1
|
Wells M, Kelly PJ, Mullaney L, Lee ML, Stirling R, Etter S, Larance B. Predictors of alcohol and other drug treatment completion among young people accessing residential and community-based treatment: A retrospective analysis of routinely collected service data. Addiction 2024. [PMID: 38946548 DOI: 10.1111/add.16602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/24/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND AND AIMS Young people accessing alcohol and other drug (AOD) treatment experience high rates of treatment disengagement, contributing to poorer outcomes. To improve outcomes, it is important to identify factors associated with treatment retention. This study measured the relationships between client characteristics, treatment characteristics, clinical severity measures and completion of treatment among young people. DESIGN, SETTING AND PARTICIPANTS This study was a retrospective analysis of routinely collected data set in residential- and community-based AOD services in New South Wales, Australia. Routinely collected data from the Network of Alcohol and Other Drug Agencies' (NADA) database were used. Included individuals were aged 10-24 years and accessed treatment between 2012 and 2023 (n = 17 474). MEASUREMENTS Variables included client-related characteristics, service characteristics and baseline measures of clinical severity [Kessler-10 (K10), EUROHIS-QoL, severity of dependence scale (SDS)]. Multivariable binary logistic regression models assessed the relationships between these characteristics and treatment completion. FINDINGS Rates of treatment completion were highest among adolescents in community-based treatment (57%) and lowest among young adults in residential treatment (35%). Polysubstance use was negatively associated with treatment completion among adolescents [adjusted odds ratio (adjOR) = 0.71, P < 0.001] and adults (adjOR = 0.70, P < 0.001) in community-based treatment, and adolescents in residential treatment (adjOR = 0.62, P = 0.006), as was housing insecurity (adolescents in community treatment, adjOR = 0.61, P = 0.001; adults in community treatment, adjOR = 0.77, P = 0.002; adolescents in residential treatment, adjOR = 0.42, P = 0.005). Attending youth-specific services was associated with higher treatment completion rates among adults in community-based (adjOR = 1.81, P < 0.001) and residential treatment (adjOR = 1.72, P < 0.001). Varying correlates of treatment completion were identified throughout treatment groups, reflecting the differences in population and/or needs across contexts. CONCLUSIONS In New South Wales, Australia, fewer than half of young people accessing alcohol and other drug treatment between 2012 and 2023 completed treatment, and completion rates were lower among those facing barriers such as polysubstance use and housing insecurity.
Collapse
Affiliation(s)
- Megan Wells
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Peter J Kelly
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Mei Lin Lee
- School of Psychology, University of Wollongong, Wollongong, Australia
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
| | - Robert Stirling
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Sarah Etter
- Network of Alcohol and Other Drug Agencies, Sydney, Australia
| | - Briony Larance
- School of Psychology, University of Wollongong, Wollongong, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| |
Collapse
|
2
|
Milburn NG, Rice E, Petry L. Understanding Homelessness Among Young People to Improve Outcomes. Annu Rev Clin Psychol 2024; 20:457-479. [PMID: 38109482 DOI: 10.1146/annurev-clinpsy-080921-081903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
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.
Collapse
Affiliation(s)
- Norweeta G Milburn
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, University of California, Los Angeles, California, USA;
| | - Eric Rice
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
- USC Center for Artificial Intelligence in Society, University of Southern California, Los Angeles, California, USA
| | - Laura Petry
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
3
|
Preston AJ, Rew L, Spees J. Social Determinants of Health and Psychological Capital Among Youth Experiencing Homelessness. West J Nurs Res 2024:1939459241253150. [PMID: 38824395 DOI: 10.1177/01939459241253150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
BACKGROUND Social determinants of health affect health behaviors and outcomes. Youth experiencing homelessness suffer significant deprivation of resources such as inadequate housing, reduced education, poor health care, and decreased economic stability. Inner resources, such as psychological capital, may also be related to health behaviors and health outcomes. OBJECTIVE In this study, we sought to describe and explore associations among selected determinants of health and self-reported scores on indicators of psychological capital among youth experiencing homelessness. METHODS This cross-sectional secondary analysis was conducted with a randomized subsample of 148 youth. We calculated chi-square frequencies to describe the data, classical item analyses to evaluate responses, and correlation tests to examine significance of associations. RESULTS Youth in this sample demonstrated that they possess inner resources associated with determinants of health. Education, health care, and social support were significantly associated with attributes of psychological capital (hope, efficacy, resilience, optimism). Sexual minority groups had high representation in this subsample (25.7%), indicating a need for more study and equitable services for this population. CONCLUSION More research should be conducted to better understand the associations between determinants of health, psychological capital, and health behaviors among disadvantaged youth to advance health equity initiatives.
Collapse
Affiliation(s)
- Angela J Preston
- The University of Texas at Austin School of Nursing, Austin, TX, USA
- The University of Texas at Tyler School of Nursing, Tyler, TX, USA
| | - Lynn Rew
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| | - Jason Spees
- The University of Texas at Austin School of Nursing, Austin, TX, USA
| |
Collapse
|
4
|
Taib NI, Arinell H, Öster C, Ramklint M. Mental disorders in former street-working boys. Eur Child Adolesc Psychiatry 2024; 33:1783-1792. [PMID: 37598108 PMCID: PMC11211161 DOI: 10.1007/s00787-023-02282-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/31/2023] [Indexed: 08/21/2023]
Abstract
The continuity of mental disorders in street-working children is rarely studied. This study therefore investigated homotypic continuity, recurrence of the same disorder, and heterotypic continuity, when a new disorder follows on the previous, of mental disorders from childhood to adulthood in street-working boys from Duhok City, Kurdistan Region of Iraq. Mental disorders were assessed by structured diagnostic interviews in 40 street-working boys in 2004-2005 and again in 2021, when the participants' mean ages were 12.1 (SD 1.8) and 29.7 (SD 2.3), respectively. Mental disorders were common; 24 participants (60%) satisfied the criteria for at least one diagnosis at baseline and 28 (70%) at follow-up. Comorbidity increased from 1.2 (SD 1.4) disorders initially to 2.5 (SD 1.8) at follow-up. Only anxiety disorders showed homotypic continuity. Depressive disorders exhibited the greatest increase over time whereas externalizing disorders exhibited a decreasing tendency. The number of mental disorders in adulthood was related to the number of mental disorders in childhood but not to the number of childhood traumas experienced, having previously worked for more than two hours per day, having worked for over two years on the streets, or having at least one dead parent as a child. Parental ratings on the Child Behaviour Check List (CBCL) from childhood were also unrelated to the number of adult disorders. More longitudinal studies with bigger samples of both genders are needed to fully evaluate the continuity of mental disorders in street-working children and to determine whether the number of mental disorders in childhood is a stronger predictor of being mentally disordered in adult life than psychosocial risk factors or experiences of internalizing or externalizing symptoms in childhood.
Collapse
Affiliation(s)
- Nezar Ismet Taib
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden.
| | - Hans Arinell
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Caisa Öster
- Department of Medical Sciences, Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
| | - Mia Ramklint
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
- Department of Medical Sciences, Psychiatry, Uppsala University Hospital, 751 85, Uppsala, Sweden
| |
Collapse
|
5
|
Brown JM, Sofis M, Zimmer S, Kaplan BA. Delay discounting is associated with addiction and mental health measures while controlling for health behaviors and health barriers in a large US sample. Addict Behav Rep 2024; 19:100545. [PMID: 38680208 PMCID: PMC11046061 DOI: 10.1016/j.abrep.2024.100545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/20/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024] Open
Abstract
Background Excessive discounting of future rewards [delay discounting (DD)] may be a transdiagnostic process and treatment target underlying behavioral health outcomes, including trauma, depression, anxiety, and problematic substance use. However, multiple health behaviors and barriers are also related to these outcomes, including social media usage, adverse childhood experiences (ACEs), sleep quality, healthcare access, housing status, and exercise. To extend research examining DD as transdiagnostic process, we recruited a large, heterogenous sample to examine the association between DD, problematic substance use, and mental health outcomes while controlling for certain health behaviors and health barriers. Method In a cross-sectional online survey of 3992 US residents, we administered validated measures of PTSD, depression, anxiety, and problematic alcohol, stimulant, and opioid use. Using linear or ordinal logistic models, scores for each outcome were regressed onto DD while controlling for demographics, health behaviors, and health barriers. Results Including only DD and demographics, DD was associated with each outcome at low effect sizes (ƒ2 = .013, OR range = 1.08-1.16). Except for opioid ASSIST scores, these relationships held when controlling for social media usage, sleep, housing status, healthcare access, ACEs, physical exercise, and demographic variables (ƒ2 = .002, OR range = 1.03-1.12), increasing confidence that DD concurrently and directly relates to four of these five clinical outcomes. Discussion These findings support the conceptualization of DD as a transdiagnostic process underlying certain psychopathologies and suggest targeting DD in co-occurring substance use disorder and/or mental health treatments may result in clinically significant outcomes.
Collapse
Affiliation(s)
- Jeremiah M. Brown
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| | - Michael Sofis
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| | - Sara Zimmer
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| | - Brent A. Kaplan
- Advocates for Human Potential, 490-B Boston Post Road, Sudbury, MA 01776, USA
| |
Collapse
|
6
|
Leonard A, Duroseau B. Overview of the Epidemiology and Clinical Care Considerations for Adolescents and Young Adults Living with or at Risk of Human Immunodeficiency Virus. Nurs Clin North Am 2024; 59:329-344. [PMID: 38670698 PMCID: PMC11058420 DOI: 10.1016/j.cnur.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
This article provides an updated examination of human immunodeficiency virus (HIV) epidemiologic trends among adolescents and young adults (AYAs) in the United States, highlighting the significant public health challenge posed by HIV within this demographic. Despite a notable decline in HIV diagnoses among AYAs, challenges remain, particularly due to 50% of AYAs living with HIV being unaware of their status. The article aims to evaluate current clinical recommendations, identify deficiencies, and propose evidence-based improvements for HIV prevention, diagnosis, and care, with the goal of enhancing health outcomes and reducing HIV prevalence among AYAs.
Collapse
Affiliation(s)
- Adam Leonard
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins School of Nursing, Baltimore, MD, USA; Community Health Systems, University of California, San Francisco School of Nursing, San Francisco, CA, USA.
| | - Brenice Duroseau
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins School of Nursing, Baltimore, MD, USA. https://twitter.com/thenpthatcares
| |
Collapse
|
7
|
Baiden P, LaBrenz CA, Broni MN, Baiden JF, Adepoju OE. Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study. Psychiatry Res 2024; 334:115823. [PMID: 38430817 DOI: 10.1016/j.psychres.2024.115823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14-18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.
Collapse
Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX 76019, United States.
| | - Catherine A LaBrenz
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX 76019, United States
| | - Marisa N Broni
- University of Ghana, School of Public Health, P. O. Box LG 25, Legon, Accra, Ghana
| | - John F Baiden
- East Airport International School, P. O. Box KAPM 57, KIA, Accra, Ghana
| | - Omolola E Adepoju
- University of Houston, Tilman J. Fertitta Family College of Medicine, 5055 Medical Circle, Houston, TX 77204, United States
| |
Collapse
|
8
|
Brown S, Barman-Adhikari A, Garcia K, Chassman S, Hsu HT, Petering R, Santa Maria D, Narendorf S, Shelton J, Bender K, Ferguson K. Substance use typologies among young people experiencing homelessness in seven cities across the United States: A latent class analysis. Addict Behav 2024; 150:107929. [PMID: 38056194 DOI: 10.1016/j.addbeh.2023.107929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Substance use and other health-risk risk factors, including mental health, trauma, and sexual-risk behaviors, often co-occur among youth experiencing homelessness (YEH). The present study aimed to identify subgroups of YEH based on polysubstance use and the linkages to sociodemographic and health-risk characteristics. METHODS From June 2016 to July 2017, 1,426 YEH (aged 18-26 years) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information via a self-administered electronic survey on substance use, mental health, trauma, sexual risk behaviors, and sociodemographic characteristics. The majority of YEH identified as Black (37.3%), cisgender (92.8%), and heterosexual (69.2%). On average, YEH were 20.9 years (SD = 2.1). This study employed latent class analysis (LCA) to identify subgroups of YEH according to their substance use. Multinomial logistic regression analyses were conducted to identify sociodemographic and health-risk characteristics associated with class-membership. RESULTS Four latent classes of YEH substance use were identified: (1) high polysubstance use; (2) moderate stimulant and high marijuana, alcohol, and prescription drug use; (3) high marijuana, alcohol, and prescription drug use; (4) low/moderate marijuana and alcohol use. Multinomial logistic regression models indicated that geographic location, gender, race/ethnicity, mental health, trauma history, and sexual risk behaviors were significant correlates of substance use class membership among YEH. CONCLUSIONS These findings offer important implications for the prevention and treatment of substance use among YEH. Screening protocols should consider co-occurring risk factors such as traumatic experiences, sexual risk behaviors, and mental health history as indicators of polysubstance use.
Collapse
Affiliation(s)
- Samantha Brown
- School of Social Work, Colorado State University, 450 W Pitkin St, Fort Collins, CO 80521, USA.
| | - Anamika Barman-Adhikari
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO 80208, USA.
| | - Kevin Garcia
- School of Social Work, Colorado State University, 450 W Pitkin St, Fort Collins, CO 80521, USA
| | - Stephanie Chassman
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO 80208, USA.
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, 729 Clark Hall, Columbia, MO 65211, USA
| | - Robin Petering
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, 1503-1, Los Angeles, CA 90015, USA
| | - Diane Santa Maria
- Department of Nursing Systems, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 591, Houston, TX 77030, USA
| | - Sarah Narendorf
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd. #110HA, Houston, TX 77204-4013, USA
| | - Jama Shelton
- Silberman School of Social Work at Hunter College, 2180 Third Ave., New York, NY 10035, USA
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO 80208, USA.
| | - Kristin Ferguson
- School of Social Work, Arizona State University, 411 N. Central Ave., #865, Phoenix, AZ 85004-0689, USA
| |
Collapse
|
9
|
Staton M, Tillson M, Levi MM, Webster M, Oser C, Leukefeld C. Screening Incarcerated Women for Opioid Use Disorder. JOURNAL OF DRUG ISSUES 2024; 54:57-73. [PMID: 38046434 PMCID: PMC10688603 DOI: 10.1177/00220426231151595] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The overall aim of the present study is to examine the utility of the DSM OUD Checklist and the NM-ASSIST screening tools to identify symptoms consistent with OUD among incarcerated women in county jails. This study contributes to the existing literature because research on screening and assessment approaches for incarcerated women has been limited. The focus of the current study is to describe the screening procedures and study recruitment for a larger parent study focused on increasing treatment linkages. Study findings indicate a positive correlation between indicators of OUD using the two screening tools, as well as a high degree of correlation between street opioid misuse and other high-risk drug indicators (overdose and injection practices). These findings underscore the importance of outreach, screening, and intervention in real-world settings, including jails, in order to increase access to OUD treatment among this vulnerable sample of women.
Collapse
Affiliation(s)
- Michele Staton
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Martha Tillson
- Department of Sociology, College of Arts & Sciences, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Mary M. Levi
- Department of Psychology, College of Arts & Sciences, University of Kentucky, Lexington, KY, USA
| | - Matthew Webster
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Carrie Oser
- Faculty Affiliate, Center for Health Equity Transformation, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Carl Leukefeld
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
10
|
Staton M, Tillson M, Levi MM, Dickson M, Webster M, Leukefeld C. Identifying and Treating Incarcerated Women Experiencing Substance Use Disorders: A Review. Subst Abuse Rehabil 2023; 14:131-145. [PMID: 38026785 PMCID: PMC10655602 DOI: 10.2147/sar.s409944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
While research on substance use disorder (SUD) treatment among justice-involved populations has grown in recent years, the majority of corrections-based SUD studies have predominantly included incarcerated men or men on community supervision. This review 1) highlights special considerations for incarcerated women that may serve as facilitating factors or barriers to SUD treatment; 2) describes selected evidence-based practices for women along the cascade of care for SUD including screening and assessment, treatment and intervention strategies, and referral to services during community re-entry; and 3) discusses conclusions and implications for SUD treatment for incarcerated women.
Collapse
Affiliation(s)
- Michele Staton
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Mary M Levi
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Megan Dickson
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Matt Webster
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Carl Leukefeld
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
11
|
Sebalo I, Königová MP, Sebalo Vňuková M, Anders M, Ptáček R. The Associations of Adverse Childhood Experiences (ACEs) With Substance Use in Young Adults: A Systematic Review. Subst Abuse 2023; 17:11782218231193914. [PMID: 38025908 PMCID: PMC10631312 DOI: 10.1177/11782218231193914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/25/2023] [Indexed: 12/01/2023]
Abstract
Introduction Young adulthood is a transitional period between adolescence and adulthood. Due to the unique pressures of taking on a new social role and associated uncertainties, young adults are at heightened risk for drug and alcohol use. Furthermore, adverse childhood experiences (ACEs) increases the likelihood of using maladaptive coping strategies such as using substances to avoid or soothe negative emotions. The current review aimed to summarize the associations between exposure to ACEs before the age of 18 years and subsequent drug or alcohol use between the ages of 18 and 25 years. Methods The review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search of the Web of Science, PubMed, and PsycINFO databases was conducted in February 2022. Results The initial search yielded 7178 articles, with 777 duplicates. Consequently, 6401 titles were inspected for relevance. After reading the full text, 88 articles were included in the review. Conclusion This review provides clear evidence that exposure to multiple ACEs is a robust risk factor for the use of alcohol, cannabis and other drugs by young adults. Poor self-regulation and maladaptive coping strategies were identified as mechanisms explaining this link; however, further detailed research is needed.
Collapse
Affiliation(s)
- Ivan Sebalo
- Centre of Research and Education in Forensic Psychology, School of Psychology, University of Kent, Canterbury, UK
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| | - Michaela Poslt Königová
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| | - Martina Sebalo Vňuková
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| | - Martin Anders
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| | - Radek Ptáček
- Department of Psychiatry, Charles University and General University Hospital, Prague, Czechia
| |
Collapse
|
12
|
Guillén AI, Panadero S, Vázquez JJ. The Effects of Traumatic Events on Mental Health Among Women Experiencing Homelessness: A Longitudinal Study. Violence Against Women 2023:10778012231178002. [PMID: 37282561 DOI: 10.1177/10778012231178002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this longitudinal study, we aim to evaluate the prevalence and impact of interpersonal and non-interpersonal traumatic events among women experiencing homelessness in Madrid (Spain) (N = 136). The information was collected through a structured interview and standardized instruments at baseline and at a 12-month follow-up. The most prevalent events were physical assaults, intimate partner violence, and severe illnesses or accidents. Path analysis revealed that personal and non-interpersonal traumatic events had direct effects on mental health, but also had differential indirect effects. Greater efforts are needed to address the effects of various types of potentially traumatic events and to design effective trauma-informed interventions for women experiencing homelessness.
Collapse
Affiliation(s)
- Ana I Guillén
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, Spain
| | - Sonia Panadero
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, Spain
| | - José Juan Vázquez
- Department of Social Psychology, University of Alcalá, Alcalá de Henares, Spain
| |
Collapse
|
13
|
Gibbs KD, Jones JT, LaMark W, Abdulmooti S, Bretz L, Kearney KD, Narendorf SC, Santa Maria DM. Coping during the COVID-19 pandemic among young adults experiencing homelessness and unstable housing: A qualitative study. Public Health Nurs 2023; 40:17-27. [PMID: 36251216 PMCID: PMC9844081 DOI: 10.1111/phn.13136] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Young adults experiencing homelessness (YAEH) experience more stressors compared to housed peers, yet little is known about the impact of the COVID-19 pandemic on these youth. The purpose of this qualitative study was to explore how YAEH perceived the pandemic's impact on their well-being and coping. METHODS YAEH were recruited from those participating in an HIV prevention study. Semi-structured interviews were conducted and analysis was guided by Lazarus and Folkman's transactional theory of stress and coping. RESULTS Four major themes were identified from interviews with 40 youth: (1) ongoing harms, (2) COVID-19 as a stressor, (3) mental health impacts, and (4) coping strategies. Participants described unmet basic needs, emotions of frustration and anxiety, and several coping strategies including substance use. CONCLUSION Many YAEH reported experiencing continued challenges that were compounded by the stressors related to the COVID-19 pandemic. Special considerations are needed to address pandemic-related exacerbations of mental health symptoms and substance use among YAEH.
Collapse
Affiliation(s)
- Karen DiValerio Gibbs
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas,Texas Children's HospitalHoustonTexas
| | - Jennifer Torres Jones
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
| | - Whitney LaMark
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
| | - Sarah Abdulmooti
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
| | - Lauren Bretz
- Baylor College of MedicineSection of Adolescent MedicineHoustonTexas
| | - Kelly D. Kearney
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
| | | | - Diane M. Santa Maria
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
| |
Collapse
|
14
|
McCormick KA, Chatham A, Klodnick VV, Schoenfeld EA, Cohen DA. Mental Health Service Experiences Among Transition-Age Youth: Interpersonal Continuums that Influence Engagement in Care. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2022; 40:1-12. [PMID: 36373126 PMCID: PMC9638293 DOI: 10.1007/s10560-022-00890-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Purpose. Transition-age youth (TAY) who have experienced or are experiencing complex trauma, system involvement and homelessness are at increased risk for serious mental health needs and related challenges. However, these vulnerable and historically marginalized TAY typically have low rates of mental health service engagement. This study examines how and why TAY experiencing system involvement, homelessness, and serious mental health and substance use symptoms engage in mental health services, and what facilitates and/or hinders their engagement in services. Methods. Twenty-one TAY completed a virtual interview about their previous and current mental health service experiences, and why they did or did not engage with mental health services. A modified grounded theory qualitative analysis approach was used to understand how participants' personal sense of meaning interacted with programmatic factors to construct participant experiences with mental health services. Results. Most participants (81%, n = 17) received mental health services, namely psychiatry (76%, n = 16) and counseling/therapy (48%, n = 10), and peer support (10%, n = 2). Participants described their mental health service experiences along three interpersonal and relational continuums between themselves and their providers: feeling (mis)understood, being treated with (dis)respect, and experiencing (dis)trust. Discussion. Study findings reveal that for these particularly vulnerable and marginalized TAY, relational and interpersonal factors significantly influenced their engagement in mental health services. Study findings call for providers to re-imagine their working alliance with highly vulnerable TAY through culturally-attuned practices that promote understanding, respect, and trust. Findings also call for TAY-serving programs and policies to re-imagine peer support as a mental health service option for this highly vulnerable population.
Collapse
Affiliation(s)
- Katie A. McCormick
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, 78712 Austin, TX United States
| | - Ana Chatham
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, 78712 Austin, TX United States
| | - Vanessa V. Klodnick
- Youth & Young Adult Services Research and Innovation, 4101 N. Ravenswood Ave, 60613 Thresholds, Chicago, IL United States
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1823 Red River, 78701 Austin, TX United States
| | - Elizabeth A. Schoenfeld
- LifeWorks, 835 N. Pleasant Valley Rd, 78702 Austin, TX United States
- Department of Human Development & Family Sciences, School of Human Ecology, The University of Texas at Austin, 108 E. Dean Keeton St, 78712 Austin, TX United States
| | - Deborah A. Cohen
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd, 78712 Austin, TX United States
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1823 Red River, 78701 Austin, TX United States
- Dell Medical School Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin, 1601 Trinity St., Bldg, B, 78712 Austin, TX United States
| |
Collapse
|
15
|
Burke CW, Firmin ES, Wilens TE. Systematic review: Rates of psychopathology, substance misuse, and neuropsychological dysfunction among transitional age youth experiencing homelessness. Am J Addict 2022; 31:523-534. [PMID: 36036233 DOI: 10.1111/ajad.13340] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 01/31/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Colin W Burke
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth S Firmin
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Chikwava F, O’Donnell M, Ferrante A, Pakpahan E, Cordier R. Patterns of homelessness and housing instability and the relationship with mental health disorders among young people transitioning from out-of-home care: Retrospective cohort study using linked administrative data. PLoS One 2022; 17:e0274196. [PMID: 36054257 PMCID: PMC9439254 DOI: 10.1371/journal.pone.0274196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 08/23/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The study examined the relationship between mental health, homelessness and housing instability among young people aged 15–18 years old who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia with follow-up to 2018. We determined the various mental health disorders and other predictors that were associated with different levels of homelessness risk, including identifying the impact of dual diagnosis of mental health and substance use disorder on homelessness. Methodology Using retrospective de-identified linked administrative data from various government departments we identified various dimensions of homelessness which were mapped from the European Topology of Homelessness (ETHOS) framework and associated mental health variables which were determined from the WHO ICD-10 codes. We used ordered logistic regression and Poisson regression analysis to estimate the impact of homelessness and housing instability respectively. Results A total homelessness prevalence of 60% was determined in the care-leaving population. After adjustment, high risk of homelessness was associated with dual diagnosis of mental health and substance use disorder, intentional self-harm, anxiety, psychotic disorders, assault and maltreatment, history of involvement with the justice system, substance use prior to leaving care, residential and home-based OHC placement and a history of staying in public housing. Conclusions There is clearly a need for policy makers and service providers to work together to find effective housing pathways and integrated health services for this heterogeneous group of vulnerable young people with complex health and social needs. Future research should determine longitudinally the bidirectional relationship between mental health disorders and homelessness.
Collapse
Affiliation(s)
- Fadzai Chikwava
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Melissa O’Donnell
- Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Anna Ferrante
- Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Eduwin Pakpahan
- Department of Mathematics, Physics & Electrical Engineering, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Reinie Cordier
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- * E-mail:
| |
Collapse
|
17
|
Vera L, Reed KK, Rose E, DeYampert L, Woodard J, Cortes J, Henry A, Thompson AN, Williams KN, Blount Q, Castater C, Schenker M, Smith RN. Prevalence of Housing Insecurity in Survivors of Traumatic Injury. Am Surg 2022; 88:2274-2279. [PMID: 35608389 DOI: 10.1177/00031348221101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Almost 20% of the US population are housing insecure (HI) due to inadequate living conditions, imbalanced costs to income, nonsustainable shelter, or overcrowding. Housing insecure and physical trauma share similar risk factors, but their direct association is not well elucidated. The objective of our study was to determine the prevalence of HI in survivors of traumatic injury. METHODS We conducted a prospective cohort study at an urban, level 1 trauma center. A survey on social determinants of health was administered to adult patients, and demographic, injury specifics, and clinical outcomes data were collected. HI was defined by affirmative answers to questions related to history of homelessness or concern about sustainable shelter. The cohort was stratified by HI; groups were compared using the Mann-Whitney U and Fisher exact tests, as appropriate. RESULTS Of 116 study participants, four were excluded due to missing data. Of the 112, 42 (37.8%) reported HI and most were black (69%) males (73.8%). There were no demographic differences between groups. Conversely, HI patients had a higher rate of penetrating traumatic injury (34.1% vs 14.5%, P-value = .03) and were significantly less educated compared to secure participants (P-value = .03) [no degree (26.2% vs 10.3%), high school degrees (21.4% vs 41.2%)] with concomitant illicit drug use (63.4% vs 27.9%, P < .001), and history of addiction (52.4% vs 7.2%, P < .001). CONCLUSION HI far exceeds national averages in our cohort. Although difficult to ascertain a cause-effect relationship, HI may be a modifiable risk factor for trauma that negatively influences outcomes.
Collapse
Affiliation(s)
- Luis Vera
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Elizabeth Rose
- 19911Eisenhower Army Medical Center, Fort Gordon, GA, USA
| | | | | | | | - Antonio Henry
- 25798Rollins School of Public Health, Atlanta, GA, USA
| | | | | | - Quinton Blount
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | | | - Mara Schenker
- 12239Emory University School of Medicine, Atlanta, GA, USA
| | - Randi N Smith
- 12239Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
18
|
Rogers CJ, Pakdaman S, Forster M, Sussman S, Grigsby TJ, Victoria J, Unger JB. Effects of multiple adverse childhood experiences on substance use in young adults: A review of the literature. Drug Alcohol Depend 2022; 234:109407. [PMID: 35306395 DOI: 10.1016/j.drugalcdep.2022.109407] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACE), including maltreatment and household dysfunction, are consistent predictors of health compromising behaviors in adulthood. While most ACE studies have focused on adults, there is an emerging body of research focusing on young adulthood. METHODS This review describes research focused on the relationship between ACE and substance use among young adults. Two databases were searched for studies published from 1998 to 2021 that assess the relationship between ACE and substance use among young adults. Of the 1474 articles identified in the search, 43 met the inclusion criteria. RESULTS Consensus across reviewed studies is that the relationship between ACE and substance use demonstrated in the general adult population is evident in young adults, although effects varied by demographic variables such as gender and ethnic background. CONCLUSIONS The need for standardized measures across studies, racial/ethnic considerations, and the importance of building trauma informed prevention programs targeting this age group are discussed.
Collapse
Affiliation(s)
- Christopher J Rogers
- Department of Population and Public Health Science, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
| | - Sheila Pakdaman
- Department of Population and Public Health Science, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Myriam Forster
- Department of Health Sciences, California State University, Northridge, CA, USA
| | - Steve Sussman
- Department of Population and Public Health Science, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Timothy J Grigsby
- Department of Environmental and Occupational Health University of Nevada, Las Vegas, USA
| | - Jazmine Victoria
- Department of Health Sciences, California State University, Northridge, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Science, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
19
|
Heiderscheit A. Analysis of the type of imagery and imagery themes from Bonny Method of Guided Imagery and Music (GIM) sessions with adults in chemical dependency treatment. ARTS IN PSYCHOTHERAPY 2022. [DOI: 10.1016/j.aip.2022.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Maestrelli LG, Sousa Martins Silva A, de Azevedo-Marques Périco C, Torales J, Ventriglio A, Castaldelli-Maia JM. Homelessness and Depressive Symptoms: A Systematic Review. J Nerv Ment Dis 2022; 210:380-389. [PMID: 35413031 DOI: 10.1097/nmd.0000000000001453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The present systematic review aimed to summarize data on the prevalence and treatment of depressive symptoms among homeless people. We referred to the PubMed and Google Scholar databases to identify relevant studies on the topic. Among the 43 included studies, we found great variability in the prevalence of depressive symptoms among homeless people (ranging from 9.9% to 77.5%). Comparative studies among the homeless versus nonhomeless population showed that rates of depressive symptoms are 5 to 14 times higher in the homeless population. Similar differences were also found for suicidal ideation. The lack of research and treatment plans for this specific population further encourages more evidence and special therapeutic intervention. Although little has been found in the literature, a substantial improvement in the quality of life and reduction in depressive symptoms was demonstrated when therapeutic interventions were performed among homeless people (i.e., housing, nursing, access to community care and effective services and supports programs, mindfulness, pharmacological treatment).
Collapse
Affiliation(s)
| | | | | | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, Asunción, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | |
Collapse
|
21
|
The syndemic effects of adverse mental health conditions and polysubstance use on being at risk of clinical depression among marginally housed and homeless transitional age youth living in San Francisco, California. PLoS One 2022; 17:e0265397. [PMID: 35298526 PMCID: PMC8929626 DOI: 10.1371/journal.pone.0265397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to identify the correlates of being at risk of clinical depression and examine the role of syndemic factors among marginally housed and homeless transitional age youth (TAY). From 2017-2018, 100 TAY between the ages of 18 and 24 in San Francisco were recruited from Larkin Street Youth Services into a cross-sectional study. Participants completed surveys on mental health, substance use, and HIV risk behaviors. A syndemic score ranging from 0-3 was calculated by summing dichotomous measures of moderate or severe anxiety in the past two weeks, PTSD symptoms in the past month and polysubstance use in the past three months. We used modified Poisson regression with robust error variances to identify the correlates of being at risk of clinical depression in the past week, all primary effects measures were modeled separately. Among 100 participants, the average age was 21 (SD = 1.7), 67% were male, 38% were Multiracial, 54% identified as gay, lesbian, bisexual or pansexual, 13% were unstably housed, 50% were homeless and 23% were living with HIV. The majority (74%) were at risk of clinical depression, 51% had symptoms of moderate or severe anxiety, 80% exhibited symptoms of PTSD and 33% reported polysubstance use. After controlling for age in years, gender, race/ethnicity and sexual orientation, factors independently associated with being at risk of clinical depression were; symptoms of moderate or severe anxiety (adjusted risk ratio [aRR] = 1.62, 95% confidence interval [CI] = 1.23-2.12, P<0.001), symptoms of PTSD (aRR = 3.78, 95% CI = 1.58-9.04, P = 0.003), polysubstance use (aRR = 1.33, 95% CI = 1.06-1.68), P = 0.012), an increasing syndemic score (aRR = 1.40, 95% CI = 1.21-1.62), P<0.001), and having one, two or three syndemic factors (compared to none); (aRR = 2.68, 95% CI = 1.08-6.65, P = 0.032), (aRR = 3.24, 95% CI = 1.24-7.83, P = 0.003) and (aRR = 3.97, 95% CI = 1.65-9.52, P = 0.002), respectively. Integrated behavioral health models that treat co-occurring disorders simultaneously are needed to reduce syndemic risk among marginally housed and homeless TAY.
Collapse
|
22
|
Smith-Grant J, Kilmer G, Brener N, Robin L, Underwood JM. Risk Behaviors and Experiences Among Youth Experiencing Homelessness-Youth Risk Behavior Survey, 23 U.S. States and 11 Local School Districts, 2019. J Community Health 2022; 47:324-333. [PMID: 35013979 PMCID: PMC9119052 DOI: 10.1007/s10900-021-01056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/26/2022]
Abstract
Youth experiencing homelessness experience violence victimization, substance use, suicide risk, and sexual risk disproportionately, compared with their stably housed peers. Yet few large-scale assessments of these differences among high school students exist. The youth risk behavior survey (YRBS) is conducted biennially among local, state, and nationally representative samples of U.S. high school students in grades 9-12. In 2019, 23 states and 11 local school districts included a measure for housing status on their YRBS questionnaire. The prevalence of homelessness was assessed among states and local sites, and relationships between housing status and violence victimization, substance use, suicide risk, and sexual risk behaviors were evaluated using logistic regression. Compared with stably housed students, students experiencing homelessness were twice as likely to report misuse of prescription pain medicine, three times as likely to be threatened or injured with a weapon at school, and three times as likely to report attempting suicide. These findings indicate a need for intervention efforts to increase support, resources, and services for homeless youth.
Collapse
Affiliation(s)
- Jennifer Smith-Grant
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA.
- U.S. Public Health Service Commissioned Corps, Washington, DC, USA.
| | - Greta Kilmer
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| | - Nancy Brener
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| | - Leah Robin
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| | - J Michael Underwood
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, Mailstop US 8-1, Atlanta, GA, 30329, USA
| |
Collapse
|
23
|
Liu M, Luong L, Lachaud J, Edalati H, Reeves A, Hwang SW. Adverse childhood experiences and related outcomes among adults experiencing homelessness: a systematic review and meta-analysis. LANCET PUBLIC HEALTH 2021; 6:e836-e847. [PMID: 34599894 DOI: 10.1016/s2468-2667(21)00189-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/05/2021] [Accepted: 07/30/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are strong risk factors for homelessness and poor health and functioning. We aimed to evaluate the lifetime prevalence of ACEs and their associations with health-related and functioning-related outcomes among homeless adults. METHODS In this systematic review and meta-analysis, we searched from database inception to Nov 11, 2020, for original and peer-reviewed studies in English that documented lifetime prevalence of ACEs or associations between ACEs and health-related or functioning-related outcomes. We selected studies if they included a definable group of homeless adults and measured at least four ACE categories. We calculated pooled estimates of lifetime prevalence of one or more ACEs and four or more ACEs with random-effects models. We used the leave-one-out method in sensitivity analyses and studied meta-regressions to explore potential moderators of ACE prevalence. We also did a narrative summary of associations between ACEs and health-related and functioning-related outcomes, as there were too few studies on each outcome for quantitative meta-analysis. This study is registered with PROSPERO, CRD42020218741. FINDINGS We identified 2129 studies through systematic search, of which 29 studies (16 942 individuals) were included in the systematic review, 20 studies (10 034 individuals) were included in the meta-analysis for one or more ACEs, and 15 studies (5693 individuals) were included in the meta-analysis for four or more ACEs. Studies included samples of adults experiencing homelessness in the USA, Canada, and the UK; participants in the included studies were predominantly male (65·2%) and mean ages ranged between 18·3 and 58·1 years, but many studies did not report race, ethnicity, and sexual and gender minority data. Lifetime prevalence of one or more ACEs among homeless adults was 89·8% (95% CI 83·7-93·7) and the lifetime prevalence of four or more ACEs was 53·9% (45·9-61·7). Considerable heterogeneity was identified in both meta-analyses (I2>95%). Of the potential moderators analysed, the ACE measurement tool significantly moderated the estimated lifetime prevalence of one or more ACEs and four or more ACEs, and age also significantly moderated the estimated lifetime prevalence of four or more ACEs. In the narrative synthesis, ACEs were consistently positively associated with high suicidality (two studies), suicide attempt (three studies), major depressive disorder (two studies), substance misuse (two studies), and adult victimisation (two studies). INTERPRETATION The lifetime prevalence of ACEs is substantially higher among homeless adults than among the general population, and ACE exposure might be associated with prevalence of mental illness, substance misuse, and victimisation. Policy efforts and evidence-based interventions are urgently needed to prevent ACEs and address associated poor outcomes among this population. FUNDING Rhodes Trust and Canadian Institutes of Health Research.
Collapse
Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, MA, USA; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
| | - Linh Luong
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Hanie Edalati
- Department of Psychiatry, University of Montreal, Montreal, QC, Canada
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
24
|
Ramos GG, West AE, Begay C, Telles VM, D'Isabella J, Antony V, Soto C. Substance use disorder and homelessness among American Indians and Alaska Natives in California. J Ethn Subst Abuse 2021; 22:350-371. [PMID: 34339341 DOI: 10.1080/15332640.2021.1952125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
American Indian and Alaska Native (AIAN) communities have higher rates of substance use than other racial and ethnic groups. Substance use disorder (SUD) is tied to the increased risk of experiencing homelessness. National policies have also led to the disproportionate rates of homelessness among AIAN communities. However, specific experiences related to the occurrence of SUD and homelessness among AIAN in California, as well as seeking and accessing SUD treatment, are not well understood. This study explored potential SUD risk and resilience factors for AIANs experiencing homelessness and their experiences when seeking services for SUD. Nineteen interviews were conducted in northern, central, and southern California. Thematic analysis was used for these data. The five primary codes were: (1) risk factors for SUD, (2) resilience related to SUD service seeking, (3) services available, (4) barriers accessing services, and (5) services needed. Based on the results, themes for risk were trauma, mental health, and community conditions. Themes for resilience were identified at individual and community levels and included personal motivation and community support and inclusiveness. Themes for services available were limited knowledge about service types and services' location. The themes for barriers accessing services were identified at internal and external levels, and included lack of readiness and transportation challenges, respectively. Themes for services needed included continuum of care, integrated care, and culturally sensitive services. Findings highlight the importance of addressing the potential risk factors and service needs of AIANs experiencing homelessness to provide comprehensive and culturally sensitive services to reduce substance use.
Collapse
Affiliation(s)
- G G Ramos
- University of Southern California, Los Angeles, CA, USA
| | - A E West
- University of Southern California, Los Angeles, CA, USA
| | - C Begay
- University of Southern California, Los Angeles, CA, USA
| | - V M Telles
- University of Southern California, Los Angeles, CA, USA
| | - J D'Isabella
- University of Southern California, Los Angeles, CA, USA
| | - V Antony
- University of Southern California, Los Angeles, CA, USA
| | - C Soto
- University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
25
|
Comparing substance use and mental health among sexual and gender minority and heterosexual cisgender youth experiencing homelessness. PLoS One 2021; 16:e0248077. [PMID: 33705446 PMCID: PMC7951876 DOI: 10.1371/journal.pone.0248077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 02/18/2021] [Indexed: 11/20/2022] Open
Abstract
Youth homelessness has been demonstrated to disproportionately affect sexual and gender minority (SGM) youth compared to heterosexual cisgender peers. In this context, we aimed to compare health risks between service-seeking SGM and heterosexual cisgender youth experiencing homelessness, including harmful risks stemming from substance use and severity of symptoms of mental health disorders. We recruited 100 racially diverse, unstably housed participants aged 18-24 who access services at an urban non-profit organization in San Francisco, CA. Data analysis included 56 SGM participants who identified as gay, lesbian, bisexual, pansexual, unsure, transgender, and nongender, and 44 heterosexual cisgender participants. In contrast to previous studies reporting significantly higher frequency of substance use and more severe symptoms of depression, generalized anxiety, and post-traumatic stress disorder among SGM youth compared to heterosexual cisgender peers, many of these health disparities were not observed in our diverse study population of service-seeking youth. Furthermore, with the exception of methamphetamine, SGM participants did not exhibit greater harmful risks resulting from substance use, such as health, social, financial, and legal complications. We discuss the reduced burden of health disparities between SGM and heterosexual cisgender youth in our service-seeking study population within the context of gender- and sexuality-affirming programming offered at the partnering community organization. We conclude that longitudinal data on these tailored community-level interventions are needed to further explore the reduced burden of health disparities observed among service-seeking SGM youth experiencing homelessness in San Francisco in order to continue supporting pathways out of homelessness for youth of all sexual and gender identities nationwide.
Collapse
|