematic review of the literature

BACKGROUND

Homelessness during adolescence impacts negatively upon young people's physical and mental wellbeing. To be effective, programs aimed at addressing the health needs of this population must include knowledge of both the presenting and underlying acute and chronic conditions that characterise this high risk group of youth.

METHODS

We undertook a systematic review of the international literature for studies that used validated instruments and techniques to diagnose prevalence rates of physical and mental health disorders in homeless adolescents.

RESULTS

Twenty-one studies fulfilled the selection criteria. Of these, nine studies examined mental health diagnoses including depression, post-traumatic stress disorder, anxiety and substance abuse disorders. With one exception, the remaining twelve studies all related to sexually transmitted infections.

CONCLUSION

Homeless adolescents are diagnosed with widely varying rates of mental health disorders and high rates of sexually transmitted infection. Other likely chronic and acute physical conditions appear to be neglected in the published research.

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.

Personality disorders and treatment drop out in the homeless

The homeless drop out of treatment relatively frequently. Also, prevalence rates of personality disorders are much higher in the homeless group than in the general population. We hypothesize that when both variables coexist - homelessness and personality disorders - the possibility of treatment drop out grows. The aim of this study was to analyze the hypotheses, that is, to study how the existence of personality disorders affects the evolution of and permanence in treatment. One sample of homeless people in a therapeutic community (N = 89) was studied. The structured clinical interview for the diagnostic and statistical manual of mental disorders (DSM-IV-TR) was administered and participants were asked to complete the Millon Clinical Multiaxial Inventory-II (MCMI-II). Cluster B personality disorders (antisocial, borderline, and narcissistic) avoided permanence in the treatment process while cluster C disorders, as dependent, favored adhesion to the treatment and improved the prognosis. Knowledge of these personality characteristics should be used to advocate for better services to support homeless people and prevent their dropping out before completing treatment.

The mediating roles of stress and maladaptive behaviors on self-harm and suicide attempts among runaway and homeless youth

Runaway and homeless youth often have a constellation of background behavioral, emotional, and familial problems that contribute to stress and maladaptive behaviors, which, in turn, can lead to self-harming and suicidal behaviors. The current study examined the roles of stress and maladaptive behaviors as mediators between demographic and psychosocial background characteristics and self-injurious outcomes through the lens of the stress process paradigm. The model was tested in a sample of runaway and homeless youth from Los Angeles County (N = 474, age 12-24, 41 % female, 17 % White, 32.5 % African American, 21.5 % Hispanic/Latino). Background variables (gender, age, sexual minority status, parental drug use history, and emotional distress) predicted hypothesized mediators of maladaptive behaviors and recent stress. In turn, it was hypothesized that the mediators would predict self-harming behaviors and suicide attempts in the last 3 months. Females and LGBT (lesbian, gay, bisexual, transgender) youth were more likely to have self-harmed and attempted suicide; younger participants reported more self-harming. The mediating constructs were associated more highly with self-harming than suicide attempts bivariately, although differences were modest. Maladaptive behaviors and recent stress were significant predictors of self-harm, whereas only recent stress was a significant predictor of suicide attempts. All background factors were significant predictors of recent stress. Older age, a history of parental drug use, and greater emotional distress predicted problem drug use. Males, younger participants, and participants with emotional distress reported more delinquent behaviors. Significant indirect effects on self-harming behaviors were mediated through stress and maladaptive behaviors. The hypothesized paradigm was useful in explaining the associations among background factors and self-injurious outcomes and the influence of mediating factors on these associations.

Homelessness among lesbian, gay, and bisexual youth: implications for subsequent internalizing and externalizing symptoms

Although lesbian, gay, and bisexual (LGB) youth with a history of homelessness (running away or being evicted from their homes by parents) report more psychological symptoms than homeless heterosexual peers, it is unclear whether symptoms are due to homelessness, given the absence of a non-homeless comparison group. This study longitudinally investigates whether LGB youth with a history of homelessness report more subsequent psychological symptoms than non-homeless LGB youth and examines potential mediators of any such relationships. Of the 156 LGB youth interviewed (49% female; 78% non-White), 48% reported past homeless experiences. Homelessness was associated with subsequent symptoms of anxiety, depression, conduct problems, and substance abuse and to changes in symptoms over time even after controlling for childhood sexual abuse and early development of sexual orientation. Stressful life events, negative social relationships, and social support from friends mediated the relationships between homelessness and symptomatology. These findings suggest the need for interventions to reduce stress and enhance social support among LGB youth with a history of homelessness in order to reduce psychological symptoms.

Resilience and suicidality among homeless youth

Homeless and street-involved youth are considered an extremely high risk group, with many studies highlighting trajectories characterized by abusive, neglectful, and unstable family histories, victimization and criminal involvement while on the streets, high rates of physical and mental illness, and extremely high rates of mortality. While there exists a substantial body of knowledge regarding risk, in recent years attention has been increasingly shifting to the examination of resilience, intervention, and service delivery models for these young people. The present study describes the findings from a quantitative examination of personal and street-related demographics, psychological distress, self-esteem, resilience, and suicidality among 47 homeless and street-involved youth. Key findings indicate that the apparent erosion of mental health variables, including resilience, occurs as a function of how long the youths have been without stable housing. Finally, those youths' perceived resilience was associated with less suicidal ideation whereas higher psychological distress was associated with higher suicidal ideation, even when accounting for resiliency.

Correlates of depressive symptoms among homeless young adults

Adolescent homelessness has received increasing attention because of its fast growth throughout the United States and the poor mental outcomes experienced by homeless young people. This cross-sectional study (N = 156) identified correlates of depressive symptomatology among homeless young adults and investigated how depressive symptoms are influenced by the coping strategies these young adults use. The findings are based on analysis of baseline data collected for a hepatitis vaccination intervention pilot study conducted in partnership with a young adult's drop-in center in Santa Monica, California. Standardized tools assessed drug use history, coping ability, and psychiatric symptomatology. Linear regression modeling was used to identify correlates of depressive symptom severity. Poor perceived physical health, recent crack cocaine use, and recent use of tranquilizers were significantly associated with increased severity of depressive symptoms. Self-destructive escape, nondisclosure/avoidance, passive problem solving, and thoughts of harming self were also associated with increased severity of depressive symptoms.

That which does not kill you makes you stronger: runaway youth's resilience to depression in the family context

The present study sought to uncover the relationship between risk and protective factors for depressive symptomatology among runaway youth. To that aim, 3 models of resiliency-the compensatory, risk-protective, and challenge models-were tested separately on girls and boys. The data came from a cross-sectional survey on a sample of 140 runaway adolescents between the ages of 12 and 17 years who were recruited from the only runaway crisis shelter in a large Midwestern city. Risk factors in the proposed model included primary caretaker's depressive symptoms, family conflict, and adolescent's and primary caretaker's verbal aggression; protective factors included adolescent's report of task-oriented coping and family cohesion. Findings supported the challenge model for predicting adolescent depressive symptoms, suggesting that moderate levels of risk can be beneficial for these runaway adolescents. In addition, risk and protective factors differed by adolescent gender. Implications for preventive interventions and future research are discussed.

Socio-cultural features and sex profile of the individuals with serious suicide attempts in southeastern Turkey: a one-year survey

Our objective was to elucidate potential causes of higher rates of suicide attempts in females compared to males in southeastern Turkey through a 1-year survey. Gender-related differences observed in 96 subjects who attempted suicide by poisoning for the first time were as follows: in comparison to male, females were predominantly within the age interval of 15-24 years, experienced more stressful events in the previous week before suicide attempt, had lower education level, and had a lower rate of employment. One year after the suicide attempt, unfavorable attitude of family, lack of support, persisting unfavorable lifestyle comparable with that prior to the first attempt, and higher rates of domestic violence were more pronounced in females compared to males. These findings might be contributing factors to the higher suicide attempt rates observed in females compared to the males.

Coping and suicidality among homeless youth

This study examined the impact of coping strategies employed by homeless youth upon suicidal ideation, suicide attempts on the streets, and feeling trapped/helpless. Coping strategies examined in the analysis included problem-focused and avoidant coping, along with several coping strategies identified in previous exploratory qualitative studies. Greater risk was associated with avoidant coping, social withdrawal, use of drugs and alcohol as coping, with "belief in a better future" linked to lowered risk levels. Gender interactions emerged with respect to avoidant coping and social withdrawal, both of which served as greater contributors to risk levels among females. Several approaches to coping including problem-focused strategies and strategies identified by youths in previous qualitative works emerged as not serving to ameliorate suicidality.

Socioeconomic differences in adolescent stress: the role of psychological resources

PURPOSE

To investigate whether psychological resources influenced the association between parent education (PE), a marker of socioeconomic status (SES), and perceived stress.

METHODS

Cross-sectional analyses were conducted in a sample of 1167 non-Hispanic black and white junior and senior high school students from a Midwestern public school district in 2002-2003. Hierarchical multivariable regression analyses examined relationships between PE (high school graduate or less = E1, > high school, < college = E2, college graduate = E3, and professional degree = E4), and psychological resources (optimism and coping style) on teens' perceived stress. Greater optimism and adaptive coping were hypothesized to influence (i.e., mediate or moderate) the relationship between higher PE and lower stress.

RESULTS

Relative to adolescents from families with a professionally educated parent, adolescents with lower parent education had higher perceived stress (E3 beta = 1.70, p < .01, E2 beta = 1.94, p < .01, E1 beta = 3.19, p < .0001). Both psychological resources were associated with stress: higher optimism (beta = -.58, p < .0001) and engagement coping (beta = -.19, p < .0001) were associated with less stress and higher disengagement coping was associated with more stress (beta = .09, p < .01). Adding optimism to the regression model attenuated the effect of SES by nearly 30%, suggesting that optimism partially mediates the inverse SES-stress relationship. Mediation was confirmed using a Sobel test (p < .01).

CONCLUSIONS

Adolescents from families with lower parent education are less optimistic than teens from more educated families. This pessimism may be a mechanism through which lower SES increases stress in adolescence.

Trauma, depression, coping, and mental health service seeking among impoverished women

The authors examined the relationship among trauma, coping, depression, and mental health service seeking in a probability sample of sheltered homeless and low-income housed women. Results highlight the diversity of trauma. In a longitudinal analysis, women who lived in shelters or experienced major violence had a twofold increase in their risk of depression over the 6-month follow-up. In a cross-sectional analysis, childhood sexual abuse, living in a shelter, physical violence, childhood physical abuse, and death or injury of a friend or relative predicted avoidant coping and symptoms of depression. Active coping and depression predicted mental health service seeking among traumatized women. Modifying coping strategies may ameliorate some of the negative impact of trauma and potentially enhance mental health service use among at-risk women.

Homeless near a thousand homes: outcomes of homeless youth in a crisis shelter

Clients who received crisis services at a homeless shelter for transition-aged youth were recruited for a study to describe the youth served, to track outcomes of care, and to examine factors associated with differing outcomes. Participants were 202 men and women who completed a battery of interviews and self-report measures at intake and at 3 follow-up points. Youth served had experienced high levels of adversity and trauma and typically had poor educational and vocational preparation. A multidisciplinary array of services was provided, and overall, participants showed significant improvement from intake to discharge and in the 6 months after discharge. Background, service, and psychological factors did not predict housing outcomes. Better vocational outcome was associated with more recent work experience. Results point to the need for providers of services to the homeless to be aware of the distinct needs and characteristics of transition-aged youth.