Personal and family distress in homeless adolescents

Associations Between Adolescent Problematic Internet Use and Relationship Problems in Chinese Families: Findings from a Large-scale Survey

BACKGROUND

Problematic internet use (PIU) is prevalent among Chinese adolescents. There is a need to better understand how the quality of parent-adolescent relationship is associated with adolescent PIU to guide the development of effective prevention and early intervention programs.

OBJECTIVE

This study aims to evaluate parent-adolescent conflict and parenting styles as potential risk factors associated with adolescent PIU.

METHODS

A sample of 6552 students (aged 10-19 years) from 22 schools in Guangdong, China, was recruited. The participants completed self-report questionnaires measuring their perceptions of conflict with their parents (involving verbal conflict, emotional abuse, and physical abuse) as well as their perceptions of their parents' parenting styles (including parental care and parental control as measured by the Parental Bonding Inventory), and PIU using the Adolescent Pathological Internet Use Scale. Grade level and gender were examined as moderators of these associations.

RESULTS

Using multiple regression analyses, we found that greater mother-adolescent conflict, father-adolescent conflict, and parental control, and lower levels of parental care, were associated with higher levels of adolescent PIU (P<.001). The association between mother-adolescent conflict and PIU was stronger in older students than in younger students (P=.04), whereas the association between father-adolescent conflict and PIU was stronger in male students than in female students (P=.02). Compared with those who reported no mother-adolescent conflict, participants who experienced verbal conflict and emotional abuse, but not physical abuse from their mothers, reported higher levels of PIU (P<.001). Compared with those who reported no father-adolescent conflict, participants who experienced verbal conflict, emotional abuse, and physical abuse from their fathers had significantly higher levels of PIU (P<.001, P<.001, and P=.02, respectively).

CONCLUSIONS

These findings point to the value of interventions to reduce parental verbal conflict, emotional abuse, and physical abuse, and to increase positive parenting styles, to lower the risk of PIU in Chinese adolescents.

Life-course predictors of homelessness from adolescence into adulthood: A population-based cohort study

INTRODUCTION

Internationally, the prevalence of young adult homelessness is concerning. Few data on life-course predictors from longitudinal studies exist, limiting our capacity to inform prevention strategies at the population-level.

METHODS

Data were drawn from a state representative population-based sample of young adults from Victoria, Australia participating in the International Youth Development Study (IYDS; N = 927, 54% female). Participants were recruited in state-representative secondary school samples at Grade 7 (age 13, 2002), with follow-up in Grades 9 (age 15) and 11 (age 17) and at ages 21, 23 and 25. Using longitudinal path modelling, we conducted a series of analyses testing life-course predictors of young adult homelessness across multiple socializing contexts, and the interrelationships among them.

RESULTS

The rate of young adult homelessness was 5.5%. Path modelling showed higher levels of family conflict at ages 13 and 15 uniquely predicted homelessness by age 25. This effect remained after accounting for other risk factors in peer-group (e.g., interactions with antisocial peers), school (e.g., low academic performance), and community contexts (e.g., low neighborhood attachment). Peer drug use and interaction with antisocial peers at age 15 mediated the association between family conflict at age 13 and homelessness by age 25.

CONCLUSIONS

Findings point to the vulnerability of early adolescents to family conflict. This vulnerability heightens risk for young adult homelessness. Findings strengthen the case for both primary prevention programs that build healthy relationships between family members from early on in adolescence and for investment in homelessness prevention at key developmental periods.

Forty Years of Research on Predictors of Homelessness

Homelessness is a chronic public health issue in the U.S. This paper reviews the endurance and evolution of individual, youth, and family homelessness over the past 40-plus years. Thematic findings detail research on predictors of homelessness among adolescents, runaway youth, veterans, older adults, sheltered families, and female-headed families. Results provide a summary of contributors to homelessness, including issues related to family instability, unemployment and poverty, mental illness, substance use, unstable living arrangements, child maltreatment, social support, crime, and violence. Findings highlight key and persistent predictors of homelessness found across decades, as well as more recently identified and nuanced precursors to individual or family displacement. The goal of this work was to summarize what is known about predictors of homelessness to inform targeted research, practice, and policies.

Youth experiencing transitional and temporary homelessness: A pilot study

Homeless youth represent a vulnerable and understudied population, particularly those among them who are hidden, experiencing transitional or temporary homelessness. Little research focuses on this group, including the methods and settings to identify and tailor interventions to their circumstances. Given the immediate risks and possible transition to chronic homelessness, their identification is critical for prevention and intervention efforts. This exploratory pilot study investigated transitional and temporary homelessness among youth. The study demonstrated the ability to identify such participants. Twenty participants completed a survey that measured demographics, behavioral risk factors, and the Brief Symptom Inventory (BSI; Derogatis, 1993). Reports of relationships with parents varied. They included positive maternal relationships, but also concerns about intrafamilial conflict. While frequent change of schools was reported, generally positive feelings toward school were expressed. Social relationships suggest limited exposure to other homeless youth. Some substance abuse was noted, possibly at lower rates than expected for hard drugs. The BSI results are suggestive of health concerns. The study demonstrated that it is possible to capture children experiencing transitional or temporary homelessness in alternative school settings. It is essential that efforts be made to identify them and provide early supports toward preventing chronic homelessness.

On the fringes: How youth experiencing homelessness conceptualize social and economic inequality-A Photovoice study

This study used Photovoice methods with young adults experiencing homelessness to collaboratively identify issues that are of greatest importance in an open-ended, exploratory, and inductive manner. Participants selected two concepts to focus their inquiry: freedom and prosperity. Within these concepts, participants discussed nature as a source of inspiration, a desire to better themselves and to change their situations, and passion for contributing to social change by exposing economic inequality and raising awareness about homelessness. These findings demonstrate that young people are keenly aware of the structural and macro-level factors that have contributed to their risks of social exclusion and marginalization.

[Role of families of homeless persons with mental disorders : retrospective and prospective view of relationships]

This paper explores the experience of families supporting a homeless relative with mental illness. The authors investigate the types of support offered by families; they also examine the relational and personal dimensions which can support a redefining of the role and consequently a modulation of the level of support. Using a qualitative research, semi-structured interviews were realized with 14 family members. The results indicate that housing and the financial support are the types of support most frequently stopped while the emotional and the social support tend to be pursued. The control in the relation, the emotionalism and the perception of future appear as important element for the initiation of a role redefining process.

Invited commentary: seeking a coherent strategy in our response to homeless and street-involved youth: a historical review and suggested future directions

This invited commentary seeks to encourage a critical dialogue about youth homelessness that might assist in re-energizing a field that seems increasingly stagnant with a research body focused primarily on analyses of risk, hopelessly inadequate policy frameworks in most cities, diminishing funds for services, and decreasing media attention. Reviewing major trends in research and public responses to youth homelessness in the past century, I propose that there exist three major culturally-bound dimensions from which we construct our understanding of and responses to youth homelessness. These dimensions, which are considered in a transactional framework, are the scope of responsibility, the location of moral responsibility, and the amount of agency attributed to the youth. In this review I highlight the manner in which our historically binary and uncritical understanding of these dimensional characterizations of youth homelessness has led to major lapses in the effectiveness of our collective efforts to address this problem. I highlight gaps in the existing body of research literature and provide this framework, arguing that a strategic and cohesive response is vital if we are to move from reiterations of risk and hackneyed calls for prevention strategies to the generation of meaningful solutions.

Change in parent- and child-reported internalizing and externalizing behaviors among substance abusing runaways: the effects of family and individual treatments

Shelter-recruited adolescents are known to have high rates of substance abuse and co-occurring internalizing and externalizing problem behaviors. Many studies have documented these mental health concerns, but only a small number of studies have tested interventions that may be useful for ameliorating these vulnerabilities. The current study compared three empirically supported psychotherapy interventions, Motivational Interviewing (MI), the Community Reinforcement Approach (CRA), and Ecologically-Based Family Therapy (EBFT) with 179 substance abusing runaway adolescents (47 % female, 74 % minority) and their primary caretaker recruited through a Midwestern runaway crisis shelter. Examining both child and primary caretaker reports, each treatment was associated with significant reductions in internalizing and externalizing behaviors to 24 months post-baseline. However, the trajectory of change differed among the treatments. Adolescents receiving MI showed a quicker reduction in internalizing and externalizing behaviors but also a quicker increase in these behaviors compared to adolescents receiving EBFT, who continued to evidence improvements to 24 months. The findings provide support for continued evaluation of these treatments for use with this vulnerable population of adolescents.

Incidence, type and intensity of abuse in street children in India

OBJECTIVE

The aims of this cross-sectional survey were to examine the prevalence, type and intensity of abuse in street children in Jaipur city, India.

METHOD

Based on purposive random sampling, 200 street children, inclusive of equal number of boys and girls, were selected from the streets of Jaipur city, India, and administered an in-depth interview schedule which included five areas of abuse, namely, "general abuse," "health abuse," "verbal abuse," "physical abuse," and "psychological abuse." Data was interpreted using percentages, t-test and correlations.

RESULTS

Street children reported experiences of abuse in all the five areas under study. Larger numbers of children (61.8%) scored in the "moderate" category of abuse while 36.6% children indicated abuse in "severe" and "very severe" categories on the intensity of abuse. Highest mean scores were obtained on the "verbal" and "psychological" area of abuse. Gender differences were significant in health and overall abuse, indicating boys to be significantly more abused than girls. There were significant positive correlations of abuse with increasing "age" and "income" of street children; and the occurrence of "multi-type" maltreatment and neglect in street children was clearly present.

CONCLUSION

Different forms of abuse are prevalent in street children in India. This area of study needs attention both by the researchers and the social workers.

PRACTICE IMPLICATIONS

children who are identified in severe and very severe categories of abuse should be worked with in a follow up study with the help of governmental and nongovernmental agencies working in the field for child welfare.

Trauma and post-traumatic stress disorder among homeless adults in Sydney

OBJECTIVE

International studies indicate high prevalence rates of post-traumatic stress disorder within homeless populations. In Australia, studies indicate high rates of trauma among homeless adults, yet post-traumatic stress disorder has not been investigated in homeless Australian adults. The primary aim of this project was to determine the prevalence of post-traumatic stress disorder among homeless adults in Sydney. Further, another aim of the study was to determine whether the onset of post-traumatic stress disorder preceded the first episode of homelessness or was a consequence of homelessness.

METHOD

The sample consisted of 70 homeless men and women aged 18-73 years, who were randomly sampled through eight homeless services. A computer-assisted face-to-face structured clinical interview was conducted with each participant. Lifetime prevalence of post-traumatic stress disorder was determined via the Composite International Diagnostic Interview.

RESULTS

The majority of the sample had experienced at least one traumatic event in their lifetime (98%). Indeed, the mean number of traumas per person was six. The 12 month prevalence of post-traumatic stress disorder was higher among homeless adults in Sydney in comparison to the Australian general population (41% vs 1.5%). But 79% of the sample had a lifetime prevalence of post-traumatic stress. In 59% of cases, the onset of post-traumatic stress disorder preceded the age of the first reported homeless episode.

CONCLUSIONS

Homeless adults in Sydney frequently experience trauma and post-traumatic stress disorder. The study found that trauma and post-traumatic stress disorder more often precede homelessness, but re-victimization is common. These findings highlight the high mental health needs among homeless people and have implications for services for homeless people.

Youth Homelessness and Social Stigma

Building upon previous exploratory qualitative research (Kidd SA (2003) Child Adol Social Work J 20(4):235-261), this paper examines the mental health implications of social stigma as it is experienced by homeless youth. Surveys conducted with 208 youths on the streets and in agencies in New York City and Toronto revealed significant associations between perceived stigma due to homeless status and sexual orientation, pan handling and sex trade involvement, and amount of time homeless. Higher perceived stigma was also related to low self esteem, loneliness, feeling trapped, and suicidal ideation, with guilt/self-blame due to homeless status having the strongest impact on mental health variables.

A longitudinal study of the effects of early abuse on later victimization among high-risk adolescents

Although previous research on adolescents finds a link between early abuse and later victimization, the majority of this research is cross-sectional and based on samples of currently homeless adolescents. Therefore, factors that predict the likelihood of victimization have not been systematically examined. As such, the current study longitudinally examines the effects of early abuse and poor parenting on victimization via running away, delinquency, and early sexual onset among a sample of over 700 currently housed high-risk adolescents. Results revealed that having experienced sexual and physical abuse, as well as lower levels of parental monitoring and closeness, significantly predicted running away at wave 1. Adolescents who had run at wave 1 were significantly more likely to run again, more likely to engage in delinquency, and more likely to have had an early sexual onset at wave 3, all of which significantly predicted victimization at wave 4.

The health of street youth: a Canadian perspective

OBJECTIVE

To review epidemiologic studies of the health of street youth in industrialized countries, with a special focus on Canadian youth.

METHODS

We identified 52 peer-reviewed studies from searches of the MEDLINE database and bibliographies of published papers, for data on blood-borne and sexually transmitted infections, mental health problems, pregnancy, violence and mortality.

RESULTS

Rates of hepatitis B, hepatitis C, and HIV infection are much higher among street youth than among their non-street peers. Likewise, the prevalence of all mental health problems assessed in street youth is greater than that in non-street youth. Pregnancy is more frequent among street than household youth. Street youth also experience high levels of violence: a large proportion report physical abuse or assault. Finally, mortality is about 11 times the expected rate based on age and sex and is mainly caused by suicide and drug overdose.

CONCLUSION

Current research results are useful to orient public health interventions for street youth, but further epidemiologic research is needed. The need for Canadian data is particularly acute in specific areas including mental health, violence, pregnancy, and sexually transmitted infections such as, for example, herpes infection and syphilis.

Do street youths' perceptions of their caregivers predict HIV-risk behavior?

This study examined street youths' perceptions of their caregivers and the association between these perceptions and HIV-risk behavior in a random probability sample of 715 12- to 23-year-old street youths from Los Angeles and San Diego, CA (mean age, 18.7 years). All participants had been homeless at some point during the past 12 months, with 70% recruited from nonshelter sites. Although youths reported high rates of hostility, unavailability, substance use, and legal problems among their caregivers, 86% reported that their caregivers had at least one attribute associated with support. Caregiver problems were associated with youth having had more sexual partners in the past 30 days and having higher risk drug use. High caregiver support was associated with more sexual partners and lower use of condoms with steady partners. Caregiver attributes did not predict condom use with transient partners.

From home to street: understanding young people's transitions into homelessness

This paper explores why young people leave home and become homeless. Drawing on life history interviews conducted with 50 homeless youth in Los Angeles, explanations provided by participants for becoming homelessness and how they understand their experiences are presented. In professional discourses, homeless young people are often portrayed as victims of physical abuse and emotional neglect. Although participants' narratives reveal that abuse and neglect play a central role in their decisions to leave home, many maintain a sense of agency in the recounting of how they became homeless. The importance of service providers recognizing young people's agency is discussed.

Factors associated with homelessness of adolescents under supervision of the youth protection system

There are two factors that limit our knowledge of the risk factors associated with homelessness among runaway adolescents, namely (1) the samples used are often composed of youth homeless service users and/or youths living on the streets (visible homelessness), whereas most adolescents in fact use "private" resources (hidden homelessness), and (2) failure to use an adequate control group to identify risk factors associated specifically with homelessness. Our study compares the characteristics of two groups of youths under the supervision of the youth protection system, according to the presence or absence of periods of homelessness. The results throw light on the factors underlying the shift from "at risk" to "homeless", showing that youths with experience of homelessness are more likely to have been placed in substitute home environments, have experienced significant relationship difficulties with one of their parents (deterioration of the parent/youth relationship and parental abuse) and to have been diagnosed with behavioural disorders. The findings suggest that the decision to place young people under supervision is based more on the dynamic between risk factors rather than on the existence of behavioural problems.

Evaluating child and youth homelessness

Following a review of approaches taken to generate accurate estimates of the scale of child and youth homelessness in America, this article documents the methods and results of a multipronged count of homeless children and youth in New Haven, Connecticut. The survey used in this count accessed demographics and service needs, and was administered on the streets and in a wide range of service provision settings. A total of 170 homeless families were located, comprised primarily of young, single, African American women and their children. These families included 323 children, suggesting an annual prevalence of 1,688 in this community. This work addresses the paucity of information on homeless children and youth located in small to midsized cities

[Victimization and problems of behavior. Two components of profile types of runaway adolescents]

OBJECTIVE

This study examines the relationship between two explanatory factors connected to the phenomena of runaways and the homeless among adolescents: behavioral problems of youths and parental violence to which they are subjected. The study demonstrates that these two factors are independently related to the different categories of homeless and runaway adolescents.

METHODOLOGY

The data was collected from 130 adolescents (12 to 17 years of age) who were runaways for short periods on a recurring basis. Two subgroups were formed: Group A consisted of 79 adolescents who did not exhibit behavioral problems; Group B consisted of the other 51 who did exhibit them. The two groups had certain similar family characteristics (income levels, parents' occupations, structure and stability of the family).

RESULTS

The bivariate analyses reveal significant differences between the two groups of runaways relating to: (1) gender, (2) a diagnosed conduct disorder, (3) affiliations with deviant peers, and (4) experiences of parental violence. The discriminant analysis demonstrates that these four variables clearly differentiate the two groups of runaways and predict the appropriate group membership for 84% of the cases. Therefore, the members of Group B have a higher probability of being diagnosed as having a conduct disorder, being male, and associating with delinquent peers. This group had not experienced a higher level of parental violence. The opposite is true for the members of Group A.

CONCLUSION

Our study demonstrates that parental violence and behavioral problems are variables that are independently related to the defined categories of runaways. Therefore, these variables do not constitute, as some thinkers have claimed, the components of a unique dynamic able to explain the phenomenon of the runaway. Our results vitiate the doubts sometimes expressed by researchers about the importance of parental violence to the phenomenon of adolescent runaways.

System youth: a subgroup of substance-abusing homeless adolescents

PURPOSE

While many youths residing at homeless shelters will return home, many are placed in group or foster homes. Few researchers have examined the experiences of adolescents with a history of these out-of-home placements. This study examined shelter residents and compared the experiences of system and non-system youth.

METHODS

Information regarding youths' family functioning, substance use, depression and related problem behaviors was obtained from substance abusing system (n = 62) and non-system (n = 82) adolescents staying at local runaway shelters.

RESULTS

System males engaged in significantly more delinquent behaviors than did non-system males and system females. Alcohol and drug problem consequences were positively associated with longevity in the system, while having ever attempted suicide was negatively associated with system longevity. System youth reported: 1) taking more prescribed psychotropic medications 2) experiencing more sexual abuse, and 3) less parental overprotection, as compared to non-system youth. Gender differences were found in which females reported more conflictual problem solving interactions with their parents than did males, as well as more comorbid diagnoses.

IMPLICATIONS

Although longitudinal research is needed, findings argue that without intervention efforts targeted at identified problem behaviors, youth are at risk to continue their system involvement into adulthood.

Prevalence of psychological distress and psychiatric disorders among homeless youth in Australia: a comparative review

OBJECTIVE

To review the prevalence literature on psychological distress and psychiatric disorders among homeless youth in Australia, and to compare these rates with Australian youth as a whole.

METHOD

Computerized databases were utilized to access all published Australian studies on psychological distress (as measured by standardized symptom scales and suicidal behaviour) and psychiatric disorders among homeless youth; in addition, unpublished Australian studies were utilized whenever accessible. A total of 14 separate studies were located, only three of which have included non-homeless control groups. In the current review, prevalence data from uncontrolled youth homelessness studies are compared with data from Australian community and student surveys.

RESULTS

Homeless youth have usually scored significantly higher on standardized measures of psychological distress than all domiciled control groups. Youth homelessness studies have also reported very high rates of suicidal behaviour, but methodological limitations in these studies make comparisons with community surveys difficult. Furthermore, rates of various psychiatric disorders are usually at least twice as high among homeless youth than among youth from community surveys.

CONCLUSIONS

Homeless youth in Australia have extremely high rates of psychological distress and psychiatric disorders. As homeless youth are at risk of developing psychiatric disorders and possibly self-injurious behaviour the longer they are homeless, early intervention in relevant health facilities is required.

Variables Associated with Therapy Attendance in Runaway Substance Abusing Youth: Preliminary Findings

Service providers and researchers note that youth with substance abuse problems are difficult to engage in treatment and, when engaged, often drop out early. Estimates of the alcohol and drug abuse rate of runaway youth range from 70% to 95%. This study evaluated predictors of therapy attendance in a sample of substance abusing youth recruited through two southwestern runaway shelters. Runaway youth and their families (N = 36) were engaged into a 15-session ecologically-based family therapy (EBFT) intervention. Fewer days between the pretreatment assessment and the first therapy session, as well as less perceived parental care, predicted more therapy sessions attended. No relationship was found between level of substance use and treatment attendance. The findings highlight the importance of engaging families in therapy soon after the youth's arrival to the shelter, as treatment motivation may decrease as the crisis lessens.

Psychological consequences of child maltreatment in homeless adolescents: untangling the unique effects of maltreatment and family environment

OBJECTIVE

This study examined the differential effects of various forms of abuse, as well as their combined effects. The study also sought to separate the factors uniquely associated with abuse from those associated with the more general problems present in an abusive family environment.

METHODOLOGY

Data were collected from 329 homeless adolescents. Preliminary analyses indicated some degree of matching for family background variables. Any differences in demographic or family characteristics were controlled for statistically.

RESULTS

Chi-square analyses revealed significant differences across groups for rates of assault, rape, depression/dysthymia, and attempted suicide. Multivariate analyses (MANOVAs) indicated significant differences in severity of internalizing problems and cognitive problems. Without exception, the group with histories of both physical and sexual abuse exhibited the most severe symptomatology and was at greatest risk for revictimization. Multiple regression analyses suggested that abuse histories were predictive of internalizing problems while family characteristics were more predictive of externalizing problems.

CONCLUSIONS

The findings indicate that both abuse type and family characteristics contribute to the development of symptomatology. Future prospective and longitudinal studies are needed to clarify the sequelae of abuse, as well as the possible cause and effect relations between abuse, family characteristics, and psychological outcome.

A risk-amplification model of victimization and depressive symptoms among runaway and homeless adolescents

This report is an examination of a theoretical model of risk amplification within a sample of 255 homeless and runaway adolescents. The young people were interviewed on the streets and in shelters in urban centers of four Midwestern states. Separate models were examined for males (n = 102) and females (n = 153). Results indicated that street experiences such as affiliation with deviant peers, deviant subsistence strategies, risky sexual behaviors, and drug and/or alcohol use amplified the effects of early family abuse on victimization and depressive symptoms for young women. These street adaptations significantly increased the likelihood of serious victimization over and above the effects of early family history for both young men and women. Similarly, street behaviors and experiences increased the likelihood of depressive symptoms for young women over the effects of early family abuse, but not for young men. The risk-amplification model from the life course theoretical perspective is discussed as an example of the cumulative continuity of maladaptive behaviors.

Mental health problems among homeless adolescents

This paper reviews 18 surveys of mental health problems among homeless adolescents and reports on a pilot study of the same topic conducted in Amsterdam. Sampling methods and measures of mental health are discussed. The reported estimates of mental health problems vary greatly, very probably because of methodological differences. Despite the different methods used, there seems to be considerable research evidence to support a high prevalence of mental disorders among homeless adolescents. The results of the pilot study of 50 homeless adolescents in Amsterdam are consistent with the surveys reviewed. A highly structured interview was conducted at all four services sites for homeless adolescents in Amsterdam. Of the homeless adolescents interviewed, 78% had at least one lifetime DIS/DSM-III-R diagnosis, and 64% had at least one 1-month diagnosis.

Families of homeless and runaway adolescents: a comparison of parent/caretaker and adolescent perspectives on parenting, family violence, and adolescent conduct

OBJECTIVE

Almost all of what is known about the families of runaways and homeless adolescents is based on adolescent self-reports. The validity of such research is currently being questioned by policy makers. The purpose of this study was to compare runaway and homeless adolescent reports and parent/caretaker reports on measures of parenting, family violence, and adolescent conduct.

METHOD

Reports of 120 runaway adolescents and their parents/caretakers from four Midwestern states were compared on measures of parental monitoring, parental warmth and supportiveness, parental rejection, physical and sexual abuse, and adolescent conduct. Comparison groups of nonrunaway adolescents and their mothers in two-parent and single-parent families from the same geographical area were also used for parenting and adolescent conduct measures.

RESULTS

The findings indicated that although there were significant differences in means between adults and adolescents regardless of runaway status, adults and adolescent reports were in the same direction and present similar portraits of families of runaway and homeless young people. Both the parents/caretakers and their runaway adolescents reported lower levels of parental monitoring and warmth and supportiveness and higher levels of parental rejection than comparison groups of nonrunaway families. Parents/caretakers and runaway adolescents reported high levels of family violence and sexual abuse. Similarly, they concur regarding conduct problems for the adolescents.

CONCLUSIONS

The findings suggest that runaway and homeless adolescents accurately depict the troubled family situations that they choose to leave. The policy implications for recent debates involving criminalization and mandatory return to parental custody of homeless and runaway youth are discussed.

Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.