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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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Johnsen S, Cuthill F, Blenkinsopp J. Outreach-based clinical pharmacist prescribing input into the healthcare of people experiencing homelessness: a qualitative investigation. BMC Health Serv Res 2021; 21:7. [PMID: 33397341 PMCID: PMC7780619 DOI: 10.1186/s12913-020-06013-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background Severely and multiply disadvantaged members of the homeless population are disproportionately vulnerable to exceptionally high levels of multi-morbidity and premature death. Given widespread calls for the development of interventions that might improve the uptake and effectiveness of healthcare for this population, this study investigated patient and other stakeholder perspectives regarding an outreach service, delivered by prescribing pharmacists in collaboration with a local voluntary sector provider, within homelessness services and on the street in Glasgow (UK). Methods The qualitative study involved semi-structured face-to-face interviews with 40 purposively sampled individuals with current or recent experience of homelessness (32 of whom had direct experience of the service and 8 of whom did not), all (n = 4) staff involved in frontline delivery of the service, and 10 representatives of stakeholder agencies working in partnership with the service and/or with the same client group. Pseudonymised verbatim interview transcriptions were analysed systematically via thematic and framework analysis. Results The service was effective at case finding and engaging with patients who were reluctant to utilise or physically unable to access existing (mainstream or specialist ‘homeless’) healthcare provision. It helped patients overcome many of the barriers that homeless people commonly face when attempting to access healthcare, enabled immediate diagnosis and prescription of medication, and catalysed and capitalised on windows of opportunity when patients were motivated to address healthcare needs. A number of improvements in health outcomes, including but not limited to medication adherence, were also reported. Conclusions A proactive, informal, flexible, holistic and person-centred outreach service delivered within homelessness service settings and on the street can act as a valuable bridge to both primary and secondary healthcare for people experiencing homelessness who would otherwise ‘fall through the gaps’ of provision. Prescribing pharmacist input coupled with third sector involvement into healthcare for this vulnerable population allows for the prompt treatment of and/or prescription for a range of conditions, and offers substantial potential for improving health-related outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06013-8.
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Affiliation(s)
- Sarah Johnsen
- Institute for Social Policy, Housing and Equalities Research, Heriot-Watt University, Edinburgh, UK.
| | - Fiona Cuthill
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Janice Blenkinsopp
- Institute for Social Policy, Housing and Equalities Research, Heriot-Watt University, Edinburgh, UK
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To MJ, Palepu A, Aubry T, Nisenbaum R, Gogosis E, Gadermann A, Cherner R, Farrell S, Misir V, Hwang SW. Predictors of homelessness among vulnerably housed adults in 3 Canadian cities: a prospective cohort study. BMC Public Health 2016; 16:1041. [PMID: 27716129 PMCID: PMC5048475 DOI: 10.1186/s12889-016-3711-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 09/23/2016] [Indexed: 11/22/2022] Open
Abstract
Background Homelessness is a major concern in many urban communities across North America. Since vulnerably housed individuals are at risk of experiencing homelessness, it is important to identify predictive factors linked to subsequent homelessness in this population. The objectives of this study were to determine the probability of experiencing homelessness among vulnerably housed adults over three years and factors associated with higher risk of homelessness. Methods Vulnerably housed adults were recruited in three Canadian cities. Data on demographic characteristics, chronic health conditions, and drug use problems were collected through structured interviews. Housing history was obtained at baseline and annual follow-up interviews. Generalized estimating equations were used to characterize associations between candidate predictors and subsequent experiences of homelessness during each follow-up year. Results Among 561 participants, the prevalence of homelessness was 29.2 % over three years. Male gender (AOR = 1.59, 95 % CI: 1.14–2.21) and severe drug use problems (AOR = 1.98, 95 % CI: 1.22–3.20) were independently associated with experiencing homelessness during the follow-up period. Having ≥3 chronic conditions (AOR = 0.55, 95 % CI: 0.33–0.94) and reporting higher housing quality (AOR = 0.99, 95 % CI: 0.97–1.00) were protective against homelessness. Conclusions Vulnerably housed individuals are at high risk for experiencing homelessness. The study has public health implications, highlighting the need for enhanced access to addiction treatment and improved housing quality for this population.
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Affiliation(s)
- Matthew J To
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tim Aubry
- University of Ottawa, Ottawa, ON, Canada
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Evie Gogosis
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Vachan Misir
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Bernstein RS, Meurer LN, Plumb EJ, Jackson JL. Diabetes and hypertension prevalence in homeless adults in the United States: a systematic review and meta-analysis. Am J Public Health 2015; 105:e46-60. [PMID: 25521899 DOI: 10.2105/ajph.2014.302330] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We estimated hypertension and diabetes prevalence among US homeless adults compared with the general population, and investigated prevalence trends. We systematically searched 5 databases for published studies (1980-2014) that included hypertension or diabetes prevalence for US homeless adults, pooled disease prevalence, and explored heterogeneity sources. We used the National Health Interview Survey for comparison. We included data from 97366 homeless adults. The pooled prevalence of self-reported hypertension was 27.0% (95% confidence interval=23.8%, 29.9%; n=43 studies) and of diabetes was 8.0% (95% confidence interval=6.8%, 9.2%; n=39 studies). We found no difference in hypertension or diabetes prevalence between the homeless and general population. Additional health care and housing resources are needed to meet the significant, growing burden of chronic disease in the homeless population.
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Affiliation(s)
- Rebecca S Bernstein
- Rebecca S. Bernstein and Linda N. Meurer are with Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee. Ellen J. Plumb is with Department of Family and Community Medicine, Thomas Jefferson University Hospital, Philadelphia, PA. Jeffrey L. Jackson is with Medical College of Wisconsin and Department of Internal Medicine, Division of General Internal Medicine, Zablocki VA Medical Center, Milwaukee
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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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Abstract
SummaryEvidence from England, Australia, Canada, Japan and the USA indicates that the single homeless population is ageing, and that increasing numbers of older people are homeless. This paper reviews evidence of changes in the age structure of the single homeless population, and the factors that are likely to have had an influence on the growth of the older homeless population. In many Western cities, the housing situation of older people is changing and there is a growing reliance on the private rented sector. Unemployment is also having an impact on older people who are under the official retirement age. An increasing number of older people are experiencing problems linked to alcohol, drugs, gambling and criminality, and these are all behaviours that can contribute to homelessness. Despite high levels of morbidity and disability among older homeless people, they are a relatively neglected group and receive little attention from policy makers and mainstream aged care services.
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