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Shao L, Zhao C, Yu G. The Long-Term Effect of Early-Life Uncertainty on Mental Health in Adolescence and Adulthood: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:3211-3225. [PMID: 38551176 DOI: 10.1177/15248380241241028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2024]
Abstract
Turbulent changes in early life are a hidden source of childhood trauma, increasing potential risks for mental illness. Many studies have identified the link between childhood uncertainty and mental health. However, research on the long-term effect of early-life uncertainty (EU) on mental health has not been systematically synthesized. This meta-analysis aims to provide a quantitative estimate of the association between EU and subsequent mental health outcomes. Eight electronic databases and gray literature were searched. Twenty-eight studies met our inclusion criteria: samples of non-clinical adolescents or adults and clear and valid assessments. Random-effect models were used to calculate the pooled effect sizes of EU on internalizing problems, externalizing problems, and well-being. Meta-regression and subgroup analysis were used to explore potential moderators. Results indicated small to moderate associations involving EU and internalizing problem (r = .28; 95% confidence interval [CI] [0.228, 0.326]) and externalizing problem (r = .16; 95% CI [0.102, 0.220]). EU was not significantly associated with well-being (r = -.41; 95% CI [-0.738, 0.071]). Furthermore, moderator analyses found that composite uncertain experiences in childhood had a stronger negative effect than single experiences. EU was a stronger predictor of mental health problems in adults than in adolescents. Cross-sectional studies would amplify the correlation between EU and mental illness compared to longitudinal studies. In the future, childhood uncertain and unpredictable risks should receive more attention. More research needs to focus on positive psychological indicators and samples from non-Western countries.
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Affiliation(s)
- Lei Shao
- School of Education, Renmin University of China, Beijing, China
| | - Chengjia Zhao
- School of Education, Renmin University of China, Beijing, China
| | - Guoliang Yu
- Institute of Psychology, Renmin University of China, Beijing, China
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2
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Stevens GD. Children and Youth Are a Critical Part of the American Story of Homelessness. Med Care 2024:00005650-990000000-00258. [PMID: 39115972 DOI: 10.1097/mlr.0000000000002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Affiliation(s)
- Gregory D Stevens
- Department of Public Health, California State University, Los Angeles, CA
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3
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Torrico T, Fitzsimmons E, Patel S, Lopez J, Padhy R, Salam MT, Abdijadid S. Antenatal Psychiatric Hospitalization: Factors Associated With Newborns' Custody Under Child Protective Services (CPS). J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00039-9. [PMID: 38522509 DOI: 10.1016/j.jaclp.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 02/06/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Psychiatric illness during pregnancy is associated with adverse obstetric outcomes, but investigations into its impact on parenting capacity are limited. Child Protective Services (CPS) contact disproportionately impacts families marginalized by poverty, mental health disorders, and substance use disorders. Recently, there have been investigations into the significance of psychiatric illness and nonmental health-related factors that predict CPS custody arrangements. OBJECTIVE To identify clinical factors associated with newborns' custody under CPS for mothers with antenatal psychiatric hospitalization. METHODS We conducted a retrospective review of electronic medical records over a 10-year period (2012-2021) for patients who were pregnant during their inpatient psychiatric hospitalizations. We followed 81 patients (18 to 43 years old) who delivered within the hospital. The study endpoint was whether the newborn was placed under CPS custody. For the purposes of this study, psychiatric illness was categorized by the presence or absence of psychotic symptoms. We utilized logistic regressions to investigate the associations of these demographic and clinical factors with the study outcome of CPS custody. RESULTS For the entire study population, 64.2% of newborns had CPS custody arrangements. In multivariate analysis, after adjusting for potential confounders, patients with psychotic symptoms were at increased odds of having CPS custody arrangements (odds ratio = 8.43; 95% confidence interval 2.16-32.85) compared with patients without psychotic symptoms. Furthermore, multivariate analyses revealed that patients with a history of homelessness also had a higher risk (odds ratio = 6.59; 95% confidence interval: 1.24-35.13) of CPS custody arrangements for their newborns than those without a history of homelessness. CONCLUSIONS The results of this study suggest that among pregnant and psychiatrically hospitalized patients, those with psychotic symptoms are significantly more likely to have CPS custody arrangements compared to those without psychotic symptoms. However, it is important to note that psychotic symptoms were not definitive for the inability to parent appropriately. In fact, nearly 25% of the study population who had psychotic symptoms were able to successfully transition home with their newborns as mothers. This emphasizes the importance of optimizing the management of psychotic symptoms, particularly among those who have children or plan to have children. The findings of this study also highlight the chronic impacts that those who have struggled with homelessness may experience, including parenting capacity after homelessness resolves.
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Affiliation(s)
- Tyler Torrico
- Department of Psychiatry, Kern Medical, Bakersfield, CA.
| | | | - Shrey Patel
- Department of Psychiatry, Dignity Health Common Spirit, St. Joseph's Medical Center, Stockton, CA
| | - Juan Lopez
- Department of Obstetrics and Gynecology, Kern Medical, Bakersfield, CA
| | - Ranjit Padhy
- Department of Psychiatry, Kern Medical, Bakersfield, CA
| | - Muhammad T Salam
- Department of Psychiatry, Kern Medical, Bakersfield, CA; Department of Population and Public Health Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA
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Mudiganti S, Nasrallah C, Brown S, Pressman A, Kiger A, Casey JA, LaMori JC, Pesa J, Azar KMJ. Homelessness Among Acute Care Patients Within a Large Health Care System in Northern California. Popul Health Manag 2024; 27:13-25. [PMID: 38236711 DOI: 10.1089/pop.2023.0190] [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: 02/09/2024] Open
Abstract
The impacts of homelessness on health and health care access are detrimental. Intervention and efforts to improve outcomes and increase availability of affordable housing have mainly originated from the public health sector and government. The role that large community-based health systems may play has yet to be established. This study characterizes patients self-identified as homeless in acute care facilities in a large integrated health care system in Northern California to inform the development of collaborative interventions addressing unmet needs of this vulnerable population. The authors compared sociodemographic characteristics, clinical conditions, and health care utilization of individuals who did and did not self-identify as homeless and characterized their geographical distribution in relation to Sutter hospitals and homeless resources. Between July 1, 2019 and June 30, 2020, 5% (N = 20,259) of the acute care settings patients had evidence of homelessness, among which 51.1% age <45 years, 66.4% males, and 24% non-Hispanic Black. Patients experiencing homelessness had higher emergency department utilization and lower utilization of outpatient and urgent care services. Mental health conditions were more common among patients experiencing homelessness. More than half of the hospitals had >5% of patients who identified as homeless. Some hospitals with higher proportions of patients experiencing homelessness are not located near many shelter resources. By understanding patients who self-identify as homeless, it is possible to assess the role of the health system in addressing their unmet needs. Accurate identification is the first step for the health systems to develop and deliver better solutions through collaborations with nonprofit organizations, community partners, and government agencies.
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Affiliation(s)
- Satish Mudiganti
- Sutter Health Institute for Advancing Health Equity, Sutter Health, Sacramento, California, USA
| | - Catherine Nasrallah
- Division of Rheumatology, Medical Department, University of California San Francisco, San Francisco, California, USA
| | - Stephanie Brown
- Sutter Health Institute for Advancing Health Equity, Sutter Health, Sacramento, California, USA
| | - Alice Pressman
- Sutter Health Institute for Advancing Health Equity, Sutter Health, Sacramento, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Anna Kiger
- Sutter Health Institute for Advancing Health Equity, Sutter Health, Sacramento, California, USA
| | - Joan A Casey
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington, USA
| | - Joyce C LaMori
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Jacqueline Pesa
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Kristen M J Azar
- Sutter Health Institute for Advancing Health Equity, Sutter Health, Sacramento, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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5
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Kleinman RA, Morris NP. Suicide, Homicide, and Other Violent Deaths Among People Experiencing Homelessness in the United States: A Cross-sectional Study. Public Health Rep 2023; 138:309-314. [PMID: 35466793 PMCID: PMC10031825 DOI: 10.1177/00333549221087228] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Limited information exists about violent deaths among people experiencing homelessness (PEH) across the United States. Using data from a national reporting system, we describe characteristics of suicides, homicides, and other deaths classified as violent among PEH in the United States. METHODS We obtained data on demographic characteristics, mechanisms of injury, and circumstances surrounding violent deaths from January 1, 2016, through December 31, 2018, in 31 states from the National Violent Death Reporting System. RESULTS Of 122 113 violent deaths in 31 states during 2016-2018, 1757 (1.4%) occurred among PEH and 3952 (3.2%) occurred among people for whom homelessness status was unknown or missing. Of all violent deaths among PEH, 878 were suicides (1.1% of all suicides), 458 were homicides (1.6% of all homicides), 352 were of undetermined intent (2.8% of all deaths of undetermined intent), and 59 were the result of legal interventions (3.8% of all deaths due to legal interventions). Hanging/suffocation/strangulation was the most common mechanism of suicide among PEH (44.4%), followed by deaths due to firearms (21.6%). Firearms were the most common mechanism of homicide deaths among PEH (48.0%). Black PEH were more likely to die by homicide than by suicide, and White PEH were more likely to die by suicide than by homicide. Among the 843 suicide victims for whom additional information was known, 345 (40.9%) had a history of suicidal thoughts or plans, 245 (29.1%) had disclosed intent to die by suicide, and 183 (21.7%) were receiving treatment for a mental health condition. CONCLUSIONS Efforts to reduce mortality and improve health outcomes among PEH should consider the high rates of violent deaths in this population.
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Affiliation(s)
- Robert A Kleinman
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nathaniel P Morris
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
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Tsai J, Mitchell L, Nakashima J, Blue-Howells J. Unmet needs of homeless U.S. veterans by gender and race/ethnicity: Data from five annual surveys. Psychol Serv 2023; 20:149-156. [PMID: 34780210 PMCID: PMC10149315 DOI: 10.1037/ser0000557] [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: 02/02/2023]
Abstract
There has been insufficient research on gender, race, and ethnic differences in unmet needs of homeless populations. This study analyzed 5 years of data collected by Project Community Homelessness Assessment, Local Education, and Networking Groups (CHALENG) surveys from 2012 to 2016 to examine gender, race, and ethnic differences in "literally homeless" veterans (i.e., veterans living in the streets, shelters, vehicles, or any other place not meant for habitation). Of 7,040 participants, there were 6,335 male and 705 female literally homeless veterans from 4 self-identified racial/ethnic categories (White, Black, Hispanic, and Other). The results showed that homeless female veterans were significantly more likely to report unmet needs related to emergency shelter, transitional housing, and dental care than male veterans. Among men, White veterans reported greater unmet needs in housing, healthcare, basic needs, and specialized needs than racial/ethnic minority veterans. Among women, veterans who were racial/ethnic minorities reported greater unmet needs than their White counterparts. These findings suggest programmatic attention to gender, race, and ethnicity is important in addressing diverse needs of homeless veterans and specialized services may be needed to address their specific and consistent unmet needs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Jack Tsai
- Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
| | - Lorena Mitchell
- Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516
| | - John Nakashima
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
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Cione C, Vetter E, Jackson D, McCarthy S, Castañeda E. The Implications of Health Disparities: A COVID-19 Risk Assessment of the Hispanic Community in El Paso. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:975. [PMID: 36673730 PMCID: PMC9859471 DOI: 10.3390/ijerph20020975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/30/2022] [Accepted: 01/01/2023] [Indexed: 06/01/2023]
Abstract
Since the outbreak of the COVID-19 pandemic in the United States, Latinos have suffered from disproportionately high rates of hospitalization and death related to the virus. Health disparities based on race and ethnicity are directly associated with heightened mortality and burden of illness and act as underlying causes for the staggering impacts of COVID-19 in Latin communities in the United States. This is especially true in the city of El Paso, Texas, where over 82% of the population is Hispanic. To ascertain the level of danger that COVID-19 poses in El Paso, we constructed a point-in-time risk assessment of its Latin population and assessed a Latin individual's likelihood of hospitalization or death related to COVID-19 by comparing relevant health profiles with high-risk co-morbidities that the Centers for Disease Control (CDC) identified in 2020. Data for this risk assessment come from 1152 surveys conducted in El Paso. The assessment included comprehensive demographic, socioeconomic, and health data to analyze disparities across Hispanic sub-populations in the city. Results revealed that around 49.3% of Hispanics in the study had been previously diagnosed with a high-risk co-morbidity and therefore have an increased likelihood of hospitalization or death related to COVID-19. Additional factors that led to increased risk included low income, homelessness, lack of U.S. citizenship, and being insured. The findings from this study additionally demonstrate that structural inequality in the U.S. must be addressed, and preventive measures must be taken at local and state levels to decrease the mortality of pandemics. Baseline population health data can help with both of these goals.
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Affiliation(s)
- Carina Cione
- Center for Latin American and Latino Studies, American University, Washington, DC 20016, USA
| | - Emma Vetter
- Department of Sociology & Anthropology, George Mason University, Fairfax, VA 22030, USA
| | - Deziree Jackson
- Department of Sociology, Indiana University Bloomington, Bloomington, IN 47405, USA
| | - Sarah McCarthy
- Department of Sociology, State University of New York at Albany, Albany, NY 12222, USA
| | - Ernesto Castañeda
- Department of Sociology, Center for Latin American and Latino Studies, Immigration Lab, Center for Health, Risk, and Society, American University, Washington, DC 20016, USA
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8
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Porter NAC, Brosnan HK, Chang AH, Henwood BF, Kuhn R. Race and Ethnicity and Sex Variation in COVID-19 Mortality Risks Among Adults Experiencing Homelessness in Los Angeles County, California. JAMA Netw Open 2022; 5:e2245263. [PMID: 36472872 PMCID: PMC9856229 DOI: 10.1001/jamanetworkopen.2022.45263] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022] Open
Abstract
Importance Few studies have used precise age-specific data to construct age-standardized estimates of the relative risks (RRs) of COVID-19 mortality for people experiencing homelessness (PEH) vs the general population, and none to date has addressed race and ethnicity and sex variations in COVID-19 mortality among PEH with COVID-19 infection. Objective To measure age-standardized mortality rate ratios for PEH vs the general population overall and by sex and race and ethnicity. Design, Setting, and Participants In this cross-sectional study, crude and age-specific COVID-19 mortality rates per 100 000 people were calculated using 5-year age groups and standardized mortality ratios for PEH and the general population aged 25 years and older, assessing differences by race and ethnicity and sex, from January 1, 2020, to November 1, 2021. Mortality and population estimates came from COVID-19 mandatory case reporting conducted by the Los Angeles County Department of Public Health, the annual point-in-time homeless count, and the US Census. Main Outcomes and Measures The main outcome was COVID-19 deaths sourced from clinician reports, death certificates, medical examiner reports, and vital records deaths. PEH status was determined using the US Department of Housing and Urban Development definitions for homelessness at the time of COVID-19 diagnosis or symptom onset. Results The study population included 25 441 deaths among an estimated 6 382 402 general population individuals and 256 deaths among an estimated 52 015 PEH. The race and ethnicity of the PEH sample was as follows: 15 539 Black (29.9%), 18 057 Hispanic (34.7%), 14 871 female (28.6%), 37 007 male (71.3%), and 3380 aged 65 years or older (6.5%), compared with the estimated general population of 6 382 402, which was 591 003 Black (9.3%), 2 854 842 Hispanic (44.7%), 3 329 765 female (52.2%), 3 052 637 male (47.8%), and 1 190 979 aged 65 years or older (18.7%). Crude death rates were 0.49% for PEH and 0.40% for the general population, but PEH experienced age-specific COVID-19 mortality risk 2.35 (95% CI, 2.08-2.66) times higher than the general population. There was significant risk associated with PEH status compared with their counterparts in the general population for Black PEH (RR, 1.69; 95% CI, 1.31-2.18), Hispanic PEH (RR, 2.34; 95% CI, 1.96-2.79), White PEH (RR, 8.33; 95% CI, 6.37-10.88), female PEH (RR, 3.39; 95% CI, 2.56-4.48), and male PEH (RR, 1.74; 95% CI, 1.52-2.00). Conclusions and Relevance This cross-sectional study of COVID-19 mortality among PEH with COVID-19 infection provides evidence suggesting excess risk of age-adjusted COVID-19 mortality among PEH compared with the general population. This study furthers understanding of the intersectional association between homelessness and race and ethnicity, as higher levels of mortality but narrower racial disparities among PEH than in the general population were observed.
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Affiliation(s)
- Natalie A. C. Porter
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
| | | | - Alicia H. Chang
- Los Angeles Department of Public Health, Los Angeles, California
| | - Benjamin F. Henwood
- Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Randall Kuhn
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles
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Conard PL, Keller MJ, Armstrong ML. The Risks, Invisibility, and Health Issues Facing Women Veterans Who Are Homeless. Nurs Womens Health 2021; 25:471-481. [PMID: 34736917 DOI: 10.1016/j.nwh.2021.09.007] [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: 03/14/2021] [Revised: 04/26/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022]
Abstract
Women veterans may experience a variety of traumatizing events and conditions before, during, and after their military service, such as intimate partner violence, military sexual trauma, moral injury, and posttraumatic stress disorder. These experiences put them at greater risk for significant behavioral and physical health sequelae, which can be associated with difficulty with civilian reintegration and complexities around homelessness. Homeless women military veterans are often uncounted, undergo different environmental situations than their male counterparts, and are vulnerable to sexual violence and unintended pregnancies. Identifying homeless women military veterans is an important first step; otherwise, they remain "invisible." Comprehensive, collaborative, interdisciplinary health care in which trust is established and care is holistic and individualized will produce the most optimal outcomes.
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Health Disparities and Their Effects on Children and Their Caregivers During the Coronavirus Disease 2019 Pandemic. Pediatr Clin North Am 2021; 68:1133-1145. [PMID: 34538304 PMCID: PMC8445754 DOI: 10.1016/j.pcl.2021.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has uncovered long-standing health disparities in marginalized communities, including racial and ethnic minorities and children with underlying medical and social problems. African Americans, Hispanics, and Native Americans have higher rates of COVID-19 infections and deaths than their population percentages in the United States. Unique populations of children, including children with developmental disabilities, children in the foster care system, children with chronic medical problems, and children who are homeless are particularly vulnerable to COVID-19 infection. This article explores how the COVID-19 pandemic superimposed on health disparities directly and indirectly affects children, adolescents, and their caregivers.
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Stefancic A, Bochicchio L, Svehaug K, Alvi T, Cabassa LJ. "We Die 25 Years Sooner:" Addressing Physical Health Among Persons with Serious Mental Illness in Supportive Housing. Community Ment Health J 2021; 57:1195-1207. [PMID: 33385266 DOI: 10.1007/s10597-020-00752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
People diagnosed with serious mental illness (SMI) experience significant health disparities, including high rates of premature mortality. Supportive housing may serve as a critical service setting for addressing physical health, but comprehensive health-related services within these programs remain an exception. This study sought to identify barriers, and potential solutions, to addressing the physical health needs of people with SMI within supportive housing. Semi-structured interviews and focus groups were conducted with multiple stakeholders (clients, peer specialists, non-peer staff, leadership) across three supportive housing agencies. There was general consensus regarding multiple barriers at the individual, organizational, policy/system, and community levels. Nevertheless, stakeholders also identified strategies in domains such as staffing, organizational culture, partnerships, communication, and infrastructure for addressing barriers. These findings can inform planning for implementation of health initiatives within supportive housing while also highlighting the need for broader community, systems, and policy change.Trial Registration Number: NCT02175641.
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Affiliation(s)
- Ana Stefancic
- Department of Psychiatry, Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA.
| | | | - Katy Svehaug
- Department of Psychiatry, Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Talha Alvi
- Southern Methodist University, 6116 North Central Expressway, PO Box 750442, Dallas, TX, 75206, USA
| | - Leopoldo J Cabassa
- Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
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Tinland A, Loubiere S, Cantiello M, Boucekine M, Girard V, Taylor O, Auquier P. Mortality in homeless people enrolled in the French housing first randomized controlled trial: a secondary outcome analysis of predictors and causes of death. BMC Public Health 2021; 21:1294. [PMID: 34215235 PMCID: PMC8254224 DOI: 10.1186/s12889-021-11310-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Homeless people face large excess mortality in comparison with the general population, but little is known about the effect of housing interventions like Housing First (HF) on their mortality. Aims of the study 1) to explore 2-years mortality among homeless people with severe mental illness (SMI) included in French HF randomized controlled trial (RCT). 2) To examine causes of death among homeless participants. Methods For 703 participants of HF RCT: 353 in experimental group (HF) and 350 in control group (Treatment As Usual - TAU), any proof of life or death and causes of death were collected with a thorough retrospective investigation among relatives, institutions and administrative databases. Data collection took place from March to June 2017. Results 4.8% (n = 34) of the study participants died over the study period. Mean age of death was 40.9 (+/− 11.4) years. The overall 2-years mortality rate was 0.065 in the HF group (n = 23) versus 0.034 in the TAU group (n = 11). Mortality was associated with medications for opioid use disorder in multivariate Cox analysis (HR: 2.37, 95%CI 1.15–5.04, p = 0.025). Those in HF group seem to be more at risk of death compared to TAU group, mainly during the first 6 months of being housed, although the difference did not reach significance (HR: 0.49, 95%CI 0.24–1.01, p = 0.054). Violent deaths occurred in 52.2% of HF group’s deaths versus 18.2% of TAU group’s deaths, this excess being explained by 34.8% (n = 8) deaths by overdoses in HF group versus none in TAU group. Limitations 1) 8.7% (n = 2) people in HF group died before HF intervention but were analyzed in intention-to-treat. 2) No proof of life or death has been found for only 0.6% in HF group (n = 2) but for 9.5% people in TAU group (n = 33) that could be anonymous deaths. 3) Undetermined causes represented 8.7% of deaths in HF group versus 36.4% in TAU group. 4) The small number of events (deaths) in the study population is a limitation for statistical analysis. Conclusions Due to important limitations, we cannot conclude on HF effect on mortality, but our results nevertheless confirm that the vulnerability of long-term homeless people with SMI persists after accessing independent housing. Earlier intervention in the pathways of homelessness should be considered, alongside active specific support for addictions. Trial registration Ethics Committee Sud Mediterrannée V n° 11.050: trial number 2011-A00668–33: 28/07/2011. Clinicaltrials ID NCT01570712: 4/4/2012.
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Affiliation(s)
- Aurélie Tinland
- Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France. .,Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.
| | - Sandrine Loubiere
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
| | - Matthieu Cantiello
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Mohamed Boucekine
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Vincent Girard
- Department of Psychiatry, Marseille Public Hospital, 147 boulevard Baille, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
| | - Owen Taylor
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France
| | - Pascal Auquier
- Aix-Marseille University, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, F-13005, Marseille, France.,Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Marseille Public Hospital (APHM), F-13385, Marseille, France
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Nerenz DR, Austin JM, Deutscher D, Maddox KEJ, Nuccio EJ, Teigland C, Weinhandl E, Glance LG. Adjusting Quality Measures For Social Risk Factors Can Promote Equity In Health Care. Health Aff (Millwood) 2021; 40:637-644. [PMID: 33819097 DOI: 10.1377/hlthaff.2020.01764] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Risk adjustment of quality measures using clinical risk factors is widely accepted; risk adjustment using social risk factors remains controversial. We argue here that social risk adjustment is appropriate and necessary in defined circumstances and that social risk adjustment should be the default option when there are valid empirical arguments for and against adjustment for a given measure. Social risk adjustment is an important way to avoid exacerbating inequity in the health care system.
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Affiliation(s)
- David R Nerenz
- David R. Nerenz is the director emeritus of the Center for Health Policy and Health Services Research, Henry Ford Health System, in Detroit, Michigan
| | - J Matthew Austin
- J. Matthew Austin is an assistant professor at the Johns Hopkins Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, in Baltimore, Maryland
| | - Daniel Deutscher
- Daniel Deutscher is a senior research scientist at Net Health Systems, Inc., in Pittsburgh, Pennsylvania, and the director of patient reported outcome measures at the MaccabiTech Institute for Research and Innovation, Maccabi Healthcare Services, in Tel Aviv, Israel
| | - Karen E Joynt Maddox
- Karen E. Joynt Maddox is an assistant professor of medicine in the Department of Internal Medicine, Washington University School of Medicine, in St. Louis, Missouri
| | - Eugene J Nuccio
- Eugene J. Nuccio is an assistant professor of medicine at the University of Colorado, Anschutz Medical Campus, in Denver, Colorado
| | - Christie Teigland
- Christie Teigland is a principal in the health economics and advanced analytics practice at Avalere Health, in Washington, D.C
| | - Eric Weinhandl
- Eric Weinhandl is a senior epidemiologist in the Chronic Disease Research Group at the Hennepin Healthcare Research Institute, in Minneapolis, Minnesota
| | - Laurent G Glance
- Laurent G. Glance is vice chair for research and a professor in the Department of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, in Rochester, New York
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Maina G, Ogenchuk M, Gaudet S. Living with parents with problematic substance use: Impacts and turning points. Public Health Nurs 2021; 38:730-737. [PMID: 33715197 DOI: 10.1111/phn.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Growing up in an environment where substance use is prevalent creates a climate for adverse childhood experiences. These experiences can contribute to mental and psychological problems later in life. METHODS This study used an exploratory study design to explore the experiences of individuals whose upbringing was influenced by substance use at home or who had parents with addiction problems. RESULTS Four themes shaped the participants' lives: (1) impact of substance use at home on children; (2) school influences on substance use; (3) aggravating traumatic life experiences, and d) rebuilding a battered life. CONCLUSION Growing up in homes with addictions created an environment for traumatic events and encounters. Participants adopted diverse strategies to cope with these experiences, such as leaving home, using substances early in life, and dropping out of school. Screening and intervention for childhood trauma should be encouraged both in schools and community health settings. Such interventions can reduce substance use among school children to deal with ensuing trauma.
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Affiliation(s)
- Geoffrey Maina
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | | | - Summer Gaudet
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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Lemoine C, Loubière S, Boucekine M, Girard V, Tinland A, Auquier P. Cost-effectiveness analysis of housing first intervention with an independent housing and team support for homeless people with severe mental illness: A Markov model informed by a randomized controlled trial. Soc Sci Med 2021; 272:113692. [PMID: 33545494 DOI: 10.1016/j.socscimed.2021.113692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/13/2020] [Accepted: 01/04/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Coralie Lemoine
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France; Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, 27 Boulevard Jean Moulin, 13385, Marseille, France.
| | - Sandrine Loubière
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France; Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, 27 Boulevard Jean Moulin, 13385, Marseille, France.
| | - Mohamed Boucekine
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France; Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, 27 Boulevard Jean Moulin, 13385, Marseille, France.
| | - Vincent Girard
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France.
| | - Aurélie Tinland
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France; Department of Psychiatry, Sainte-Marguerite University Hospital, Boulevard Sainte Marguerite, 13009, Marseille, France.
| | - Pascal Auquier
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005, Marseille, France; Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, 27 Boulevard Jean Moulin, 13385, Marseille, France.
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16
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Cione C, Castañeda E, Ferdinando A, Prince J, Jackson D, Vetter E, McCarthy S. COVID-19 Susceptibility among Latin People in El Paso, TX. SSRN 2020:3608396. [PMID: 32714118 PMCID: PMC7366809 DOI: 10.2139/ssrn.3608396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/12/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Carina Cione
- CHRS and Department of Sociology, American University, Washington, DC
| | - Ernesto Castañeda
- CHRS and Department of Sociology, American University, Washington, DC
| | - Abby Ferdinando
- CHRS and Department of Sociology, American University, Washington, DC
| | - Jhamiel Prince
- CHRS and Department of Sociology, American University, Washington, DC
| | - Deziree Jackson
- CHRS and Department of Sociology, American University, Washington, DC
| | - Emma Vetter
- CHRS and Department of Sociology, American University, Washington, DC
| | - Sarah McCarthy
- CHRS and Department of Sociology, American University, Washington, DC
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17
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Logan-Greene P, Kim BKE, Nurius PS. Adversity profiles among court-involved youth: Translating system data into trauma-responsive programming. CHILD ABUSE & NEGLECT 2020; 104:104465. [PMID: 32278929 DOI: 10.1016/j.chiabu.2020.104465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 02/11/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Court-involved youth have high levels of adverse childhood experiences (ACEs), which can impact functioning in adolescence and throughout adulthood. Yet there is limited research to help clinicians translate these histories into trauma-responsive programming guidelines. OBJECTIVE This manuscript utilizes data that is routinely collected to inform practitioners about how to utilize trauma histories to inform program and practice decisions. METHODS This study used administrative data with a diverse sample of medium- to high-risk youth on probation (N = 5,378) to examine how ACE clusters, identified through Latent Class Analysis, evinced differential treatment needs across multiple domains. RESULTS Six identified classes - Low All, Parental Incarceration, Parental Health Problems, High Conflict, High Maltreatment, and High All - were assessed for differences in self-regulation, mental health, substance use, academic functioning, family/social resources, and behavioral problems. Classes varied significantly on all assessed domains, indicating differential needs for effective interventions to interrupt negative trajectories. CONCLUSIONS Utilizing existing data in a real-world setting and addressing challenges and barriers in real-time can help bring research evidence to practice. In addition to juvenile justice settings, we conclude with discussion of ways that allied community based services in schools, youth programming, and family services can benefit from awareness of these youth adversity profiles.
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Affiliation(s)
- Patricia Logan-Greene
- School of Social Work, University at Buffalo, 685 Baldy Hall, Buffalo, NY 14260, United States.
| | - B K Elizabeth Kim
- University of Southern California, USC Suzanne Dworak-Peck School of Social Work, 669W 34th St., SWC 218, Los Angeles, CA 90089, United States.
| | - Paula S Nurius
- University of Washington School of Social Work, 4101 15th Ave NE, Seattle, WA 98105, United States.
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18
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Understanding the Collaborative Planning Process in Homeless Services: Networking, Advocacy, and Local Government Support May Reduce Service Gaps. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:262-269. [PMID: 29889180 DOI: 10.1097/phh.0000000000000812] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Continuum of Care (CoC) process-a nationwide system of regional collaborative planning networks addressing homelessness-is the chief administrative method utilized by the US Department of Housing and Urban Development to prevent and reduce homelessness in the United States. The objective of this study is to provide a benchmark comprehensive picture of the structure and practices of CoC networks, as well as information about which of those factors are associated with lower service gaps, a key goal of the initiative. DESIGN A national survey of the complete population of CoCs in the United States was conducted in 2014 (n = 312, 75% response rate). This survey is the first to gather information on all available CoC networks. Ordinary least squares (OLS) regression was used to determine the relationship between internal networking, advocacy frequency, government investment, and degree of service gaps for CoCs of different sizes. SETTING United States. PARTICIPANTS Lead contacts for CoCs (n = 312) that responded to the 2014 survey. MAIN OUTCOME MEASURE Severity of regional service gaps for people who are homeless. RESULTS Descriptive statistics show that CoCs vary considerably in regard to size, leadership, membership, and other organizational characteristics. Several independent variables were associated with reduced regional service gaps: networking for small CoCs (β = -.39, P < .05) and local government support for midsized CoCs (β = -.10, P < .05). For large CoCs, local government support was again significantly associated with lower service gaps, but there was also a significant interaction effect between advocacy and networking (β = .04, P < .05). CONCLUSIONS To reduce service gaps and better serve the homeless, CoCs should consider taking steps to improve networking, particularly when advocacy is out of reach, and cultivate local government investment and support.
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19
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Hajat A, Nurius P, Song C. Differing trajectories of adversity over the life course: Implications for adult health and well-being. CHILD ABUSE & NEGLECT 2020; 102:104392. [PMID: 32032803 PMCID: PMC7259709 DOI: 10.1016/j.chiabu.2020.104392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACE), can give rise to long-term mental and physical health consequences as well as additional stressors later in the life course. This study aims to examine differing profiles of trajectories of adversity over the life course and investigate their association with socioeconomic and health outcomes. METHODS We used population representative data from the Washington State 2011 Behavioral Risk Factor Surveillance System BRFSS survey n = 7953. Six ACE items were paired with six Adverse Adulthood Experience AAE items in respondents' adulthood that parallel the ACE e.g. physical abuse in childhood and physical victimization in adulthood. We applied latent class analysis to identify distinct trajectories of adversity; then tested for differences across trajectories in terms of demographic, socioeconomic, and health measures. RESULTS Six latent classes were identified: individuals with high AAE: (1. Consistently High, 2. Substance Abuse and Incarceration, 3. Adult Interpersonal Victimization) and individuals with low AAE (4. Repeat Sexual Victimization, 5. High to Low, and 6. Consistently Low). The Consistently High group had the highest prevalence of ACE and AAE and fared poorly across wide ranging outcomes. Other groups displayed specific patterns of ACE and AAE exposures (including salient subgroups such as those with incarceration exposure) as well as differences in demographic characteristics, illustrating disparities. CONCLUSIONS Subgroup analyses such as this are complementary to population generalized findings. Understanding differences in life course patterns of adversity can shed light on interventions in earlier life and better target service provision to promote health and well-being.
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Affiliation(s)
- Anjum Hajat
- Department of Epidemiology, University of Washington, Box 357236 Seattle, WA 98195 USA.
| | - Paula Nurius
- School of Social Work, University of Washington, 4101 15th Avenue NE Seattle, WA 98105-6250 USA.
| | - Chiho Song
- School of Social Work, University of Washington, 4101 15th Avenue NE Seattle, WA 98105-6250 USA.
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20
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Taylor O, Loubiere S, Tinland A, Vargas-Moniz M, Spinnewijn F, Manning R, Gaboardi M, Wolf JRLM, Bokszczanin A, Bernad R, Kallmen H, Toro P, Ornelas J, Auquier P. Lifetime, 5-year and past-year prevalence of homelessness in Europe: a cross-national survey in eight European nations. BMJ Open 2019; 9:e033237. [PMID: 31791966 PMCID: PMC6924844 DOI: 10.1136/bmjopen-2019-033237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To examine the lifetime, 5-year and past-year prevalence of homelessness among European citizens in eight European nations. DESIGN A nationally representative telephone survey using trained bilingual interviewers and computer-assisted telephone interview software. SETTING The study was conducted in France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain and Sweden. PARTICIPANTS European adult citizens, selected from opt-in panels from March to December 2017. Total desired sample size was 5600, with 700 per country. Expected response rates of approximately 30% led to initial sample sizes of 2500 per country. MAIN OUTCOME MEASURES History of homelessness was assessed for lifetime, past 5 years and past year. Sociodemographic data were collected to assess correlates of homelessness prevalence using generalised linear models for clustered and weighted samples. RESULTS Response rates ranged from 30.4% to 33.5% (n=5631). Homelessness prevalence was 4.96% for lifetime (95% CI 4.39% to 5.59%), 1.92% in the past 5 years (95% CI 1.57% to 2.33%) and 0.71% for the past year (95% CI 0.51% to 0.98%) and varied significantly between countries (pairwise comparison difference test, p<0.0001). Time spent homeless ranged between less than a week (21%) and more than a year (18%), with high contrasts between countries (p<0.0001). Male gender, age 45-54, lower secondary education, single status, unemployment and an urban environment were all independently strongly associated with lifetime homelessness (all OR >1.5). CONCLUSIONS The prevalence of homelessness among the surveyed nations is significantly higher than might be expected from point-in-time and homeless service use statistics. There was substantial variation in estimated prevalence across the eight nations. Coupled with the well-established health impacts of homelessness, medical professionals need to be aware of the increased health risks of those with experience of homelessness. These findings support policies aiming to improve health services for people exposed to homelessness.
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Affiliation(s)
- Owen Taylor
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS, Aix-Marseille Universite, Marseille, France
| | - Sandrine Loubiere
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS, Aix-Marseille Universite, Marseille, France
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, APHM, Marseille, France
| | - Aurelie Tinland
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS, Aix-Marseille Universite, Marseille, France
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, APHM, Marseille, France
| | - Maria Vargas-Moniz
- APPsyCI - Applied Psychology Research Center: Capabilities and Inclusion, Instituto Superior de Psicologia Aplicada, Lisboa, Lisboa, Portugal
| | - Freek Spinnewijn
- FEANTSA - European Federation of National Organisations Working with the Homeless, Brussels, Belgium
| | - Rachel Manning
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Marta Gaboardi
- Department of Developmental and Social Psychology, University of Padova School of Psychology, Padova, Veneto, Italy
| | - Judith R L M Wolf
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Hakan Kallmen
- Stockholm Center for Psychiatry Research and Education, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Paul Toro
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Jose Ornelas
- APPsyCI - Applied Psychology Research Center: Capabilities and Inclusion, Instituto Superior de Psicologia Aplicada, Lisboa, Lisboa, Portugal
| | - Pascal Auquier
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS, Aix-Marseille Universite, Marseille, France
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, APHM, Marseille, France
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21
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van Dongen SI, van Straaten B, Wolf JRLM, Onwuteaka‐Philipsen BD, van der Heide A, Rietjens JAC, van de Mheen D. Self-reported health, healthcare service use and health-related needs: A comparison of older and younger homeless people. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e379-e388. [PMID: 31020738 PMCID: PMC6850679 DOI: 10.1111/hsc.12739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 01/09/2019] [Accepted: 02/27/2019] [Indexed: 05/13/2023]
Abstract
The number of older homeless people with a limited life expectancy is increasing. European studies on their health-related characteristics are lacking. This study compared self-reported health, healthcare service use and health-related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross-sectional data from 378 participants who completed 2.5-year follow-up, we analysed differences in self-reported health, healthcare service use, and health-related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health-related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non-acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter-based or community outreach programmes that proactively provide multidisciplinary healthcare services.
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Affiliation(s)
- Sophie I. van Dongen
- Department of Public HealthErasmus University Medical CentreRotterdamthe Netherlands
| | | | - Judith R. L. M. Wolf
- Radboud Institute for Health Sciences, Impuls ‐ Netherlands Centre for Social Care ResearchRadboud University Medical CentreNijmegenthe Netherlands
| | - Bregje D. Onwuteaka‐Philipsen
- Department of Public and Occupational Health, Expertise Centre for Palliative CareVU University Medical Centre, Amsterdam Public Health Research InstituteAmsterdamthe Netherlands
| | - Agnes van der Heide
- Department of Public HealthErasmus University Medical CentreRotterdamthe Netherlands
| | - Judith A. C. Rietjens
- Department of Public HealthErasmus University Medical CentreRotterdamthe Netherlands
| | - Dike van de Mheen
- IVO Addiction Research InstituteThe Haguethe Netherlands
- School of Social and Behavioural Sciences, Tranzo Scientific Centre for Care and WelfareTilburg UniversityTilburgthe Netherlands
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Crumé HJ, Nurius PS, Fleming CM. Cumulative Adversity Profiles Among Youth Experiencing Housing and Parental Care Instability. CHILDREN AND YOUTH SERVICES REVIEW 2019; 100:129-135. [PMID: 32546880 PMCID: PMC7297188 DOI: 10.1016/j.childyouth.2019.02.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study applies cumulative adversity and stress proliferation theories to examine risk and protective resource profiles of youth with three different levels of housing and parental care instability. Data derive from a state representative sample (n=27,087) of school-based adolescent students. ANCOVA analyses identified significant differences in sociodemographic and psychosocial functioning variables for youth with 0, 1, or 2 forms of housing and parental care instability, with more deleterious functioning being observed among youth with greater levels of instability. Those experiencing either or both housing and parental care instability are more represented by males, sexual minorities, and youth of color; psychosocial risk and protective factors demonstrated consistent differences between instability groups. Dimensions of cumulative adversity operate with social marginalities (e.g., race, sexual minority status) relative to instability, with higher frequency of victimization, lower grades, diminished self-regulation capabilities and school engagement, weakened psychological health, and strained family and peer relationships. The paper discusses theorized mechanisms through which cumulative adversity conveys effects as well as implications for social work prevention and resilience-fostering strategies in schools and other youth-serving settings.
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23
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Fusaro VA, Levy HG, Shaefer HL. Racial and Ethnic Disparities in the Lifetime Prevalence of Homelessness in the United States. Demography 2018; 55:2119-2128. [PMID: 30242661 PMCID: PMC7665902 DOI: 10.1007/s13524-018-0717-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Homelessness in the United States is often examined using cross-sectional, point-in-time samples. Any experience of homelessness is a risk factor for adverse outcomes, so it is also useful to understand the incidence of homelessness over longer periods. We estimate the lifetime prevalence of homelessness among members of the Baby Boom cohort (n = 6,545) using the 2012 and 2014 waves of the Health and Retirement Study (HRS), a nationally representative survey of older Americans. Our analysis indicates that 6.2 % of respondents had a period of homelessness at some point in their lives. We also identify dramatic disparities in lifetime incidence of homelessness by racial and ethnic subgroups. Rates of homelessness were higher for non-Hispanic blacks (16.8 %) or Hispanics of any race (8.1 %) than for non-Hispanic whites (4.8 %; all differences significant with p < .05). The black-white gap, but not the Hispanic-white gap, remained significant after adjustment for covariates such as education, veteran status, and geographic region.
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Affiliation(s)
- Vincent A Fusaro
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Helen G Levy
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
| | - H Luke Shaefer
- School of Social Work & Gerald R. Ford School of Public Policy, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
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Alexander-Eitzman B, North CS, Pollio DE. Transitions between Housing States among Urban Homeless Adults: a Bayesian Markov Model. J Urban Health 2018; 95:423-430. [PMID: 29623655 PMCID: PMC5993694 DOI: 10.1007/s11524-018-0236-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The purpose of this study is to explore how marginalization, substance abuse, and service utilization influence the transitions between streets, shelters, and housed states over the course of 2 years in a population of urban homeless adults. Survey responses from three yearly interviews of 400 homeless adults were matched with administrative services data collected from regional health, mental health, and housing service providers. To estimate the rates of transition between housed, street, and shelter status, a multi-state Markov model was developed within a Bayesian framework. These transition rates were then regressed on a set of independent variables measuring demographics, marginalization, substance abuse, and service utilization. Transitions from housing to shelters or streets were associated with not being from the local area, not having friends or family to count on, and unemployment. Pending charges and a recent history of being robbed were associated with the shelters-to-streets transition. Remaining on the streets was uniquely associated with engagement in "shadow work" and, surprisingly, a high use of routine services. These findings paint a picture of unique and separate processes for different types of housing transitions. These results reinforce the importance of focusing interventions on the needs of these unique housing transitions, paying particular attention to prior housing patterns, substance abuse, and the different ways that homeless adults are marginalized in our society.
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