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Bulanchuk N, Edwards E, Pietrzak RH, Tsai J. The mediating role of social support in associations between childhood adversity, military sexual trauma, and homelessness in a nationally representative sample of US veterans. JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 52:399-414. [PMID: 38289875 DOI: 10.1002/jcop.23105] [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: 10/27/2022] [Revised: 02/27/2023] [Accepted: 12/17/2023] [Indexed: 02/01/2024]
Abstract
Among veterans, availability of social support and histories of military sexual trauma (MST) and/or adverse childhood experiences (ACEs) are particularly salient correlates of homelessness. Using path analyses, we investigated whether social support (i.e., interpersonal social support and community integration) would at least partially account for the relationships of MST and ACEs with any lifetime homelessness in a large, nationally representative sample of veterans (N = 4069, 9.8% female). Interpersonal social support and community integration partially explained the relationship between ACEs and any lifetime homelessness. However, they did not mediate the relationship between MST and any lifetime homelessness. Female veterans also reported higher trauma rates and lower perceived social support than male counterparts during correlational analyses. These results reinforce existing literature on the importance of research and interventions tailored to veterans with low social support and integration. Results have potential to inform interventions and policy for veterans experiencing and/or at risk for homelessness.
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Affiliation(s)
- Nicole Bulanchuk
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York, USA
- Department of Veterans Affairs, VISN 2 MIRECC, Bronx, New York, USA
| | - Emily Edwards
- Department of Veterans Affairs, VISN 2 MIRECC, Bronx, New York, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Robert H Pietrzak
- Department of Veterans Affairs, National Center for PTSD, New Haven, Connecticut, USA
| | - Jack Tsai
- Department of Veterans Affairs, National Center for Homelessness Among Veterans, San Antonio, Texas, USA
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McKenzie A, Burdett H, Croak B, Rafferty L, Greenberg N, Stevelink SAM. Adjustment disorder in the Armed Forces: a systematic review. J Ment Health 2023; 32:962-984. [PMID: 36330797 DOI: 10.1080/09638237.2022.2140792] [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: 02/10/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the UK military, adjustment disorder (AjD) is reported as one of the most diagnosed mental disorders, alongside depression, in personnel presenting to mental health services. Despite this, little is understood about what may predict AjD, common treatment or outcomes for this population. AIM The systematic review aimed to summarise existing research for AjD in Armed Forces (AF) populations, including prevalence and risk factors, and to outline clinical and occupational outcomes. METHOD A literature search was conducted in December 2020 to identify research that investigated AjD within an AF population (serving or veteran) following the PRISMA guidelines. RESULTS Eighty-three studies were included in the review. The AjD prevalence estimates in AF populations with a mental disorder was considerably higher for serving AF personnel (34.9%) compared to veterans (12.8%). Childhood adversities were identified as a risk factor for AjD. AjD was found to increase the risk of suicidal ideation, with one study reporting a risk ratio of 4.70 (95% Confidence Interval: 3.50-6.20). Talking therapies were the most common treatment for AjD, however none reported on treatment effectiveness. CONCLUSION This review found that AjD was commonly reported across international AF. Despite heterogeneity in the results, the review identifies several literature gaps.
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Affiliation(s)
- Amber McKenzie
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Howard Burdett
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Bethany Croak
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Laura Rafferty
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Neil Greenberg
- King's Centre for Military Health Research, King's College London, London, United Kingdom
| | - Sharon A M Stevelink
- King's Centre for Military Health Research, King's College London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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3
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Hahn HA, Blosnich JR. Adverse Childhood Experiences Among Lesbian, Gay, Bisexual, and Queer Veterans. Am J Prev Med 2023; 65:704-709. [PMID: 37037327 PMCID: PMC10523897 DOI: 10.1016/j.amepre.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/12/2023]
Abstract
INTRODUCTION Adverse childhood experiences portend vulnerability to numerous physical and mental health concerns across the lifespan. Separate bodies of work suggest that both lesbian, gay, bisexual, and queer individuals and military veterans are more likely to report adverse childhood experiences than their non-lesbian, gay, bisexual, and queer and non-veteran counterparts, respectively. Although lesbian, gay, bisexual, and queer veterans experience health disparities compared with non-lesbian, gay, bisexual, and queer veterans, the prevalence of adverse childhood experiences among individuals with both lesbian, gay, bisexual, and queer and veteran identities is yet unknown. METHODS Participants were U.S. military veterans (N=14,461) from 18 states that included Sexual Orientation and Gender Identity and adverse childhood experiences modules in the 2019 and 2020 Behavioral Risk Factor Surveillance System survey. Multivariable logistic regression was used to determine the odds of adverse childhood experiences reported by lesbian, gay, bisexual, and queer veterans compared with those reported by non-lesbian, gay, bisexual, and queer veterans. Analyses were conducted in 2023. RESULTS While accounting for sociodemographic factors, lesbian, gay, bisexual, and queer veterans were more likely to report living with someone who experienced mental illness (AOR=2.17, 95% CI=1.35, 3.51), emotional abuse (AOR=1.58, 95% CI=1.11, 2.25), and sexual abuse (AOR=2.21, 95% CI=1.29, 3.76) than non-lesbian, gay, bisexual, and queer veterans. CONCLUSIONS With past work indicating that childhood abuse experiences are especially predictive of adverse health in adulthood, these findings suggest that a higher prevalence of adverse childhood experiences among lesbian, gay, bisexual, and queer veterans may contribute to health disparities among this population.
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Affiliation(s)
- Hunter A Hahn
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Psychology, College of Arts and Sciences, The Ohio State University, Columbus, Ohio
| | - John R Blosnich
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.
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Nichter B, Tsai J, Pietrzak RH. Prevalence, correlates, and mental health burden associated with homelessness in U.S. military veterans. Psychol Med 2023; 53:3952-3962. [PMID: 35301973 PMCID: PMC10317824 DOI: 10.1017/s0033291722000617] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/09/2022] [Accepted: 02/17/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Homelessness is a major public health problem among U.S. military veterans. However, contemporary, population-based data on the prevalence, correlates, and mental health burden of homelessness among veterans are lacking. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative survey of veterans (n = 4069). Analyses examined the prevalence and correlates of homelessness, as well as the independent associations between homelessness and current probable psychiatric conditions, suicidality, and functioning. RESULTS The lifetime prevalence of homelessness was 10.2% (95% confidence interval 9.3-11.2). More than 8-of-10 veterans reported experiencing their first episode of homelessness following military service, with a mean of 10.6 years post-discharge until onset (s.d. = 12.6). Adverse childhood experiences (ACEs), cumulative trauma burden, current household income, younger age, and drug use disorder emerged as the strongest correlates of homelessness (49% of total explained variance). Veterans with a history of homelessness had elevated odds of lifetime suicide attempt, attempting suicide two or more times, and past-year suicide ideation [odd ratios (ORs) 1.3-3.1]. They also had higher rates of current probable posttraumatic stress disorder, major depressive, generalized anxiety, and drug use disorders (ORs 1.7-2.4); and scored lower on measures of mental, physical, cognitive, psychosocial functioning (d = 0.11-0.15). CONCLUSIONS One in ten U.S. veterans has experienced homelessness, and these veterans represent a subpopulation at substantially heightened risk for poor mental health and suicide. ACEs were the strongest factor associated with homelessness, thus underscoring the importance of targeting early childhood adversities and their mental health consequences in prevention efforts for homelessness in this population.
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Affiliation(s)
- Brandon Nichter
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jack Tsai
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, FL, USA
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert H. Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs, National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Carlson KF, Gilbert TA, Maxim L, Hooker ER, Shull S, DeBeer B, DeFrancesco S, Denneson L. Associations between nonfatal firearm injuries and risk of subsequent suicide among Veteran VA users: A retrospective cohort study. Acad Emerg Med 2023; 30:278-288. [PMID: 36869632 DOI: 10.1111/acem.14711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/21/2023] [Accepted: 02/03/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Suicide is a leading cause of death in the United States, particularly among Veterans. Nonfatal firearm injuries may indicate subsequent risk of suicide and, thus, provide important opportunities for prevention in emergency departments and other health care settings. We used a retrospective cohort design to analyze associations between nonfatal firearm injuries and subsequent suicide among all Veterans who used U.S. Department of Veterans Affairs (VA) health care, nationally, between 2010 and 2019. METHODS We linked VA health care and mortality data to identify VA users, nonfatal firearm injuries, and deaths. International Classification of Diseases (ICD)-10th Revision cause-of-death codes were used to identify suicides. Veterans' firearm injuries and their intent were categorized using cause-of-injury codes from the ICD Clinical Modification-9th and 10th Revisions systems. Using bivariable and multivariable regression, we estimated risk of subsequent suicide among Veterans with, versus without, nonfatal firearm injuries. Among Veterans with nonfatal firearm injuries, we examined characteristics associated with subsequent suicide; electronic health record (chart) reviews explored documentation about firearm access among those who died. RESULTS Among 9,817,020 VA-using Veterans, 11,503 experienced nonfatal firearm injuries (64.9% unintentional, 12.3% intentional self-harm, 18.5% assault). Of these, 69 (0.6%) subsequently died by suicide (42 involving firearms). The odds of subsequent suicide among Veterans with, versus without, nonfatal firearm injuries were 2.4 (95% confidence interval 1.9-3.0); odds were only slightly attenuated in multivariable modeling. Among Veterans with nonfatal firearm injuries, those with depression or substance use disorder diagnoses had twice the odds of subsequent suicide than those without. Chart reviews identified small proportions of suicide decedents who were assessed for (21.7%), and/or counseled about (15.9%), firearm access. CONCLUSIONS Findings suggest that Veterans' nonfatal firearm injuries, regardless of injury intent, may be important but underutilized opportunities for suicide prevention. Future work should explore mechanisms to reduce risk among these patients.
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Affiliation(s)
- Kathleen F Carlson
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Tess A Gilbert
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
| | - Lauren Maxim
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
| | - Elizabeth R Hooker
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
| | - Sarah Shull
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
| | - Bryann DeBeer
- Department of Veterans Affairs, Rocky Mountain MIRECC for Suicide Prevention, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Susan DeFrancesco
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
- Oregon Health and Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Lauren Denneson
- HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System (R&D 66), Oregon, Portland, USA
- Department of Psychiatry, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Arowolo T, Animasahun A, Baptiste-Roberts K, Bronner Y. Effect of COVID-19 Pandemic Response and Parental Adverse Childhood Experiences on Child Health and Well-Being. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 17:1-10. [PMID: 36818743 PMCID: PMC9924853 DOI: 10.1007/s40653-023-00517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
Family responses to crises such as COVID-19 are driven by parents' experiences. Parental history of adverse childhood experiences (ACEs) might play an important role in predicting resilience, coping capacity, and parenting practices during the COVID-19 pandemic response. The purpose of this review is to examine the impact of COVID-19 pandemic disruption on child health and well-being as influenced by the previous history of ACEs in the parents. Scopus, Google Scholar, PubMed, and PsychInfo were searched for peer-reviewed articles using the keywords "COVID-19", "Parents or Maternal Adverse Childhood Experiences", and "child health" or "child well-being". Data were extracted using a literature review matrix template. Title, abstract, and full article-level reviews were conducted by two reviewers. The association between COVID-19 disruption, negative parenting, and child behavioral and emotional problems was stronger for parents with younger children with a history of high ACE scores. Parents with high ACE scores were more likely to cope poorly with childcare duties and engage in child neglect, verbal abuse, and reduced feeding frequency, specifically during the COVID-19 pandemic. The review findings support the framework of inadequate resilience and coping skills of adults with a history of ACEs during periods of stress and unpredictability such as the COVID-19 pandemic. The negative effects of these parental stressors on a child's health and well-being are modifiable and could be mitigated by targeted interventions. Trauma-informed care should be adopted to contribute to optimum child health.
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Affiliation(s)
- Tolu Arowolo
- Department of Public Health, School of Community Health & Policy, Morgan State University, 4530 Portage Ave Campus, Ste 211 1700 E Cold Spring Lane, 21251 Baltimore, MD USA
| | - Adeola Animasahun
- Department of Public Health, School of Community Health & Policy, Morgan State University, 4530 Portage Ave Campus, Ste 211 1700 E Cold Spring Lane, 21251 Baltimore, MD USA
| | - Kesha Baptiste-Roberts
- Department of Public Health, School of Community Health & Policy, Morgan State University, 4530 Portage Ave Campus, Ste 211 1700 E Cold Spring Lane, 21251 Baltimore, MD USA
| | - Yvonne Bronner
- Department of Public Health, School of Community Health & Policy, Morgan State University, 4530 Portage Ave Campus, Ste 211 1700 E Cold Spring Lane, 21251 Baltimore, MD USA
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O’Campo P, Nisenbaum R, Crocker AG, Nicholls T, Eiboff F, Adair CE. Women experiencing homelessness and mental illness in a Housing First multi-site trial: Looking beyond housing to social outcomes and well-being. PLoS One 2023; 18:e0277074. [PMID: 36763583 PMCID: PMC9916643 DOI: 10.1371/journal.pone.0277074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/19/2022] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE There is scant research on the effectiveness of permanent supportive housing for homeless women with mental illness. This study examines the effectiveness of Housing First with an unprecedentedly large sample of homeless women from five Canadian cities, and explore baseline risk factors that predict social, health and well-being outcomes over a 24 month-period. METHODS The At Home/Chez Soi multi-site randomized controlled Housing First trial recruited over 600 women between October 2009 and July 2011. This is a post-hoc subgroup exploratory analysis of self-identified women with at least one follow-up interview who were randomized to Housing First (HF) (n = 374) or treatment-as-usual (TAU) (n = 279) and had at least one follow-up interview. Linear mixed models and generalized estimating equations were used after multiple imputation was applied to address missing data. RESULTS At the end of follow-up, the mean percentage of days spent stably housed was higher for women in the intervention 74.8% (95%CI = 71.7%-77.8%) compared with women in the treatment-as-usual group, 37.9% (95%CI = 34.4%-41.3%), p<0.001. With few exceptions, social and mental health outcomes were similar for both groups at 6-, 12-, 18- and 24-months post-enrollment. Suicidality was a consistent predictor of increased mental health symptoms (beta = 2.85, 95% CI 1.59-4.11, p<0.001), decreased quality of life (beta = -3.99, 95% CI -6.49 to -1.49, p<0.001), decreased community functioning (beta = -1.16, 95% CI -2.10 to -0.22, p = 0.015) and more emergency department visits (rate ratio = 1.44, 95% CI 1.10-1.87, p<0.001) over the study period. Lower education was a predictor of lower community functioning (beta = -1.32, 95% CI -2.27 to -0.37, p = 0.006) and higher substance use problems (rate ratio = 1.27, 95% CI 1.06-1.52, p = 0.009) during the study. CONCLUSIONS Housing First interventions ensured that women experiencing homelessness are quickly and consistently stably housed. However, they did not differentially impact health and social measures compared to treatment as usual. Ensuring positive health and social outcomes may require greater supports at enrolment for subgroups such as those with low educational attainment, and additional attention to severity of baseline mental health challenges, such as suicidality. TRIAL REGISTRATION International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374.
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Affiliation(s)
- Patricia O’Campo
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- * E-mail:
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Anne G. Crocker
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, Canada
- Department of Psychiatry & Addictions, Université de Montréal, Montreal, Canada
- School of Criminology, Université de Montréal, Montreal, Canada
| | - Tonia Nicholls
- British Columbia Mental Health & Substance Use Services, Provincial Health Services Authority, Vancouver, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Faith Eiboff
- Interdisciplinary Studies, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Carol E. Adair
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Williams B. Understanding the effects of adverse childhood experiences on older people. Nurs Older People 2023; 35:37-42. [PMID: 36475401 DOI: 10.7748/nop.2022.e1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 12/12/2022]
Abstract
There is increasing recognition that adverse childhood experiences are linked to suboptimal mental and physical health in later life. Despite this, there has been little research into the effects of adverse childhood experiences on older people. This article gives an overview of the long-term mental and physical effects of adverse childhood experiences and discusses how childhood trauma may manifest in older people. The author also discusses how nurses and unpaid family carers may themselves have been exposed to adverse childhood experiences and how this may affect their caring role. It is crucial that nurses adopt a trauma-informed approach to the care of older people to take account of possible adverse childhood experiences and prevent re-traumatisation.
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Affiliation(s)
- Bronwen Williams
- Bronwen Williams Training, Education and Development, Malvern, Worcestershire, England
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Mullady SSS, Castellanos S, Lopez L, Aguirre G, Weeks J, King S, Valle K, Goode C, Tsoy E, Possin K, Miller B, Kushel M, Lanata S. Neurocognitive health of older adults experiencing homelessness in Oakland, California. Front Neurol 2022; 13:905779. [PMID: 35937073 PMCID: PMC9353024 DOI: 10.3389/fneur.2022.905779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Background and objectives The homeless population in the US is aging. Cognitive impairment is prevalent in this population, yet little is known about the neurologic etiologies of such impairment. Addressing this gap in knowledge is important because homeless older adults with cognitive impairment due to neurodegenerative disease may need lifelong tailored support to obtain and maintain housing. In this study, we characterized the neurocognitive health of a sample of adults who experienced homelessness for the first time after age 50 using gold standard behavioral neurology examination practices. Methods We conducted a descriptive cross-sectional study of older adults who first experienced homelessness after age 50. We recruited our sample purposively from an ongoing longitudinal cohort study of adults who were aged 50 and over and homeless when they entered the cohort. For this sub study, we enrolled a convenience sample from those who reported their first episode of homelessness after age 50. We did not exclude individuals based on history of substance use. Neurologists conducted a structured neurocognitive history intake, neurological examination, neuropsychological evaluation, and functional assessment between November 2020 and February 2021. We screened all participants for neurocognitive disorders using gold standard clinical research diagnostic criteria. Results We evaluated 25 participants, most were men (76%) and Black (84%), with a median age of 61 years. The most common neurocognitive complaints included deficits in recent episodic memory (n = 15, 60%), executive functions (n = 13, 52%), and behavior/mood, with apathy being the most common complaint (n = 20, 80%). Neuropsychological testing revealed a high prevalence of socioemotional deficits (n = 20, 80%). Common neurological examination deficits included difficulties with coordination, such as impaired Luria task (n = 16, 64%), signs of distal peripheral neuropathy (n = 8, 32%), anosmia/hyposmia (n = 4, 21%), and signs of mild Parkinsonism (n = 5, 20%). The most common diagnoses were MCI (n = 7, 28%), bvFTD (n = 4, 16%), AD (n = 4, 16%), and DLB (n = 2, 8%). Discussion Our findings suggest that neurocognitive concerns and examination deficits are common among older homeless adults. Specific neurocognitive disorders may be overrepresented in this population, particularly frontotemporal disorders. Longitudinal studies involving brain biomarkers are needed to characterize the neurocognitive health of this vulnerable population more precisely.
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Affiliation(s)
- Sandeepa Satya-Sriram Mullady
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Sandeepa Satya-Sriram Mullady
| | - Stacy Castellanos
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Lucia Lopez
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Gloria Aguirre
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - John Weeks
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Stephen King
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Karen Valle
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Collette Goode
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Elena Tsoy
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine Possin
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce Miller
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Margot Kushel
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Serggio Lanata
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,Serggio Lanata
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10
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Hyde J, Bolton R, Kim B, Yakovchenko V, Petrakis BA, Visher C, McInnes K. "I've just never done that:" The influence of transitional anxiety on post-incarceration reentry and reintegration experiences among veterans. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1504-1513. [PMID: 34250693 DOI: 10.1111/hsc.13481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 06/13/2023]
Abstract
Military veterans involved in the criminal justice system are a vulnerable subpopulation that has extensive physical and behavioural health treatment needs. Like non-veteran populations, safe and stable housing, employment and social support are critical for veterans returning to society after incarceration. The challenges of social reintegration are immense, and the risk of recidivism is high. The U.S. Department of Veteran Affairs (VA) has developed specific programmes to assist veterans plan for and assist with reentry. While there have been successes, recidivism and early mortality are persistent concerns. This study examined reentry experiences of veterans living in one northeastern state to gain a better understanding of factors that influence social reintegration. The study was conducted in 2017 to inform an enhancement of VA reentry services through the addition of peer support. Qualitative interviews were conducted with 16 veterans with recent incarceration experiences and 27 reentry specialists working in five correctional facilities, two VA hospitals, five community agencies and two state departments. Interview transcripts were reviewed and coded using a Framework Analysis approach. Narratives highlight high levels of anxiety and uncertainty experienced as participants went through physical and emotional transitions associated with reentry and reintegration. This 'transitional anxiety' was often rooted in the absence of prior positive experiences engaging in socially normative activities, like obtaining housing and employment. Embarrassment and shame regarding a lack of experience with expected responsibilities were commonly reported. Although salient in veterans' narratives, reentry specialists rarely talked about problems post-incarceration in terms of limited life experience and skills, focusing instead on substance use and mental health issues. Few resources were available to support the development of critical life skills. Findings call attention to the need for understanding pre-incarceration experiences that may influence social reintegration and the development of tailored interventions to build skills and experience when needed.
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Affiliation(s)
- Justeen Hyde
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Rendelle Bolton
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Bo Kim
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Vera Yakovchenko
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Beth A Petrakis
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
| | - Christy Visher
- Center for Drug & Health Studies, Department of Sociology and Criminal Justice University of Delaware, Newark, DE, USA
| | - Keith McInnes
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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11
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Vázquez JJ, Cala-Montoya CA, Berríos A. The vulnerability of women living homeless in Nicaragua: A comparison between homeless women and men in a low-income country. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2314-2325. [PMID: 34913172 DOI: 10.1002/jcop.22777] [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: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 06/14/2023]
Abstract
This article takes a gender perspective approach to a series of issues that may affect the vulnerability of people in a homeless situation in Nicaragua, focusing particularly on women. The study was completed using data obtained from two similarly-sized samples, one of homeless men (n = 32) and the other of homeless women (n = 30). The information was gathered using a structured interview. Results show that there are key similarities in the situation and characteristics of both men and women living homeless in Nicaragua. Results also support the thought that women living homeless - some with dependent children to care for - are in a situation of particular vulnerability, suffering violence, a greater need to find safe places to stay, greater "revolving door to homelessness," more barriers to finding work and more sex work. The analysis of the issues differentiating men from women may be of use in driving forward public policies and social care resources adapted to the specific characteristics and needs of these women and their children. As can be taken from this paper, people living homeless in low-income and high-income countries share a number of similar circumstances, which in turn could facilitate a global approach to the problem.
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Affiliation(s)
- José J Vázquez
- Department of Social Psychology, Instituto Universitaro de Investigación en Estudios Latinoamericanos (IELAT), Alcalá de Henares, Universidad de Alcalá, Madrid, Spain
| | | | - Alberto Berríos
- Department of Psychology, Universidad Nacional Autónoma de Nicaragua (UNAN-León), León, Nicaragua
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12
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Jacob V, Chattopadhyay SK, Attipoe-Dorcoo S, Peng Y, Hahn RA, Finnie R, Cobb J, Cuellar AE, Emmons KM, Remington PL. Permanent Supportive Housing With Housing First: Findings From a Community Guide Systematic Economic Review. Am J Prev Med 2022; 62:e188-e201. [PMID: 34774389 PMCID: PMC8863642 DOI: 10.1016/j.amepre.2021.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/03/2021] [Accepted: 08/16/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION The annual economic burden of chronic homelessness in the U.S. is estimated to be as high as $3.4 billion. The Permanent Supportive Housing with Housing First (Housing First) program, implemented to address the problem, has been shown to be effective. This paper examines the economic cost and benefit of Housing First Programs. METHODS The search of peer-reviewed and gray literature from inception of databases through November 2019 yielded 20 evaluation studies of Housing First Programs, 17 from the U.S. and 3 from Canada. All analyses were conducted from March 2019 through July 2020. Monetary values are reported in 2019 U.S. dollars. RESULTS Evidence from studies conducted in the U.S. was separated from those conducted in Canada. The median intervention cost per person per year for U.S. studies was $16,479, and for all studies, including those from Canada, it was $16,336. The median total benefit for the U.S. studies was $18,247 per person per year, and it was $17,751 for all studies, including those from Canada. The benefit-to-cost ratio for U.S. studies was 1.80:1, and for all studies, including those from Canada, it was 1.06:1. DISCUSSION The evidence from this review shows that economic benefits exceed the cost of Housing First Programs in the U.S. There were too few studies to determine cost-benefit in the Canadian context.
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Affiliation(s)
- Verughese Jacob
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Sajal K Chattopadhyay
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sharon Attipoe-Dorcoo
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yinan Peng
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert A Hahn
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ramona Finnie
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jamaicia Cobb
- From the Community Guide Office, Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison E Cuellar
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Karen M Emmons
- Department of Social and Behavioral Sciences, School of Public Health, Harvard T.H. Chan University, Cambridge, Massachusetts
| | - Patrick L Remington
- Department of Population Health Sciences, UW-Madison School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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13
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Robinson M, Holliday R, Monteith LL, Blosnich JR, Elbogen EB, Gelberg L, Hooshyar D, Liu S, McInnes DK, Montgomery AE, Tsai J, Grassmeyer R, Brenner LA. Establishing a Research Agenda for Suicide Prevention Among Veterans Experiencing Homelessness. Front Psychol 2022; 13:683147. [PMID: 35197892 PMCID: PMC8860179 DOI: 10.3389/fpsyg.2022.683147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
Suicide among Veterans experiencing or at risk for homelessness remains a significant public health concern. Conducting research to understand and meet the needs of this at-risk population remains challenging due to myriad factors (e.g., clinical complexity including multimorbidity, difficulty monitoring risk across systems). To address this challenge, the United States Department of Veterans Affairs (VA) convened the Health Services Research and Development (HSR&D) Suicide Prevention in Veterans Experiencing Homelessness: Research and Practice Development meeting, bringing together subject-matter experts in the fields of homelessness and suicide prevention, both from within and outside of VA. During the meeting, attendees identified 10 potential research priorities at the intersection of suicide prevention and homelessness. After the meeting, Delphi methodology was used to achieve consensus on the relative importance of the identified research domains. Through this iterative Delphi process, agreement was reached regarding the need to increase understanding of barriers and facilitators to suicide risk assessment and emergency intervention for Veterans experiencing homelessness by examining the perspectives of both Veterans and healthcare providers. Elucidating the complex relationships between risk periods, subgroups, suicide means, and drivers of suicide among Veterans experiencing homelessness was also considered a top priority. This article documents the Delphi process and provides a research agenda for researchers, funding agencies, and policymakers to prioritize the most relevant and potentially impactful research domains aimed at preventing suicide among Veterans experiencing or at risk for homelessness.
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Affiliation(s)
- Maurand Robinson
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, CO, United States
- *Correspondence: Maurand Robinson,
| | - Ryan Holliday
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lindsey L. Monteith
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - John R. Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Eric B. Elbogen
- VA National Center on Homelessness among Veterans, Tampa, FL, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Dina Hooshyar
- VA National Center on Homelessness among Veterans, Tampa, FL, United States
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Shawn Liu
- VHA Homeless Programs Office, Washington, DC, United States
| | - D. Keith McInnes
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States
| | - Ann Elizabeth Montgomery
- VA National Center on Homelessness among Veterans, Tampa, FL, United States
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jack Tsai
- VA National Center on Homelessness among Veterans, Tampa, FL, United States
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Riley Grassmeyer
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa A. Brenner
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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14
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Etchin AG, Fonda JR, Howard EP, Fortier CB, Milberg WP, Pounds K, McGlinchey RE. Childhood Trauma Differentially Impacts Depression and Stress Associations with Reintegration Challenges Among Post-9/11 U.S. Veterans. Nurs Outlook 2021; 70:323-336. [PMID: 34895737 DOI: 10.1016/j.outlook.2021.10.008] [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: 06/07/2021] [Revised: 09/30/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-9/11 veterans exhibit high prevalence of deployment stress, psychological conditions, and traumatic brain injury (TBI) which impact reintegration, especially among those with a history of interpersonal early life trauma (I-ELT). The relative importance of each risk factor is unclear. PURPOSE We examined major deployment and clinical exposures of reintegration challenges among veterans with and without I-ELT. METHOD We analyzed cross-sectional data of 155 post-9/11 veterans from the Translational Research Center for TBI and Stress Disorders study. FINDINGS Depression severity had the strongest association with reintegration challenges, followed by posttraumatic stress disorder (PTSD) severity, post-deployment stress, and deployment safety concerns. Deployment safety concerns had a stronger, significant association among veterans with I-ELT. In nearly every model, PTSD and depression severities were weaker for veterans with I-ELT, compared to those without. DISCUSSION Clinicians should consider the relative risk of concurrent clinical conditions and trauma histories when considering veterans' reintegration needs.
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Affiliation(s)
- Anna G Etchin
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA.
| | - Jennifer R Fonda
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University Medical Campus, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Elizabeth P Howard
- Connell School of Nursing, Boston College, Chestnut Hill, MA; The Hinda and Arthur Marcus Institute for Aging Research (The Marcus Institute), Hebrew Senior Life, Boston, MA
| | - Catherine B Fortier
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - William P Milberg
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA
| | - Karen Pounds
- College of Nursing and Health Sciences, University of Massachusetts Dartmouth, North Dartmouth, MA
| | - Regina E McGlinchey
- Translational Research Center for TBI & Stress Disorders, VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA
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15
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Sonu S, Marvin D, Moore C. The Intersection and Dynamics between COVID-19, Health Disparities, and Adverse Childhood Experiences: "Intersection/Dynamics between COVID-19, Health Disparities, and ACEs". JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:517-526. [PMID: 34025900 PMCID: PMC8122187 DOI: 10.1007/s40653-021-00363-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is shining a spotlight on health disparities that have long been overlooked in our society. The intersection between Adverse Childhood Experiences (ACEs), longstanding health disparities, and COVID-19 cannot be ignored. The accumulation of traumatic events throughout the childhood and adolescent years can cause toxic stress in the absence of supportive adults. This repetitive activation of the stress response system can be a catalyst to long-term, negative effects on both the body and brain. A major factor to appreciate is that ACEs do not affect all populations equally. ACEs disproportionately affect groups that have been historically oppressed. The current COVID-19 pandemic highlights this point when observing both case rates and fatality rates of the virus and has the potential to create a new series of long-term health conditions that will disproportionately affect marginalized communities. A foundational first and critical step of adopting a trauma-informed approach will help lead to system change, advance equity, and create a setting of mutuality and empowerment for our patients.
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Affiliation(s)
- Stan Sonu
- Department of Medicine, Emory University School of Medicine, Atlanta, GA USA
| | - David Marvin
- Medical Student, Emory University School of Medicine, Atlanta, GA USA
| | - Charles Moore
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA USA
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16
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Koh KA, Montgomery AE. Adverse childhood experiences and homelessness: advances and aspirations. THE LANCET PUBLIC HEALTH 2021; 6:e787-e788. [DOI: 10.1016/s2468-2667(21)00210-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022] Open
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Pidgeon H, McKinney D, Tan-Creevy J, Shah M, Ansari S, Gottlieb M. Thinking Beyond the Emergency Department: Addressing Homelessness in Residency Education. Ann Emerg Med 2021; 79:397-403. [PMID: 34607743 DOI: 10.1016/j.annemergmed.2021.07.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Harrison Pidgeon
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL.
| | - Dennis McKinney
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Jeny Tan-Creevy
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Meeta Shah
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Sobia Ansari
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
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18
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Tong MS, Kaplan LM, Guzman D, Ponath C, Kushel MB. Persistent Homelessness and Violent Victimization Among Older Adults in the HOPE HOME Study. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:8519-8537. [PMID: 31135255 PMCID: PMC8715865 DOI: 10.1177/0886260519850532] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The homeless population is aging; older homeless adults may be at high risk of experiencing violent victimization. To examine whether homelessness is independently associated with experiencing physical and sexual abuse, we recruited 350 adults, aged 50 and older in Oakland, California, who met criteria for homelessness between July 2013 and June 2014. We interviewed participants at 6-month intervals for 3 years in Oakland about key variables, including housing status. Using generalized estimating equations, we examined whether persistent homelessness in each follow-up period was independently associated with having experienced physical or sexual victimization, after adjusting for known risk factors. The majority of the cohort was men (77.4%) and Black American (79.7%). At baseline, 10.6% had experienced either physical or sexual victimization in the prior 6 months. At 18-month follow-up, 42% of the cohort remained homeless. In adjusted models, persistent homelessness was associated with twice the odds of victimization (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI]: [1.41, 2.87]). Older homeless adults experience high rates of victimization. Re-entering housing reduces this risk. Policymakers should recognize exposure to victimization as a negative consequence of homelessness that may be preventable by housing.
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Affiliation(s)
- Michelle S. Tong
- University of California, Berkeley, USA
- University of California, San Francisco, USA
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19
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Orak U, Kayaalp A, Walker MH, Breault K. Resilience and Depression in Military Service: Evidence From the National Longitudinal Study of Adolescent to Adult Health (Add Health). Mil Med 2021; 187:1441-1448. [PMID: 34458920 DOI: 10.1093/milmed/usab364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/23/2021] [Accepted: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Research indicates that military service involves stressors that may be related to depression. However, the military provides financial, educational, psychological, and social advantages that may help to mitigate the effects of service-related stressors. Because most prior research was based on cross-sectional data or small clinical samples, we explored individual-level trajectories of depression over time. METHODS Data came from the restricted-use version of the National Longitudinal Study of Adolescent to Adult Health (Add Health) in four survey waves from 1994 to 2008, with a total of 1,112 service members, of whom 231 were female, and a total sample size of 13,544. Statistical estimation employed the multilevel growth curve modeling approach. RESULTS Individuals who later served in the military had lower rates of depression than their civilian counterparts at year 1 of the study, and rates of depression decreased consistently for both groups throughout the study. Service members ended up with the same level of depression compared to civilians (year 14). Sex, race and parental education were unrelated to depression, and no evidence was found for the hypothesis that the military functions as a "bridging environment" to reduce depression by providing a more attractive alternative compared to civilian life. CONCLUSIONS Individuals who were less depressed at year 1 of the study were more likely to enlist into the military. While both civilians and service members displayed decreasing depression over the years of the study, military members had less decrease in depression over time beginning at a lower level of depression than civilian. Taken together, the minor differences in depression between the civilian and military samples and the lower level of depression among military members at the beginning of the study suggest that military service selects against higher levels of depression at the start of service and, given the known stressors related to the military, membership in the service may be associated with resilience to depression.
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Affiliation(s)
- Ugur Orak
- Department of Sociology and Anthropology, Middle Tennessee State University, Murfreesboro, TN 37132, USA
| | - Alper Kayaalp
- Department of Psychology, South Dakota State University, Brookings, SD 57007, USA
| | - Mark H Walker
- Department of Sociology, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Kevin Breault
- Department of Sociology and Anthropology, Middle Tennessee State University, Murfreesboro, TN 37132, USA
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20
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Rodriguez-Moreno S, Panadero S, Vázquez JJ. The Role of Stressful Life Events among Women Experiencing Homelessness: An Intragroup Analysis. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:380-391. [PMID: 33242362 DOI: 10.1002/ajcp.12480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study is to examine stressful life events (SLEs) among homeless women and how SLEs were related to patterns and trajectories of homelessness. Specifically, the study aimed to replicate and build upon by Muñoz et al. (2005) by using cluster and discriminant analysis in a sample of 116 homeless women. The sample was classified based on SLEs, and the relationship between the resulting subgroups and sociodemographic characteristics, homeless trajectories, physical and mental health, and social support was examined. The results suggest that the three-cluster solution was theoretically and structurally meaningful: (a) the "Shorter homelessness trajectories and best health and mental health" subgroup was characterized by low levels of SLEs, a shorter homeless trajectory, lower prevalence of physical and mental health problems, and lower rates of alcohol and substances consumption; (b) the "Early onset of homelessness and poorer health and poorer mental health" subgroup was characterized by a higher prevalence of childhood and adolescence SLEs, an early onset of homelessness and greater chronification, mental health problems, and alcohol consumption; and (c) the "Chronic homelessness and poorest health and mental health" subgroup was mainly characterized by a higher prevalence of typically adulthood SLEs, as well as some SLEs that may be unique to women, a greater number of periods of homelessness, physical health problems, disabilities, and substance misuse. Increased knowledge about the different subgroups and trajectories of homeless women, as well as their specific characteristics and needs, will help us design social services and policies sensitive to all these differences.
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Affiliation(s)
- Sara Rodriguez-Moreno
- Clinical Psychology Department, School of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Sonia Panadero
- Clinical Psychology Department, School of Psychology, Complutense University of Madrid, Madrid, Spain
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21
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Gil-Salmeron A, Smith L, Yang L, Rieder A, Grabovac I. Differences in health status, health behaviour and healthcare utilisation between Immigrant and native homeless people in Spain: An exploratory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:856-866. [PMID: 33586224 DOI: 10.1111/hsc.13313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/09/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
Few studies have examined the differences between immigrant and native-born homeless populations. Our aim was to conduct an exploratory study to examine the differences in health status, health behaviour and healthcare utilisation in a sample of Spanish immigrant and native homeless people. Study was conducted in eight different temporary accommodations in the Valencia region in August 2018. Overall, 86 participants were included in the analysis who answered questionnaires concerning socio-demographic characteristics, immigration status, health status and behaviour, healthcare utilisation and experienced discrimination in healthcare and health literacy. In total, 76.7% were men with a mean age of 41.91 (14.17) years, with 60.4% having immigration background with an average of 4.8 (4.2) years since arrival in Spain. No differences were found in the subjective health status, however, native homeless participants reported significantly higher prevalence of heart disease (87.5% vs. 12.5%), hypertension (84.6% vs. 15.4%), psychological illness (63.6% vs. 36.4%) and were also more often smokers (73.5% vs. 28.8%), reported smoking more cigarettes per day (12.0 vs. 7.4) and were more often illegal drug users (17.6% vs. 2.0%). Immigrant participants were significantly more often not insured, reported more problems in healthcare access and had lower rates of visits to general practitioners and less hospital admissions. Differences were also observed in social status with the native homeless more often reporting receiving income, and living in less crowded accommodations. Our results show a variety of issues that the immigrant homeless population in Spain is confronted with that also prevents adequate social inclusion and achieving good health. However, the immigrant population engaged less often in risky health behaviour. More, and continuous, monitoring of social, mental and physical health of the homeless population is necessary. Public health interventions aiming at health promotion in the immigrant homeless populations need to focus on increasing overall social integration.
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Affiliation(s)
- Alejandro Gil-Salmeron
- Polibenestar Research Institute, University of Valencia, Valencia, Spain
- International Foundation for Integrated Care, Oxford, UK
| | - Lee Smith
- The Cambridge Center for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Anita Rieder
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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22
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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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Masheb RM, Sala M, Marsh AG, Snow JL, Kutz AM, Ruser CB. Associations between adverse childhood experiences and weight, weight control behaviors and quality of life in Veterans seeking weight management services. Eat Behav 2021; 40:101461. [PMID: 33352386 DOI: 10.1016/j.eatbeh.2020.101461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION A neglected area of trauma research with Veterans is the study of Adverse Childhood Experiences (ACEs). The present study aimed to examine the prevalence of ACEs, and to explore relationships between ACEs and measures of weight, eating behaviors and quality of life in weight loss seeking Veterans. METHODS Participants were 191 Veterans [mean age 58.9 (SD = 12.8), mean Body Mass Index (BMI) 35.4 (SD = 6.1), 86.9% male, 33.7% racial/ethnic minority] receiving care at VA Connecticut Healthcare System (VA CT) who attended an orientation session of VA's behavioral weight management program. Participants completed a measure of ACEs and measures related to weight, eating and health. RESULTS Among completers, 68.6% endorsed at least one ACE. The average number of reported ACEs was 2.2 (SD = 2.5), with 48.7% of Veterans reporting more than one type of ACE. Women were more likely to report any ACE (88.0% vs. 65.6%, p = .025) and reported significantly more ACEs compared to males (4.2 vs. 1.9, p < .001). ACEs were associated with lower physical activity (p = .05), lower quality of life (p's < 0.05), and lower weight-related quality of life (p < .01), but not weight, weight control strategies, binge eating, or alcohol use. CONCLUSION ACEs are common among weight loss seeking Veterans, particularly among female Veterans. Findings suggest that there is a high rate of ACEs in Veterans, which are associated with exercise and quality of life outcomes, but not diet and weight outcomes.
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Affiliation(s)
- Robin M Masheb
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America; Yale University School of Medicine, 333 Cedar St., New Haven, CT 06610, United States of America.
| | - Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, United States of America.
| | - Alison G Marsh
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America.
| | - Jennifer L Snow
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America.
| | - Amanda M Kutz
- VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148, United States of America.
| | - Christopher B Ruser
- VA Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, United States of America; Yale University School of Medicine, 333 Cedar St., New Haven, CT 06610, United States of America.
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Iwundu CN, Chen TA, Edereka-Great K, Businelle MS, Kendzor DE, Reitzel LR. Mental Illness and Youth-Onset Homelessness: A Retrospective Study among Adults Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228295. [PMID: 33182590 PMCID: PMC7697732 DOI: 10.3390/ijerph17228295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
Abstract
Financial challenges, social and material instability, familial problems, living conditions, structural issues, and mental health problems have been shown to contribute to youth homelessness. Based on the paucity of literature on mental illness as a reason for youth homelessness, the current study retrospectively evaluated the association between the timing of homelessness onset (youth versus adult) and mental illness as a reason for homelessness among homeless adults living in homeless shelters and/or receiving services from homeless-serving agencies. Homeless participants (N = 919; 67.3% men) were recruited within two independent studies from Dallas and Oklahoma. Covariate-adjusted logistic regressions were used to measure associations between homelessness onset and mental illness as a reason for current homelessness, history of specific mental illnesses, the historical presence of severe mental illness, and severe mental illness comorbidity. Overall, 29.5% of the sample reported youth-onset homelessness and 24.4% reported mental illness as the reason for current homelessness. Results indicated that mental illness as a reason for current homelessness (AOR = 1.62, 95% CI = 1.12–2.34), history of specific mental illnesses (Bipolar disorder–AOR = 1.75, 95% CI = 1.24–2.45, and Schizophrenia/schizoaffective disorder–AOR = 1.83, 95% CI = 1.22–2.74), history of severe mental illness (AOR = 1.48, 95% CI = 1.04–2.10), and severe mental illness comorbidities (AOR = 1.30, 95% CI: 1.11–1.52) were each associated with increased odds of youth-onset homelessness. A better understanding of these relationships could inform needs for early interventions and/or better prepare agencies that serve at-risk youth to address precursors to youth homelessness.
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Affiliation(s)
- Chisom N. Iwundu
- Department of Rehabilitation and Health Services, College of Health and Public Service, University of North Texas, Denton, TX 76203, USA;
- Correspondence: ; Tel.: +1-940-369-5356
| | - Tzu-An Chen
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (T.-A.C.); (L.R.R.)
- HEALTH Research Institute, University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Kirsteen Edereka-Great
- Department of Rehabilitation and Health Services, College of Health and Public Service, University of North Texas, Denton, TX 76203, USA;
| | - Michael S. Businelle
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research, Parkway, Suite 400, Oklahoma City, OK 73104, USA; (M.S.B.); (D.E.K.)
| | - Darla E. Kendzor
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research, Parkway, Suite 400, Oklahoma City, OK 73104, USA; (M.S.B.); (D.E.K.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (T.-A.C.); (L.R.R.)
- HEALTH Research Institute, University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
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El Mhamdi S, Lemieux A, Ben Fredj M, Bouanene I, Ben Salah A, Abroug H, Ben Salem K, al'Absi M. Social and early life adversity and chronic health conditions among Tunisian adults. Transl Behav Med 2020; 10:949-958. [PMID: 30551151 DOI: 10.1093/tbm/iby126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Early life adversities (ELAs) are shown as significant risk factors for chronic health conditions (CHCs). ELAs include multiple types of abuse such as the social abuse (peer, community, and collective violence). The purpose is to describe the relationship between childhood social abuse and chronic conditions in adulthood among a sample of adults in Tunisia and to investigate the role of obesity and tobacco use as mediators of this association. A cross-sectional study was conducted in Tunisia, from January to June 2016 using the Arabic Adverse Childhood Experiences International Questionnaire (ACE-IQ). Items of social abuse (peer violence, witnessing community violence, and exposure to collective violence) were analyzed. A total of 2,120 adults were enrolled. After adjustment for age, gender, and intrafamilial ELA, social adversities were associated significantly with the selected CHC. Experiencing more than two social ELA increase the risk of occurrence of hypertension and coronary diseases. After accounting for the indirect effect of body mass index, statistically significant partial mediation effects were observed for the cumulative number of social ELA as the exposure variable and chronic diseases as the outcome variable (p ≤ .001; % mediated = 44.5%). These findings support an association between many chronic health disorders and childhood social abuse, independently of intrafamilial ACEs.
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Affiliation(s)
- Sana El Mhamdi
- Department of Preventive and Community Medicine, University Hospital Tahar Sfar, Mahdia, Tunisia.,Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health" Tunisia
| | - Andrine Lemieux
- Duluth Medical Research Institute, University of Minnesota, Duluth, MN, USA
| | - Manel Ben Fredj
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia
| | - Ines Bouanene
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health" Tunisia
| | - Arwa Ben Salah
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health" Tunisia
| | - Hela Abroug
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia
| | - Kamel Ben Salem
- Department of Community Medicine, Faculty of Medicine, University of Monastir, Tunisia.,Research laboratory "Epidemiology Applied to Maternal and Child Health" Tunisia
| | - Mustafa al'Absi
- Duluth Medical Research Institute, University of Minnesota, Duluth, MN, USA
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Differences in Utilization of Medical and Dental Services among Homeless People in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155304. [PMID: 32717950 PMCID: PMC7432539 DOI: 10.3390/ijerph17155304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/17/2022]
Abstract
(1) Background: Homelessness contributes to both needs for care and barriers to access. This study aimed to explore the utilization of medical or dental services using Andersen's model for a vulnerable population of homeless in South Korea. (2) Methods: The data were applied from the first national survey for homeless people in South Korea, 2016. Totally 2032 persons participated in the interview survey. This study team requested the raw data through the public portal and analyzed them. (3) Results: The participants who were homeless for more than ten years, staying in small rooming house or shelter, non-employed, earning less than 500,000 won per month, and having a medical condition showed a significantly higher chance of using Medicaid. The use of outreach programs had a significant relationship with gender, duration of homelessness, and monthly income. Among dental patients, the homeless who did not consume alcohol, stayed in a shelter, and were employed had higher chances of using dental service. (4) Conclusions: Medicaid service was strongly related to enabling factors but outreach programs with predisposing factors. Dental service showed strong relationships with the enabling domain, but the pattern was opposite: the jobless had less chance to avail it. The policymakers need to consider these domains of service utilization to provide equitable access to healthcare services.
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Demakakos P, Lewer D, Jackson SE, Hayward AC. Lifetime prevalence of homelessness in housed people aged 55-79 years in England: its childhood correlates and association with mortality over 10 years of follow-up. Public Health 2020; 182:131-138. [PMID: 32298843 PMCID: PMC7294219 DOI: 10.1016/j.puhe.2019.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/06/2019] [Accepted: 12/20/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Since 2010, the number of homeless people in the UK has increased, and homelessness in its different types has become a major public health problem. Housed older people with past experience of homelessness are an understudied population that can provide valuable insight into this problem. For this reason, we examined the lifetime prevalence of homelessness and its associations with childhood adversity and mortality in a national sample of older people. STUDY DESIGN This is a longitudinal cohort study. METHODS We studied 6649 housed individuals aged 55-79 years in 2007 from the English Longitudinal Study of Ageing (ELSA). We used logistic regression to model the association between adverse childhood experiences (ACE) and lifetime experience of homelessness (ever been homeless for ≥1 months) and Cox proportional hazards regression to model the prospective association between lifetime experience of homelessness and mortality. RESULTS We identified 107 participants with lifetime experience of homelessness. We found a strong graded association between the number of ACE and lifetime experience of homelessness; participants with two ACE had 5.35 (95% confidence interval [CI]: 3.17-9.05) times greater odds of having experienced homelessness than those reporting none. Most ACE were individually associated with lifetime homelessness, but fewer remained so in the mutually adjusted model. Participants with lifetime experience of homelessness had 1.55 (95% CI: 1.01-2.37) times greater risk of mortality over a 10-year follow-up and after adjustment for covariates. CONCLUSIONS Exposure to childhood adversity is associated with increased risk of experiencing homelessness. Older housed people with past experience of homelessness are at increased risk of mortality.
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Affiliation(s)
- P Demakakos
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 6BT, UK.
| | - D Lewer
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 6BT, UK; Collaborative Centre for Inclusion Health, University College London, London, NW1 2DA, UK
| | - S E Jackson
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 6BT, UK
| | - A C Hayward
- Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, WC1E 6BT, UK; Collaborative Centre for Inclusion Health, University College London, London, NW1 2DA, UK
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Petruccelli K, Davis J, Berman T. Adverse childhood experiences and associated health outcomes: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2019; 97:104127. [PMID: 31454589 DOI: 10.1016/j.chiabu.2019.104127] [Citation(s) in RCA: 361] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/06/2019] [Accepted: 07/29/2019] [Indexed: 05/13/2023]
Abstract
BACKGROUND The Center for Disease Control (CDC) and Kaiser Permanente developed the Adverse Childhood Experiences (ACE) scale to identify negative experiences in childhood. The goal of this study is to systematically review outcomes associated with the ACEs in the CDC-Kaiser ACE scale to understand the diversity of outcomes associated with this scale. METHODS The authors conducted a search of English language articles published through September 30, 2016 using OVID Medline®; Ovid Medline® Daily; Epub Ahead of Print, In-Process & Other Non-indexed citations; ERIC®; HAPI®; and SCOPUS®. Articles were selected by trained reviewers based on a priori inclusion criteria including: research, healthy sample, used the CDC-Kaiser ACE scale, and assessed some health outcome. Two reviewers used an abstraction form to independently collect data from each study. Unadjusted and adjusted odds ratio associated with ACE scale scores were aggregated and compared. RESULTS From 3167 unique titles, we identified 96 articles that assessed health outcomes associated with the ACEs in the CDC-Kaiser ACE scale. There were more studies focusing on psychosocial/behavioral outcomes than medical outcomes. The majority of the included studies were retrospective, observational, and relied on the same data set. Psychosocial/behavioral outcomes had higher odds ratio than medical outcomes with increasing ACE scale scores. CONCLUSIONS Exposure to multiple ACEs is associated with a wide variety of outcomes. This data suggests a benefit of screening for ACEs using this scale and highlights the need to find interventions to ameliorate their effects.
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Affiliation(s)
- Kaitlyn Petruccelli
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19017, United States.
| | - Joshua Davis
- Penn State Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033, United States.
| | - Tara Berman
- Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut St, Philadelphia, PA 19017, United States; Nemours duPont Pediatrics, Primary Care, 833 Chestnut St, Suite 300, Philadelphia, PA 19107, United States.
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29
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Youth exposure to violence involving a gun: evidence for adverse childhood experience classification. J Behav Med 2019; 42:646-657. [PMID: 31367930 DOI: 10.1007/s10865-019-00053-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/30/2019] [Indexed: 01/13/2023]
Abstract
Adverse childhood experiences (ACEs) have historically included child maltreatment, household dysfunction, and other critical issues known to impact children negatively. Although youth experiences with violence are broadly captured in some ACE measures, youth exposure to violence involving a gun has not been included specifically in the operationalizing, and therefore scientific study, of ACEs. There are numerous implications of this omission, including limiting access to ACE interventions that are currently available and resources for individuals who have been exposed to gun violence. Thus, and given the persistent prevalence of gun violence in the US, we conducted a systematic review of the literature over the past two decades on the assessment of and response to ACEs and gun violence. Eighty-one journal articles across four search engines met our inclusion criteria. Our findings provide evidence that youth gun violence exposure should be classified as an ACE. In addition to increasing access to resources for youth affected by gun violence, these findings may improve the likelihood of funding and research into gun violence, with direct implications for prevention and intervention efforts.
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Radcliff E, Crouch E, Strompolis M, Srivastav A. Homelessness in Childhood and Adverse Childhood Experiences (ACEs). Matern Child Health J 2019; 23:811-820. [DOI: 10.1007/s10995-018-02698-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee YJ, Yun SY, Lee JK, Heo EY, Kim DK, Chung HS, Park TY. Comparison of clinical characteristics and outcomes between homeless and non-homeless patients admitted to intensive care units: An observational propensity-matched cohort study in Korea. J Crit Care 2019; 52:80-85. [PMID: 30986759 DOI: 10.1016/j.jcrc.2019.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare clinical characteristics and outcomes between critically ill homeless and non-homeless patients admitted to the intensive care unit (ICU) in a Korea. MATERIALS AND METHODS We retrospectively analyzed the medical charts of homeless and non-homeless patients admitted to ICU at Seoul Boramae Medical Center between January 2012 and December 2017. Patients were selected using 1: 2 propensity score matching including age, sex, and type of ICU and multivariate analyses were performed to determine risk factors for hospital and ICU mortality. RESULTS 56 homeless and 112 non-homeless matched patients were analyzed. The homeless patients were younger, included more men, and exhibited significantly higher readmission and ER admission rates. Although hospital and ICU mortality rates were similar between two groups, the homeless patients were significantly less likely to have family or substitute decision-makers and generally died after cardiopulmonary resuscitation. Adjusted multivariate analysis showed that homelessness was not an independent predictor of ICU or hospital mortality. The length of ICU stay was comparable between groups. CONCLUSIONS In Korea, ICU-admitted homeless patients are well managed without differences in terms of organ support quality and exhibit the same prognosis as non-homeless patients. However, the quality of end-of-life care for homeless patients remains poor.
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Affiliation(s)
- Ye Jin Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seo Young Yun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung Kyu Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Deog Keom Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hee Soon Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
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Van Zalk N, Smith R. Internalizing Profiles of Homeless Adults: Investigating Links Between Perceived Ostracism and Need-Threat. Front Psychol 2019; 10:350. [PMID: 30842750 PMCID: PMC6391344 DOI: 10.3389/fpsyg.2019.00350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/04/2019] [Indexed: 12/02/2022] Open
Abstract
Social ostracism among the homeless is a prevailing problem, yet few studies have focused on whether internalizing psychopathology moderates the links between feeling ostracized and perceiving threats to fundamental human needs. This study used a person-oriented approach to identify commonly occurring profiles of internalizing psychopathology characterized by symptoms of social anxiety, generalized anxiety, and depression (Low, Medium, and High Internalizers) among homeless participants residing in London, United Kingdom (N = 114; age range = 18–74; Mage = 46; 25% women). Data on perceived ostracism (feeling ignored and daily discrimination) and need-threat (belonging, self-esteem, meaningful existence, and feelings of control) was also collected. Controlling for the effects of age, living arrangement, gender, and time being homeless, feeling ignored was a significant predictor of need-threat, whereas daily discrimination was not. One significant interaction on the links between daily discrimination and need-threat emerged between Low and Medium Internalizers. For Medium Internalizers, high levels of daily discrimination were associated with high levels of need-threat. The effect was similar for High Internalizers and the opposite for Low Internalizers, though it was not significant within those groups. Taken together, these results indicate that differences in patterns of internalizing psychopathology should be taken into account when attempting to make homeless individuals feel more included in their surroundings.
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Affiliation(s)
- Nejra Van Zalk
- Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | - Rebecca Smith
- Department of Psychology, Social Work and Counselling, University of Greenwich, London, United Kingdom
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Zarse EM, Neff MR, Yoder R, Hulvershorn L, Chambers JE, Chambers RA. The adverse childhood experiences questionnaire: Two decades of research on childhood trauma as a primary cause of adult mental illness, addiction, and medical diseases. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1581447] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Emily M. Zarse
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Midtown Mental Health Center/Eskenazi Hospital, Indianapolis, IN, USA
| | - Mallory R. Neff
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Child Psychiatry, Riley Hospital, IU School of Medicine, Indianapolis, IN, USA
| | - Rachel Yoder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Child Psychiatry, Riley Hospital, IU School of Medicine, Indianapolis, IN, USA
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Child Psychiatry, Riley Hospital, IU School of Medicine, Indianapolis, IN, USA
| | - Joanna E. Chambers
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Midtown Mental Health Center/Eskenazi Hospital, Indianapolis, IN, USA
| | - R. Andrew Chambers
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- Midtown Mental Health Center/Eskenazi Hospital, Indianapolis, IN, USA
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von Bonsdorff MB, Kokko K, Salonen M, von Bonsdorff ME, Poranen-Clark T, Alastalo H, Kajantie E, Osmond C, Eriksson JG. Association of childhood adversities and home atmosphere with functioning in old age: the Helsinki birth cohort study. Age Ageing 2019; 48:80-86. [PMID: 30272114 DOI: 10.1093/ageing/afy153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 09/12/2018] [Indexed: 01/13/2023] Open
Abstract
Objective childhood adversities have been linked with adverse health outcomes, but less is known about the long-term consequences of childhood home atmosphere. We investigated whether childhood adversities and home atmosphere were associated with physical and mental functioning in older age. Methods in the Helsinki Birth Cohort Study 2003, participants born in the year 1934-44 had data available on nine childhood home atmosphere items, e.g. whether it was supportive and warm (sum score ranged between 0 and 36, higher score indicating better atmosphere), and nine childhood adversities, e.g. unemployment and divorce (sum score 0-9, coded into no; one; and two or more adversities) assessed in 2001-04. Of those, 835 had data on physical and mental functioning assessed using the Short Form 36 questionnaire in 2011-13. Results those who had experienced two or more childhood adversities were more likely to have poorer physical and mental functioning in older age compared to those with no adversities. A better home atmosphere score was associated with better mental functioning (per one unit higher score β 0.24, 95% CI 0.16-0.32, P < 0.001). In models including both childhood adversities and home atmosphere, a more favourable home atmosphere was associated with better mental functioning while the association for childhood adversities attenuated. There were no associations between childhood adversities or home atmosphere and physical functioning in the models that included both childhood exposures. Conclusions childhood adversities and home atmosphere have long-term associations with physical and mental functioning in older age.
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Affiliation(s)
- Mikaela B von Bonsdorff
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Katja Kokko
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Minna Salonen
- Folkhälsan Research Center, Helsinki, Finland
- Division of Welfare and Health Promotion, Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Monika E von Bonsdorff
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Taina Poranen-Clark
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Hanna Alastalo
- Ageing, Disability and Functional Capacity Unit, Department of Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - Eero Kajantie
- Division of Welfare and Health Promotion, Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Hospital for Children and Adolescents, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
- PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland
- Division of Welfare and Health Promotion, Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Unit of General Practice, Helsinki University Hospital, Helsinki, Finland
- Vasa Central Hospital, Vasa, Finland
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Evans EA, Upchurch DM, Simpson T, Hamilton AB, Hoggatt KJ. Differences by Veteran/civilian status and gender in associations between childhood adversity and alcohol and drug use disorders. Soc Psychiatry Psychiatr Epidemiol 2018; 53:421-435. [PMID: 29188311 DOI: 10.1007/s00127-017-1463-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/17/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE To examine differences by US military Veteran status and gender in associations between childhood adversity and DSM-5 lifetime alcohol and drug use disorders (AUD/DUD). METHODS We analyzed nationally representative data from 3119 Veterans (n = 379 women; n = 2740 men) and 33,182 civilians (n = 20,066 women; n = 13,116 men) as provided by the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). We used weighted multinomial logistic regression, tested interaction terms, and calculated predicted probabilities by Veteran status and gender, controlling for covariates. To test which specific moderation contrasts were statistically significant, we conducted pairwise comparisons. RESULTS Among civilians, women had lower AUD and DUD prevalence than men; however, with more childhood adversity, this gender gap narrowed for AUD and widened for DUD. Among Veterans, in contrast, similar proportions of women and men had AUD and DUD; with more childhood adversity, AUD-predicted probability among men surpassed that of women. Childhood adversity elevated AUD probability among civilian women to levels exhibited by Veteran women. Among men, Veterans with more childhood adversity were more likely than civilians to have AUD, and less likely to have DUD. CONCLUSIONS Childhood adversity alters the gender gap in AUD and DUD risk, and in ways that are different for Veterans compared with civilians. Department of Defense, Veterans Affairs, and community health centers can prevent and ameliorate the harmful effects of childhood adversity by adapting existing behavioral health efforts to be trauma informed, Veteran sensitive, and gender tailored.
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Affiliation(s)
- Elizabeth A Evans
- VA Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, 90073, CA, USA. .,Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, 311 Arnold House, 715 North Pleasant Street, Amherst, MA, 01003, USA. .,Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, 3601 Main St, 3rd Floor, Springfield, MA, 01107, USA.
| | - Dawn M Upchurch
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Tracy Simpson
- Seattle Division, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Alison B Hamilton
- VA Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, 90073, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Katherine J Hoggatt
- VA Health Services Research and Development (HSR&D), Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, 90073, CA, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, 90095, CA, USA
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Hoy-Ellis CP, Shiu C, Sullivan KM, Kim HJ, Sturges AM, Fredriksen-Goldsen KI. Prior Military Service, Identity Stigma, and Mental Health Among Transgender Older Adults. THE GERONTOLOGIST 2017; 57:S63-S71. [PMID: 28087796 DOI: 10.1093/geront/gnw173] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/21/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Converging evidence from large community-based samples, Internet studies, and Veterans Health Administration data suggest that transgender adults have high rates of U.S. military service. However, little is known about the role of prior military service in their mental health later in life, particularly in relation to identity stigma. In this article, we examine relationships between prior military service, identity stigma, and mental health among transgender older adults. DESIGN AND METHODS We used a subsample of transgender older adults (n = 183) from the 2014 survey of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). We employed weighted multivariate linear models to evaluate the relationships between psychological health-related quality of life (HRQOL), depressive symptomatology (Center for Epidemiological Studies Depression Scale [CES-D] scores), identity stigma, and prior military service, controlling for background characteristics. RESULTS Identity stigma was significantly related with higher depressive symptomatology and lower psychological HRQOL. Having a history of prior military service significantly predicted lower depressive symptomatology and higher psychological HRQOL. The relationships between psychological HRQOL, identity stigma, and prior military service were largely explained by depressive symptomatology. Prior military service significantly attenuated the relationship between identity stigma and depressive symptomatology. IMPLICATIONS By identifying the role of military service in the mental health of transgender older adults, this study provides insights into how prior military service may contribute to resilience and positive mental health outcomes. Directions for future research are discussed.
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Affiliation(s)
| | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle
| | | | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
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Fitzpatrick KM. How Positive Is Their Future? Assessing the Role of Optimism and Social Support in Understanding Mental Health Symptomatology among Homeless Adults. Stress Health 2017; 33:92-101. [PMID: 27037736 DOI: 10.1002/smi.2676] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/22/2015] [Accepted: 02/14/2016] [Indexed: 11/07/2022]
Abstract
Optimism has been noted as a primary protective factor in understanding mental health symptomatology in clinical and non-clinical settings. Any exploration of optimism has been absent in understanding mental health outcomes among homeless people. This study, using intensive interviews with 168 homeless adults in Northwest Arkansas, examines the role that social support and optimism play in lessening the negative impact of homeless circumstances/experiences on mental health symptomatology. Using OLS, findings support a mediating/protective role that social support and optimism play in lowering the negative effects of childhood life experiences on depressive symptoms among homeless persons. Despite the overwhelming conditions of homelessness, persons with higher levels of optimism and social support report lower depression and anxiety symptoms. The findings are discussed paying particular attention to the importance of developing and maintaining the perception of support and resiliency in preserving a positive outlook for the future among homeless persons facing often-debilitating circumstances. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Kevin M Fitzpatrick
- Department of Sociology and Criminal Justice, University of Arkansas, Fayetteville, AR, USA
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The relationship between childhood poverty, military service, and later life depression among men: Evidence from the Health and Retirement Study. J Affect Disord 2016; 206:1-7. [PMID: 27455351 PMCID: PMC5704990 DOI: 10.1016/j.jad.2016.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/08/2016] [Accepted: 07/10/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood poverty has been associated with depression in adulthood, but whether this relationship extends to later life major depression (MD) or is modified by military service is unclear. METHODS Data come from the Health and Retirement Study (HRS) 2010 wave, a longitudinal, nationally representative study of older adults. Men with data on military service and childhood poverty were included (N=6330). Childhood poverty was assessed by four indicators (i.e., parental unemployment, residential instability) experienced before age 16. Military service was categorized as veteran versus civilian, and during draft versus all-volunteer (after 1973) eras. Past year MD was defined by the Composite International Diagnostic Inventory. RESULTS Four in ten men ever served, with 13.7% in the all-volunteer military. Approximately 12% of civilians, 8% draft era and 24% all-volunteer era veterans had MD. Childhood poverty was associated with higher odds of MD (Odds Ratio (OR): 2.38, 95% Confidence Interval (CI): 1.32-4.32) and higher odds of military service (OR: 2.58, 95% CI: 1.58-4.21). Military service was marginally associated with MD (OR: 1.28, 95% CI: 0.98-1.68) and did not moderate the association between childhood poverty and MD. LIMITATIONS Self-report data is subject to recall bias. The HRS did not assess childhood physical and emotional abuse, or military combat exposure. CONCLUSIONS Men raised in poverty had greater odds of draft and all-volunteer military service. Early-life experiences, independent of military service, appear associated with greater odds of MD. Assessing childhood poverty in service members may identify risk for depression in later life.
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Oppenheimer SC, Nurius PS, Green S. Homelessness History Impacts on Health Outcomes and Economic and Risk Behavior Intermediaries: New Insights from Population Data. FAMILIES IN SOCIETY : THE JOURNAL OF CONTEMPORARY HUMAN SERVICES 2016; 97:230-242. [PMID: 31354224 PMCID: PMC6660012 DOI: 10.1606/1044-3894.2016.97.21] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Using data from the Washington Behavioral Risk Factor Surveillance System, this study assesses the relationship between homelessness history and physical and mental health outcomes as well as between homelessness history and health risk behaviors and economic precariousness as important intermediaries of subsequent health outcomes. Study results indicate that persons with a history of adult homelessness have consistently poorer health outcomes as compared to never homeless persons, and that even after accounting for childhood adversity and social assets, adult homelessness remains a consistent and strong predictor of poor health. These findings indicate that adult homelessness is a key component in understanding cumulative risk and vulnerability. Study results emphasize the importance of considering homelessness history in comprehensive health assessment and intervention services, as well as the utility of using representative public health surveys to understand population trends in housing instability.
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Winders Davis D, Myers J, Logsdon MC, Bauer NS. The Relationship Among Caregiver Depressive Symptoms, Parenting Behavior, and Family-Centered Care. J Pediatr Health Care 2016; 30:121-32. [PMID: 26189603 DOI: 10.1016/j.pedhc.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Parental depression has been associated with adverse child outcomes. However, the specific parenting behaviors that may result in such child outcomes and the effect of family-centered care (FCC) on positive parenting behavior of depressed parents has not previously been examined. METHODS Data from the National Survey of Early Childhood Health was used (n = 2,068). Groups were stratified by the presence of parental depression and compared with regard to demographics and the mean number of specific positive parenting behaviors. Generalized linear models were developed based on testing whether individuals performed more or less than the median number of positive behaviors. Lastly, we tested whether depression independently predicted each outcome after adjustment for FCC, coping, social support, and ethnicity to evaluate if depression independently predicted each outcome after adjustment. RESULTS No difference was found in demographic variables between parents who were depressed and not depressed. Parents who were not depressed performed significantly more routines (p = .036); reported coping better with parenting (p < .001); performed significantly less punitive behaviors (p = .022); and needed/had less social support (p = .002) compared with parents who were depressed. Individual items and scale scores were associated in the expected directions. FCC was independently associated with study variables but did not moderate the effect of depression. CONCLUSIONS These data identify specific parenting behaviors that differ between parents who report depressive symptoms compared with parents who do not have depressive symptoms. More targeted interventions coordinated through a medical home are needed for parents with depressive symptoms to reduce the child health disparities often associated with parental depression.
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Katon JG, Lehavot K, Simpson TL, Williams EC, Barnett SB, Grossbard JR, Schure MB, Gray KE, Reiber GE. Adverse Childhood Experiences, Military Service, and Adult Health. Am J Prev Med 2015; 49:573-82. [PMID: 26091925 DOI: 10.1016/j.amepre.2015.03.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 03/11/2015] [Accepted: 03/23/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Prevalence of adverse childhood experiences (ACE) and associations with adult health may vary by gender and military service. This study compares the gender-specific prevalence of ACE by military service and determines the associations of ACE with adult health risk factors and health-related quality of life (HRQOL). METHODS This 2014 analysis used data from the 2011 and 2012 CDC Behavioral Risk Factor Surveillance System. Total ACE was operationalized as the number of reported ACE. Associations of total ACE with adult health risk factors were estimated using general linear models; associations with HRQOL were estimated using negative binomial regression. All analyses adjusted for age and race/ethnicity. RESULTS Those with military service had more total ACE than civilians. Higher ACE was associated with poorer HRQOL among women (physical health, military service, relative risk [RR]=1.20, 95% CI=1.09, 1.33; civilians, RR=1.18, 95% CI=1.17, 1.20; mental health, military service, RR=1.21, 95% CI=1.12, 1.32; civilians, RR=1.25, 95% CI=1.23, 1.26). Among men, these associations were somewhat attenuated in those with military service relative to civilians (physical health, military service, RR=1.13, 95% CI=1.09, 1.18; civilians, RR=1.20, 95% CI=1.17, 1.24; mental health, military service, RR=1.21, 95% CI=1.16, 1.27; civilians, RR=1.30, 95% CI=1.27, 1.34). CONCLUSIONS Relative to civilians, men and women with military service report more ACE, but associations of ACE with adult HRQOL are weaker among men with military service relative to civilians. There is a need to implement and disseminate evidence-based programs to prevent ACE and for research on the long-term health consequences of ACE in military populations.
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Affiliation(s)
- Jodie G Katon
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; the Veterans Affairs Office of Patient Care Services, Office of Women's Health Services, Department of Veterans Affairs, Washington, District of Columbia.
| | - Keren Lehavot
- Mental Illness Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington
| | - Tracy L Simpson
- Mental Illness Research, Education, and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington
| | - Emily C Williams
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Sarah Beth Barnett
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Joel R Grossbard
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Mark B Schure
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Kristen E Gray
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Gayle E Reiber
- Health Services Research and Development, Veterans Affairs Puget Sound Health Care System, Seattle, Washington; Department of Health Services, School of Public Health, University of Washington, Seattle, Washington; Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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McCauley HL, Blosnich JR, Dichter ME. Adverse Childhood Experiences and Adult Health Outcomes Among Veteran and Non-Veteran Women. J Womens Health (Larchmt) 2015; 24:723-9. [PMID: 26390379 DOI: 10.1089/jwh.2014.4997] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women veterans represent a vulnerable population with unique health needs and disparities in access to care. One constellation of exposures related to subsequent poor health includes adverse childhood experiences (ACEs; e.g., physical and sexual child abuse), though research on impacts of ACEs among women veterans is limited. METHODS Data were drawn from the 2010 Behavioral Risk Factor Surveillance System for the 11 states that included the ACE module (n=36,485). Weighted chi-squared tests and multivariable logistic regression were used to assess the prevalence of ACEs among women veterans compared with women non-veterans and differences in the following outcomes, controlling for ACEs: social support, inadequate sleep, life satisfaction, mental distress, smoking, heavy alcohol use, obesity, diabetes, cardiovascular disease symptoms, asthma, and disability. RESULTS Women veterans (1.6% of the total sample) reported a higher prevalence of 7 out of 11 childhood adversities and higher mean ACE score than women non-veterans. Women veterans were more likely to be current smokers and report a disability, associations which were attenuated when controlling for ACE. CONCLUSIONS Despite women veterans' higher prevalence of ACE, their health outcomes did not differ substantially from non-veterans. Further research is needed to understand the intersections of traumatic experiences and sources of resilience over the lifecourse among women veterans.
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Affiliation(s)
- Heather L McCauley
- 1 Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine , Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - John R Blosnich
- 2 Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System , Pittsburgh, Pennsylvania
| | - Melissa E Dichter
- 3 Center for Health Equity Research and Promotion, Philadelphia VA Medical Center , Philadelphia, Pennsylvania
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Abstract
Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans.
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Affiliation(s)
- Jack Tsai
- VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut (Jack Tsai, Robert A. Rosenheck); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Jack Tsai, Robert A. Rosenheck); and Department of Epidemiology and Public Health, Yale School of Public Health, New Haven, Connecticut (Robert A. Rosenheck)
| | - Robert A. Rosenheck
- VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut (Jack Tsai, Robert A. Rosenheck); Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut (Jack Tsai, Robert A. Rosenheck); and Department of Epidemiology and Public Health, Yale School of Public Health, New Haven, Connecticut (Robert A. Rosenheck)
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Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet 2014; 384:1529-40. [PMID: 25390578 PMCID: PMC4520328 DOI: 10.1016/s0140-6736(14)61132-6] [Citation(s) in RCA: 825] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
In the European Union, more than 400,000 individuals are homeless on any one night and more than 600,000 are homeless in the USA. The causes of homelessness are an interaction between individual and structural factors. Individual factors include poverty, family problems, and mental health and substance misuse problems. The availability of low-cost housing is thought to be the most important structural determinant for homelessness. Homeless people have higher rates of premature mortality than the rest of the population, especially from suicide and unintentional injuries, and an increased prevalence of a range of infectious diseases, mental disorders, and substance misuse. High rates of non-communicable diseases have also been described with evidence of accelerated ageing. Although engagement with health services and adherence to treatments is often compromised, homeless people typically attend the emergency department more often than non-homeless people. We discuss several recommendations to improve the surveillance of morbidity and mortality in homeless people. Programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals, and the child welfare system, and the introduction of national and state-wide plans that target homeless people are likely to improve outcomes.
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Affiliation(s)
- Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Margot Kushel
- University of California San Francisco/San Francisco General Hospital, San Francisco, CA, USA
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