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O'Shaughnessy BR, Mayock P, Kakar A. The recovery experiences of homeless service users with substance use disorder: A systematic review and qualitative meta-synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104528. [PMID: 39053034 DOI: 10.1016/j.drugpo.2024.104528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/04/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The relationship between homelessness and substance use disorder (SUD) is layered and complex. Adults pursuing recovery while dealing with homelessness and SUD face many challenges. Little research has inspected qualitative first-person accounts of recovery in the context of homelessness and SUD, and few studies have employed conceptualisations of recovery beyond abstinence. In this systematic review study, we examine the qualitative literature on the recovery experiences of adult homeless service users with SUD. METHODS 2,042 records were identified via database and secondary searching strategy. After title and abstract and full text screening, 15 eligible studies remained. Critical Appraisal Skills Programme quality appraisal criteria was used to assess potential bias in the studies. Meta-ethnography was employed to synthesise extracted data. RESULTS Four themes were generated from the extracted data: Two sides of the Service Coin; Navigating Relationships; Recovery Practices and Personal Attributes; and Housing as Foundational for Recovery. CONCLUSION Unconditional housing, a broad array of supports, opportunities to contribute to society, and family reunification supports all facilitate the development of recovery for adults with SUD experiencing homelessness. Implications for policy are discussed.
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Affiliation(s)
- Branagh R O'Shaughnessy
- School of Social Work and Social Policy, Trinity College Dublin, College Green, Dublin 2, Ireland.
| | - Paula Mayock
- School of Social Work and Social Policy, Trinity College Dublin, College Green, Dublin 2, Ireland
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Doornbos MM, Zandee GL, Bjelland C. Men's mental health - Conceptualization, effects, and coping. Arch Psychiatr Nurs 2024; 50:100-107. [PMID: 38789221 DOI: 10.1016/j.apnu.2024.03.014] [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: 11/11/2022] [Revised: 10/30/2023] [Accepted: 03/10/2024] [Indexed: 05/26/2024]
Abstract
Men are predisposed to suffer with unaddressed depression and anxiety. This study sought to empower men, in three urban, racially/ethnically diverse, underserved, and impoverished neighborhoods, for mental health self-care by capturing their perceptions of depression and anxiety. Using community-based participatory research, in the context of long-term partnerships between a department of nursing and these neighborhoods, the researchers recruited 50 men aged 23-83 years. Data were collected via six homogeneous, zoom-based focus groups composed of Black, Hispanic, and White men, respectively. The men identified themes pertaining to the conceptualization and devastating effects of depression and anxiety as well as coping strategies employed to mitigate the symptoms.
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Jones-Patten A, Shin SS, Nyamathi A, Bounds D. "Cigarettes play the equalizer": discrimination experiences and readiness to quit cigarette smoking among African Americans experiencing homelessness: a qualitative analysis. Addict Sci Clin Pract 2024; 19:1. [PMID: 38163885 PMCID: PMC10759568 DOI: 10.1186/s13722-023-00432-8] [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: 04/17/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Approximately 70-80% of people experiencing homelessness in the United States use tobacco. Smoking cessation programs specifically for this population have been found to be less effective for African American participants. The purpose of this study was to explore discrimination experiences and their impact on smoking habits and readiness to quit cigarette smoking while experiencing homelessness. METHODS In the qualitative phase of this mixed methods study, five focus groups were conducted for African Americans residing in a homeless shelter in Skid Row, Los Angeles, CA. Using a semi-structured interview guide, we asked participants about discrimination experiences, how smoking habits were impacted by these experiences, and tools needed to successfully abstain from cigarette smoking. Qualitative descriptive content analysis was used to explore discrimination experiences and its association with readiness to quit cigarette smoking. RESULTS Of the 17 participants, 14 (82.4%) were male, and the average age was 46.8 years. Using a qualitative In Vivo coding method, three themes were revealed: "Experiencing Discrimination while Black", "The Psychosocial Fabric-Why Quitting Cigarette Smoking is a Challenge", and "The Lesser of Two Evils-Choosing to Smoke over More Harmful Options." Participants discussed working in the blue-collar workforce while Black, identifying as a double minority, smoking to cope with stress, early exposure to cigarettes, smoking being a central part of one's belonging to a group, and the legality of cigarette smoking. DISCUSSION Our findings show that African Americans experiencing homelessness (1) may experience discrimination in multiple settings, regardless of housing status, (2) could have grown up around cigarette smoking and remain surrounded by it while experiencing homelessness, and (3) may experience a calming effect with smoking, which slows some from reacting negatively to adverse situations. CONCLUSION Barriers to successfully abstaining from smoking are multifactorial among African Americans experiencing homelessness and should be addressed individually. Future research should explore the cultural tailoring of interventions that support cessation efforts unique to minoritized populations to improve smoking cessation programs offered to this population.
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Affiliation(s)
- Alexandria Jones-Patten
- Columbia University School of Nursing, Center for Research On People of Color, 560 W 168Th St, New York, NY, 10032, USA.
- Columbia University Irving Medical Center New York, New York, NY, USA.
| | - Sanghyuk S Shin
- Irvine School of Nursing Berk Hall, University of California, 802 West Peltason Drive, Irvine, CA, 92617, USA
| | - Adeline Nyamathi
- Irvine School of Nursing Berk Hall, University of California, 802 West Peltason Drive, Irvine, CA, 92617, USA
| | - Dawn Bounds
- Irvine School of Nursing Berk Hall, University of California, 802 West Peltason Drive, Irvine, CA, 92617, USA
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Tisott ZL, Barroso TMMDDA, Nasi C, Siqueira DFD, Lacchini AJB, Santos CFD. Experiences and challenges of a street team in Portugal with vulnerable populations: phenomenological study. Rev Gaucha Enferm 2022; 43:e20220147. [PMID: 36478015 DOI: 10.1590/1983-1447.2022.20220147.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/12/2022] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To understand the experiences and challenges faced by professionals working on a street team in Portugal in caring for the vulnerable population from the phenomenological perspective of Alfred Schutz. METHOD Qualitative approach in the light of the theoretical framework of phenomenological Sociology, developed in a street team in the central region of Portugal from phenomenological interviews with five professionals in the months of June and July 2021. The interpretation of the results was analyzed through theoretical conceptions of Alfred Schutz's phenomenological sociology and related literature. RESULTS Three categories emerged: Conflicts experienced by the street team; Frustration in the daily care provided by the street team; and, Limits in the social relationship with the vulnerable population. CONCLUSION The street team in Portugal faces challenges in caring for the vulnerable population served,requiring team skills for conflict mediation combined with an understanding of the influences of relationships, in social action.
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Affiliation(s)
- Zaira Letícia Tisott
- Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Cintia Nasi
- Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre, Rio Grande do Sul, Brasil
| | | | | | - Carla Félix Dos Santos
- Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre, Rio Grande do Sul, Brasil
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Diduck B, Rawleigh M, Pilapil A, Geeraert E, Mah A, Chen SP. Mental health needs of homeless and recently housed individuals in Canada: A meta-ethnography. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3579-e3592. [PMID: 36057960 DOI: 10.1111/hsc.13996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 08/08/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Homeless individuals are disproportionately likely to experience mental health conditions, and typically face many systemic barriers to access mental health services. This study sought to determine the mental health needs of homeless and recently housed individuals in Canada. A meta-ethnography was conducted to synthesise existing qualitative data and translate themes across a broader context. Thirty-five studies on the experiences of 1511 individuals with a history of homelessness were included. Themes were interpreted by comparing and contrasting findings across multiple contexts. Distinct, yet highly interrelated, unmet mental health needs were revealed through personal narratives of trauma, stigmatisation, victimisation, and a lack of basic necessities. Six themes that characterised this population's mental health needs were ontological security, autonomy, hope and purpose, empowerment, social connection and belonging, and access to services. This study revealed homeless individuals' unmet mental health needs to inform social and policy change and improve psychological well-being.
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Affiliation(s)
- Bronte Diduck
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Alberta, Canada
| | - Mikaela Rawleigh
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Alberta, Canada
| | - Alexandra Pilapil
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Alberta, Canada
| | - Erin Geeraert
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Alberta, Canada
| | - Amanda Mah
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Alberta, Canada
| | - Shu-Ping Chen
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Alberta, Canada
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van der Meer L, Barsties LS, Daalderop LA, Waelput AJM, Steegers EAP, Bertens LCM. Social determinants of vulnerability in the population of reproductive age: a systematic review. BMC Public Health 2022; 22:1252. [PMID: 35751043 PMCID: PMC9233331 DOI: 10.1186/s12889-022-13651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background The health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or prospective parents affect their own health depends partly on their coping or resilience abilities. Inadequate abilities allow negative effects of unfavourable social determinants to prevail, rendering them vulnerable to adverse health outcomes. Addressing these determinants in the reproductive-aged population is therefore a key approach in improving the health of the future generation. This systematic review aims to synthesise evidence on social determinants of vulnerability, i.e., inadequate coping or low resilience, in the general population of reproductive age. Methods The databases EMBASE, Medline, PsycINFO, CINAHL, Google Scholar, Web of Science, and Cochrane Library, were systematically searched from database inception to December 2th 2021. Observational studies examining social determinants and demographics in relation to vulnerability among the general population of reproductive age (men and women aged 18-40 years), conducted in a high-income country in Europe or North America, Australia or New Zealand were eligible for inclusion. Relevant data was extracted from each included article and findings were presented in a narrative and tabulated manner. Results We identified 40,028 unique articles, of which 78 were full text reviewed. Twenty-five studies were included, of which 21 had a cross-sectional study design (84%). Coping was the most frequently assessed outcome measure (n = 17, 68%). Thirty social determinants were identified. Overall, a younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events were associated with inadequate coping or low resilience. Conclusions This review shows that certain social determinants are associated with vulnerability in reproductive-aged individuals. Knowing which factors make people more or less vulnerable carries health-related implications. More high-quality research is needed to obtain substantial evidence on the strength of the effect of these social conditions in this stage of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13651-6.
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Affiliation(s)
- Lindsey van der Meer
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.
| | - Lisa S Barsties
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.,DRIFT - Dutch Research Institute for Transitions, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Leonie A Daalderop
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands.,DRIFT - Dutch Research Institute for Transitions, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Adja J M Waelput
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
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Mejia-Lancheros C, Lachaud J, Aubry T, Wiens K, O’Campo P, Stergiopoulos V, Hwang SW. Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site. Soc Psychiatry Psychiatr Epidemiol 2022; 57:67-81. [PMID: 33866385 PMCID: PMC8761129 DOI: 10.1007/s00127-021-02093-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/07/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE To conduct a multi-dimensional and time-patterned analysis to identify distinct well-being trajectory profiles over a 6-year follow-up period among adults experiencing homelessness and mental illness. METHODS Data from 543 participants of the At Home Chez Soi study's Toronto site were examined over a 6-year follow-up period, including measures of quality of life, community functioning, housing stability, and substance use. Well-being trajectories were identified using Group-Based Trajectory Modelling. Multinomial regression was used to identify predictor variables that were associated with each well-being trajectory profile. RESULTS Four well-being profiles were identified: low well-being, moderate well-being, good well-being, and high well-being. Factors associated with a greater likelihood of following a better well-being profile included receiving Housing First, reporting female gender and non-white ethnicity, having post-secondary studies, and reporting a high resilience level. Concurrently, factors associated with a lower likelihood of better well-being profiles were having a history of chronic homelessness, experiences of discrimination in the healthcare setting, having comorbid mental disorders and a high level of symptom severity, and reporting a history of traumatic brain injury and childhood adversity. CONCLUSIONS Individuals experiencing homelessness follow distinct well-being profiles associated with their socio-demographic characteristics, health status, trauma history, resilience capabilities, and access to housing and support services. This work can inform integrated housing and support services to enhance the well-being trajectories of individuals experiencing homelessness. TRIAL REGISTRATION At Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374, http://www.isrctn.com/ISRCTN42520374 .
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Affiliation(s)
- Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON, M5B 1W8, Canada.
| | - James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada
| | - Tim Aubry
- School of Psychology, University of Ottawa, Ottawa, ON Canada
| | - Kathryn Wiens
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON Canada ,Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, 30 Bonds Street, Toronto, ON M5B 1W8 Canada ,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada
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Tisott ZL, Barroso TMMDDA, Nasi C, Siqueira DFD, Lacchini AJB, Santos CFD. Experiências e desafios de uma equipe de rua em Portugal com populações vulneráveis: estudo fenomenológico. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20220147.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivo: Compreender as experiências e desafios dos profissionais de uma equipe de rua de Portugal no cuidado à população vulnerável na perspectiva fenomenológica de Alfred Schutz. Método: Abordagem qualitativa à luz do referencial Teórico da Sociologia fenomenológica desenvolvido em uma Equipe de rua localizada na região centro de Portugal a partir de entrevistas fenomenológicas com cinco profissionais nos meses de junho e julho de 2021. Os dados foram interpretados por meio da análise compreensiva conforme a sociologia fenomenológica de Alfred Schutz e de literatura correlata. Resultados: Emergiram três categorias: conflitos vivenciados pela equipe de rua; Frustração no cotidiano do cuidar pela equipe de rua; e, Limites na relação social com a população vulnerável. Conclusão: A equipe de rua de Portugal enfrenta desafios no cuidado a população vulnerável atendida sendo necessário habilidades da equipe para mediação de conflitos aliada a compreensão das influências das relações, no agir social.
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Affiliation(s)
| | | | - Cintia Nasi
- Universidade Federal do Rio Grande do Sul, Brasil
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Associations of resilience with quality of life levels in adults experiencing homelessness and mental illness: a longitudinal study. Health Qual Life Outcomes 2021; 19:74. [PMID: 33663538 PMCID: PMC7971123 DOI: 10.1186/s12955-021-01713-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/22/2021] [Indexed: 12/01/2022] Open
Abstract
Background Homelessness constitutes a traumatic period that adversely impacts health and quality of life outcomes. The potential mitigating effects of resilience on quality of life levels in people experiencing homelessness are underresearched. This study assesses the longitudinal associations between resilience and quality of life scores among adults experiencing homelessness and mental illness. Methods This study is a secondary analysis of longitudinal data collected over 6 years from participants (N = 575) of the At Home/Chez Soi study on Housing First, Toronto site. Repeatedly measured resilience scores are the primary exposure and repeatedly measured global quality of life scores and mental health-specific quality of life scores are the primary outcomes. Mixed effect models were used to assess the association between the exposures and the outcomes. Results The majority of the participants were men (69.2%) and were on average 40.4 (± 11.8) years old at baseline. The average resilience score ranged between 5.00 to 5.62 over 8 data collection points across the 6-year follow-up period. After adjusting for gender, age, ethno-racial background, Housing First intervention, physical and mental comorbidities, and lifetime homelessness, higher resilience scores were positively associated with higher Global quality of life (Adjusted-coefficient: 0.23, 95% CI 0.19–0.27) and mental health-related quality of life values (Adjusted-coefficient: 4.15, 95% CI 3.35–4.95). Conclusion In homeless adults with mental illness, higher resilience levels were positively associated with higher global and mental health related quality of life values. Further interventions and services aimed to enhance resilience mechanisms and strategies are warranted to enhance better mental health and quality of life outcomes of this population group. Trial registration At Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374. Registered 18 September 2009, http://www.isrctn.com/ISRCTN42520374.
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Jacobs R, Lanspa M, Kane M, Caballero J. Predictors of emotional wellbeing in osteopathic medical students in a COVID-19 world. J Osteopath Med 2021; 121:455-461. [PMID: 33694347 DOI: 10.1515/jom-2020-0272] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/17/2020] [Indexed: 01/21/2023]
Abstract
CONTEXT In March 2020, the World Health Organization declared the novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Due to the rapid spread, strong contagion, high incidence of lethality in severe cases, and the lack of a pharmaceutical prevention or cure, COVID-19 has posed a serious threat to human life and health. It has also had a tremendous impact on mental health, including fear and worry, difficulty sleeping or concentrating, and increased use of poor coping mechanisms. Osteopathic medical students have had additional concerns regarding the interruption of their studies, closing of clinical rotations, and postponed licensing exams. To date, few reports have focused on osteopathic medical students and their reactions to the outbreak. OBJECTIVES To assess resilience, coping, health behaviors, and emotional wellbeing of osteopathic medical students during the onset of the COVID-19 pandemic. METHODS In this cross-sectional study, we distributed an anonymous online survey to all medical students enrolled at Nova Southeastern University in May 2020 (n=1,310) via an e-mail invitation using the institution's student listservs. Our major study variables were based on published reports and anecdotal evidence; we subsequently developed the Emotional Wellbeing in Healthcare Professions Students Questionnaire (EWB-Q). This EWB-Q contained validated scales to assess the contribution of levels of coping strategies used, personal resilience, and health behaviors on the emotional wellbeing of osteopathic medical students. Multiple linear regression and other statistical analyses were conducted using SPSS v0.26. RESULTS Of the 1,310 students invited to participate, 335 (25.5%) surveys were returned. Of those, 133 had more than 33% of the necessary data missing and were removed, resulting in 202 (15.4%) completed questionnaires. The mean age of the participants was 26.7 years. About half (n=92; 45.5%) were in the clinical phase (years 3 and 4) of their medical school training (in rotations). A significant regression equation was found (F[4,171]=17.481, p<0.000, R 2 =0.290, R 2adjusted=0.274), indicating that levels of coping, personal resilience, and health behaviors (i.e., not sleeping more than usual, not exercising less than usual) accounted for a significant amount of the variance in emotional wellbeing scores in osteopathic medical students. Higher levels of resilience, greater use of coping strategies, not sleeping more than usual, and not exercising less than usual were predictors of emotional wellbeing. CONCLUSIONS Cultivating positive mental health should be a high priority for medical educators as they develop and implement curriculum-based initiatives to help medical students bolster their personal resilience and to encourage healthy coping behaviors during times of crisis and beyond. A proactive position that assists with building personal resilience and developing stress management habits is paramount in assisting students who are grappling not only with the challenges of rigorous medical training, but also with the uncertainty and stress that exists during any major global health or socioeconomic crisis.
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Affiliation(s)
- Robin Jacobs
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Michelle Lanspa
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Michael Kane
- The Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
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Zandomingo MNP, Oliveira JFD, Silva DDO, Porcino C, Suto CSS, Oliveira DS. Poverty, hunger, and abandonment: representations of the nursing team about homeless persons. Rev Bras Enferm 2020; 73 Suppl 1:e20190338. [PMID: 32490949 DOI: 10.1590/0034-7167-2019-0338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/26/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to know the structure of social representations of nursing team with regard to homeless persons. Method a qualitative research based on the structural approach of social representations. A total of 96 professionals from the nursing team working in the Psychosocial Care Network units of a Health District of Salvador, Bahia, Brazil, who answered the test of free association of words and a questionnaire with socio-demographic data. The data obtained were processed in softwares that allowed the organization of the frame of four houses and maximum similarity tree. RESULTS poverty, hunger, abandonment and unemployment are central elements of the image of homeless persons, living in a context permeated by drugs, dirt, neglect and vulnerability. Final considerations The social representation structure of homeless persons is anchored in stereotypes that can interfere both in the provision of care and in the access of the people to health services.
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Affiliation(s)
| | | | | | - Carle Porcino
- Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Liu M, Mejia-Lancheros C, Lachaud J, Nisenbaum R, Stergiopoulos V, Hwang SW. Resilience and Adverse Childhood Experiences: Associations With Poor Mental Health Among Homeless Adults. Am J Prev Med 2020; 58:807-816. [PMID: 32147372 DOI: 10.1016/j.amepre.2019.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Adverse childhood experiences are known risk factors for a range of social, economic, and health-related outcomes over the life course. Resilience is a known protective factor. This study examines the associations of adverse childhood experiences and resilience with poor mental health outcomes among homeless adults with mental illness. METHODS This study utilized data from 565 homeless adults with mental illness participating in a Housing First intervention in Toronto (2009-2013) to evaluate their sociodemographic characteristics, adverse childhood experience exposure, resilience, and mental health outcomes. Descriptive statistics were generated, and logistic regression models were used to examine the association of total adverse childhood experience score and resilience with poor mental health outcomes. Analyses were conducted in 2019. RESULTS The average total adverse childhood experience score was 4.1 (SD=2.8) among all study participants. Individuals with a lifetime duration of homelessness exceeding 36 months (p=0.011) had higher mean scores. Total score was positively associated with several mental illness diagnoses and psychopathology severity, indicated by co-occurring mental illness diagnoses (AOR=1.23, 95% CI=1.13, 1.33) and high Colorado Symptom Index scores (AOR=1.26, 95% CI=1.14, 1.38). Resilience served as a protective factor against several individual mental illness diagnoses, co-occurring mental illness diagnoses (AOR=0.85, 95% CI=0.76, 0.95), and high Colorado Symptom Index scores (AOR=0.69, 95% CI=0.61, 0.79). CONCLUSIONS Findings highlight the high prevalence of adverse childhood experiences and their negative impact on homeless adults with mental illness. Resilience protects against adverse childhood experience-associated poor mental health outcomes, thereby serving as a potential interventional target in homeless populations.
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Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, Massachusetts; MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cilia Mejia-Lancheros
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - James Lachaud
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada; Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Stephen W Hwang
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Matulič-Domadzič V, Munté-Pascual A, De Vicente-Zueras I, León-Jiménez S. "Life Starts for Me Again." The Social Impact of Psychology on Programs for Homeless People: Solidarity Networks for the Effectiveness of Interventions. Front Psychol 2020; 10:3069. [PMID: 32116874 PMCID: PMC7010906 DOI: 10.3389/fpsyg.2019.03069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/26/2019] [Indexed: 12/29/2022] Open
Abstract
The role of psychology in the improvement of people’s lives is consistent, according to the scientific literature review. More and more studies within psychology, and other social sciences, are pointing out the importance of the quality of social interactions on physical and mental health and upon perceived wellbeing. When talking about homelessness, psychology has served these individuals mostly by informing intervention programs related to preventing and responding to substance abuse, healthcare, sexual risks, or mental illnesses, and these are key problems that psychology has also studied and found to be connected to homelessness. Such strategies, which were traditionally mostly centered on tackling the weaknesses that homeless people face, are now increasingly considering the role of the social support services. The aim of this study was, on the one hand, to identify evidence on the importance of solidarity as a key factor in the process of overcoming homelessness, and associated substance abuse situations, and the barriers and conditions to achieve it. On another hand, the aim was also to approach the impact of that solidarity on their general wellbeing from the perspective of homeless subjects themselves. To achieve this aim, 20 life stories of people aged 35 to 70 years old were conducted in the metropolitan area of Barcelona. The people interviewed had been homeless in a recent period of their lives and were currently dependent on different services. The communicative methodology allowed deepening into the life stories of these individuals via egalitarian dialogue between the researchers and the participants. The results of the qualitative analysis showed that a strong solidarity network was crucial in the process of overcoming the participants’ homelessness situation and to tackle related circumstances (alcoholism and drug abuse among others), and this has had an impact in their general wellbeing and in the development of more solidarity attitudes. These findings are discussed in light of psychological knowledge and other social sciences literature on the importance of quality social environments to support positive developmental trajectories and considering the potential social impact of the intervention programs that take into account the factor of solidarity during their implementation process.
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Karadzhov D, Yuan Y, Bond L. Coping amidst an assemblage of disadvantage: A qualitative metasynthesis of first-person accounts of managing severe mental illness while homeless. J Psychiatr Ment Health Nurs 2020; 27:4-24. [PMID: 31099122 DOI: 10.1111/jpm.12524] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/17/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Understanding what strategies individuals use to cope with serious mental illness is vital for enhancing their quality of life, mental well-being and recovery, and effective use of services; An episode of homelessness can be a profoundly disruptive event that often leads to chronic stress, social isolation, a negative belief about oneself and restricted access to care, among other adverse experiences; WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: In contrast to existing reviews of qualitative research focusing on escaping homelessness, managing problem substance use and growing resilience, the current review offers an in-depth, interpretive account of coping with serious mental illness during an episode of homelessness; This paper integrates evidence showing the diverse and intricate processes via which homelessness can impede an individual's ability to successfully cope with life stressors and with chronic mental illness; Despite experiencing severe social disadvantage, many individuals demonstrate positive adaptation and coping, and even personal growth; WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is important to be aware of the many ways in which coping with serious mental illness can be influenced by adverse environmental factors such as poverty, homelessness, traumatic life experiences and institutional discrimination; Nursing practice should recognize that coping efforts by individuals facing multiple forms of social disadvantage may be shaped by acute adverse life events and institutional interactions, as well as by the stresses and strains of living on the streets; Nursing practice should focus not only on reducing clients' mental illness symptoms and facilitating positive coping behaviours, but also on helping create the conditions that aid clients in leveraging inner resources for personal growth and constructive meaning-making. Abstract Introduction An evidence gap persists concerning the impact of extreme socio-structural disadvantage, such as homelessness, on the nature and effectiveness of coping with severe mental illness (SMI). While existing reviews of qualitative research into homelessness have focused on processes such as escaping homelessness and managing concurrent problem substance use, as well as on the experiences of specific vulnerable groups such as women and youth, no analogical review has been dedicated to understanding the management of SMI during an episode of homelessness. Aim/Question A qualitative metasynthesis of first-person accounts was conducted to understand how individuals cope with SMI when experiencing homelessness. Method The systematic search strategy yielded 481 potentially eligible sources. Following the team-based full-text screening and the two-tiered quality appraisal, 14 studies involving 377 participants with lived experience were synthesized following Noblit and Hare's metaethnographic method. Results Seven third-order concepts were derived capturing the complex nature and processual character of coping, as well as the web of contextual influences upon coping strategies. The resultant line-of-argument synthesis reveals the dialectical relationship between the two higher-order constructs-"the continuum of coping" and "the assemblage of disadvantage." Discussion Despite the profoundly adverse impacts of biographical and socio-structural conditions, many individuals mobilized internal and external resources to enable various coping processes. Coping in the context of multiple disadvantage is not a monolith but rather a multidimensional, contingent and fluid phenomenon. Implications for practice Nursing practice should espouse a humanizing, structurally competent, and strength- and meaning-oriented approach in order to meet the complex and multifaceted needs of such multiply disadvantaged persons.
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Affiliation(s)
- Dimitar Karadzhov
- Centre for Health Policy, International Public Policy Institute, School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - Yeqing Yuan
- Silver School of Social Work, New York University, New York, New York
| | - Lynden Bond
- Silver School of Social Work, New York University, New York, New York
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Religious Faith and Diabetes Health Beliefs in a Homeless Population: A Qualitative Study. J Christ Nurs 2019; 36:228-235. [PMID: 31490877 DOI: 10.1097/cnj.0000000000000655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This participatory action research project explored the perspectives and challenges of homeless persons living with, or at risk for, type 2 diabetes. Because these persons were sheltered in and served by a church, their perspectives provide understanding about how religious faith may influence diabetes self-management.
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Isaak CA, Reynolds K, Sareen J, Distasio J. The entrepreneurship of survival among urban adults experiencing homelessness and mental illness. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:1548-1562. [PMID: 31212376 DOI: 10.1002/jcop.22204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 04/03/2019] [Accepted: 05/08/2019] [Indexed: 06/09/2023]
Abstract
AIMS Using an entrepreneurship lens, this study examined the narratives of urban adults experiencing homelessness and living with mental illness, to explore strategies used for day-to-day survival. METHODS Semi-structured qualitative interviews were conducted with 14 females, 30 males, and one individual identifying as "other," living in a mid-sized Canadian city. The average age was 39 years. Data were transcribed verbatim and analyzed using thematic analysis informed by grounded theory. FINDINGS Participants described creative and intentional strategies for managing life on the street without permanent shelter, including recognition of opportunities, mobilization of their own or acquired resources, and use of social connections and communication skills, and strategies that demonstrated entrepreneurial processes. CONCLUSIONS Findings suggest that participants used survival entrepreneurship strategies and processes to navigate daily life while experiencing homelessness. Recognition and validation of the propensity for enterprise and self-sufficiency are central for both individual recovery and ending homelessness within similar populations.
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Affiliation(s)
- Corinne A Isaak
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- End Homelessness Winnipeg, Winnipeg, MB, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jino Distasio
- Institute of Urban Studies, University of Winnipeg, Winnipeg, Manitoba, Canada
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Durbin A, Nisenbaum R, Kopp B, O'Campo P, Hwang SW, Stergiopoulos V. Are resilience and perceived stress related to social support and housing stability among homeless adults with mental illness? HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:1053-1062. [PMID: 30734374 DOI: 10.1111/hsc.12722] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
Perceived stress has been associated with adverse health outcomes. Although people experiencing homelessness often report multiple acute and chronic stressors, research on resilience and perceived stress on the general homeless population is limited. This longitudinal study examined homeless adults with mental illness who were part of a 24-month trial of Housing First to explore: (a) changes in levels of resilience and perceived stress during the trial, and (b) the association between levels of resilience and perceived stress with measures of social support, social functioning and percentage of days stably housed over the study period. This longitudinal study (2009-2013) that used trial data included 575 participants in Toronto, Ontario. Of these individuals, 507 were included in this study. Connor-Davidson Resilience Scale and Perceived Stress Scales (PSS) measured the two outcomes, resilience and perceived stress. Time (baseline, 12 and 24 months), housing stability and three measures of social support and social functioning were the main predictors. A longitudinal analysis was done with repeated measures analysis of resilience and perceived stress using linear mixed models with random intercepts. Mean resilience scores increased (baseline: 5.1 [95% CI: 4.9, 5.2], 12 months: 5.5 [95% CI: 5.3, 5.7], 24 months: 5.6 [95% CI: 5.4, 5.8]), and PSS scores decreased (baseline: 22.3 [95% CI: 21.5, 23.0], 24 months: 18.6 [95% CI: 17.9, 19.4]). In the multivariable analyses, increased resilience was associated with higher scores on the three social support and social functioning measures, (estimates = 0.12, 0.04, 0.02) but not percentage days stably housed. Lower PSS scores were associated with higher scores on all three social support and social functioning measures (-0.20, -0.33, -0.21) and higher percentages of days stably housed (-0.015). Strong social support and social functioning may minimise the harmful effects of stressful life events on homeless individuals by increasing resilience and reducing stress. Interventions to help homeless people build appropriate support networks should be delivered in parallel to efforts that increase housing stability.
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Affiliation(s)
- Anna Durbin
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions and Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brianna Kopp
- Research and Evaluation, algo+med, Calgary, AB, Canada
| | - Patricia O'Campo
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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