Risk Factors for Homelessness: a Study of Families of Origin
One of the most pressing social bug facing the Usa and other Western countries is the high rate of homelessness ( 1 , 2 , 3 ). It is estimated that three.5 million Americans in any given yr experience homelessness ( 1 ). It is important to understand the causes of homelessness because poorly informed service delivery for homeless populations may be ineffective or, worse, counterproductive ( 3 , four ).
The physical and mental health of people who are homeless is considerably worse than that of the general population ( five , vi , 7 ). The prevalence of mental disorders is three to four times college among the homeless population, with rates of melancholia and anxiety disorders and drug and alcohol abuse peculiarly elevated ( eight , ix , ten , 11 , 12 ). Rates of DSM diagnoses amid the homeless are almost double those amongst persons who have never been homeless, whereas the charge per unit of alcohol use disorder co-occurring with ane or more psychiatric disorders has been identified equally 5 times greater ( 13 ). Homelessness is also associated with a high risk of suicide attempts ( 14 ).
Previous research has shown that so-called biographical risk factors are important to understanding the pathways into homelessness ( 8 , xv ). Specifically, a disproportionate number of homeless people report experiences of childhood arduousness, including poor relationships with parents, neglect, physical and sexual abuse, and being forced or placed out of the domicile ( 15 , 16 , 17 ). One study indicated that upward to l% of homeless and runaway adolescents may have experienced physical abuse; almost 1-tertiary reported sexual abuse ( 18 ). These experiences may contribute to the risk of mental health problems both concurrently and later in life ( 19 , 20 , 21 ).
Other factors that accept been reported to contribute to run a risk of homelessness are school expulsion and lack of academic qualifications, poor social networks, and antisocial and offending behavior (including experiences in prison) ( five , 22 , 23 ). With of import exceptions ( 13 , 24 ), notwithstanding, most of the research on the etiology of homelessness has been conducted in service settings, including shelters and rehabilitation centers, or with psychiatric patients (current or with a history of admission to a psychiatric hospital) ( 25 , 26 , 27 ). These samples are likely to underrepresent those who are homeless for short periods or practice not belong to a specific subgroup of homeless individuals ( 28 ). Choice of sampling site will likewise influence prevalence rates (such as regional socioeconomic and political differences and exclusion criteria used by service providers) ( 29 ). Finally, homelessness has complex and multifactorial origins. With exceptions ( 13 , 24 ), many studies of homelessness have focused on a limited selection of adventure factors and have non also considered the relative part of a wide range of possible hazard factors.
Our study used a large, representative, population-based sample to evaluate relationships between well-established factors (previously identified in smaller and not-population-based samples as potentially important to understanding the etiology of homelessness) and lifetime homelessness condition and the relative importance of these factors in the prediction of homelessness.
Methods
Sample
The sample used in this study was derived from the National Longitudinal Written report of Adolescent Health (Add Wellness) a projection designed by Udry, Bearman, and Harris ( xxx , 31 ). The main sampling frame included all high schools in the Usa with an 11th grade and at least 30 enrolled students. From this pool, a systematic random sample of high schools was selected. A amassed sampling pattern was used to ensure that the sample (134 loftier schools) was representative of high schools in the United States with regard to region, urbanicity, school blazon, size, and racial and indigenous composition of the student trunk. A random sample of students was selected to accept function in computer-assisted interviews at home.
Respondents were recruited in 1994–1995, when they were eleven–xviii years old. Eligibility at this stage was based on whether respondents were listed on grade enrollment rosters. Respondents were recontacted 1 yr later (1996) and half dozen years later (2001), when they were immature adults (historic period range 18–28 years; mean±SD=21.97±1.77). Our study used data collected in 2001 (moving ridge iii), during which information was obtained on homelessness equally well as experiences of severe childhood adversity. Of persons who were recontacted for the third wave of data drove, 15,170 completed an interview (response rate 76%). After a complete description of the study was presented to respondents, their written informed consent was obtained. Most interviews (80%) were conducted at or just outside the respondent's residence or at the respondent's parents' residence (when the respondent had a dissever residence; eight%). The remaining interviews took place in the interviewer's car or at another location. All phases of the Add Health study have been approved past the Public Health Institutional Review Board of the Part of Human Enquiry Ideals. We used data from respondents who provided information about their homelessness condition at wave 3 (Due north=fourteen,888).
Measures
Measures were developed for the Add Health In-Home Adolescent Interview and were piloted extensively before being used equally role of the survey ( xxx , 31 , 32 ). For our written report, inclusion as homeless was based on responses to 3 questions: "Have you lot ever been homeless for a week or longer—that is, yous slept in a place where people weren't meant to sleep, or slept in a homeless shelter, or didn't have a regular residence in which to sleep?" "Accept you e'er stayed in a homeless shelter?" and "Where practice you lot live at present? That is, where do you stay virtually oft? Response options include 'Homeless'—that is, you lot have no regular place to stay."
Sample items regarding the assessment of each hypothesized risk factor are presented in Table 1 , and additional information tin be establish elsewhere ( 32 ). For ease of interpretation, items are grouped into five domains: childhood adversity, socioeconomic situation, mental health issues, habit problems, and criminal beliefs and violence. Seven of these factors comprised multiple items, each of which demonstrated acceptable internal consistency (Cronbach's α >.69).
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Statistical analysis
Analyses proceeded in iii stages. First, the group with a history of homelessness was compared on each individual hypothesized risk factor with the group of respondents who had never been homeless. Second, the pattern of associations among hypothesized chance variables was examined. Third, the risk factors were assessed simultaneously with logistic regression to evaluate the subset of factors that best predicted homelessness. The regression analyses also deemed for the effects of age ( 33 ), gender ( 34 ), and race and ethnicity ( 35 , 36 , 37 ), partly in low-cal of previous research showing links between these factors and homelessness. The univariate analysis and logistic regression were repeated with a sample-weights statement (in the Stata software) ( 38 ). This procedure corrects for design effects and unequal probability of pick to ensure that the results are nationally representative, with unbiased estimates. The construction of the sample weights includes an aligning for nonresponse ( 31 ).
Results
We used data from 14,888 respondents (men, seven,037; women, seven,851) who provided information about their homelessness status at wave 3. The racial and indigenous distribution of the sample was approximately 67% Caucasian (N=9,899), 23% black or African American (Northward=3,376), sixteen% Hispanic (Northward=2,416), 8% Asian or Pacific Islander (N=i,253), and half-dozen% Native American (N=815). Respondents were able to endorse more than 1 racial-indigenous group
A total of 682 respondents (iv.6% of the sample; 354 men and 328 women) were classified as ever existence homeless (610 respondents had been homeless for a calendar week or longer, 199 had stayed in a homeless shelter, and six respondents were homeless during the wave 3 interview). Preliminary analyses of demographic factors indicated that older age (odds ratio [OR]=ane.08, 95% confidence interval [CI]=ane.02–i.14) and Native American ethnicity (OR=2.80, CI=1.94–2.41) were significantly associated with homelessness (p<.01).
Univariate analyses
Prevalence rates for each risk factor hypothesized to be associated with homelessness were generally greater in the always-homeless group compared with the never-homeless group ( Tables ii and three ). The ever-homeless group had elevated levels of parental-caregiver abuse or neglect, and the proportion of e'er-homeless respondents who reported that their family unit had been investigated by social services by the fourth dimension the respondent reached sixth grade was four times greater ( Table ii ). Most half of the e'er homeless reported having run away or being ordered out of their homes by their parents, and rates of adoption and fostering placements were also college than in the never-homeless group. A large proportion of respondents in both samples were currently employed, although the charge per unit was higher in the group who had never been homeless. There were college levels of involvement in crime (as victim or perpetrator) and in the criminal justice organization in the group who had experienced homelessness ( Table 3 ). When sample weights were applied, all of the study variables, with the exception of gambling behavior and membership in a gang, were associated with homelessness.
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Intercorrelations amongst written report variables
Examination of the pattern of correlations amidst the hypothesized risk factors indicated some interesting associations betwixt domains of functioning and life experiences. [A table showing the intercorrelations is available as an online supplement to this commodity at ps.psychiatryonline.org .] Associations were found among the indicators of abuse (both sexual and physical), fail, and investigation of the family past social services (r=.18–.29, p<.01). Positive associations were constitute among the four indicators of mental illness (r=.14–.56, p<.01) and between addiction problems (drugs, alcohol, or both) and criminal behavior (r=.29–.39, p<.01). Weak positive associations were found between the physical and sexual abuse variables and mental health bug (r=.05–.12, p<.01) and drug issues (r=.08–.12, p<.01). The variable assessing whether a parent-caregiver had ever ordered the respondent out of his or her domicile was associated with drug and booze problems and the indicators of criminal beliefs (r=.10–.14, p<.01). The other indicators of childhood adversity (abuse, neglect, and investigation by social services) were associated with criminal behavior, perpetration of violence, and being a victim of violence (r=.06–.15, p<.01).
Multivariate logistic regression
The multivariate logistic regression revealed several factors that were uniquely associated with homelessness ( Table 4 ). The showtime set of variables could exist broadly classified as babyhood adversity: always having run away from dwelling (OR=4.03), ever having been ordered out of the dwelling by parents (OR=iii.16), placement in foster care (OR=ii.15), incarceration of the biological begetter (OR=1.45), parental-caregiver neglect (OR=1.47), and duration of welfare assistance to the family unit before age 18 (OR=1.xiv). A second domain reflected socioeconomic situation: grade when the respondent left school (OR=.88), recent economic difficulty (OR=ane.23), and current employment (OR=.76). A third domain of problems reflected aspects of mental illness and addiction, including a diagnosis of depression (OR=i.61), having had a psychiatric hospitalization in the past v years (OR=1.82), and problems with drugs in the by 12 months (OR=i.16). Factors non associated with homelessness included parent concrete aggression and sexual abuse, investigation of the family by social services, expulsion from schoolhouse, electric current recipient of welfare benefits, prescription medication for antidepressants, suicidal ideation, and bug with gambling and alcohol. None of the indicators of criminal behavior or violence were independently associated with homelessness.
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Analyses were repeated with sample weights to correct for pattern furnishings and unequal probability of selection. Associations with homelessness were retained for the following variables: ever having run away, ordered out of the family unit home, parental-caregiver fail, incarceration of the biological male parent, grade when respondent left school, recent socioeconomic difficulty, and psychiatric hospitalization in the past five years.
Discussion
The findings show that childhood arduousness in its diverse guises is significantly associated with homelessness among young adults. Other factors significantly and independently related to homelessness included economic disadvantage, mental illness (depression and psychiatric hospitalization), and recent drug employ. In highlighting the association between childhood experiences and homelessness when assessed in the context of an array of other possible chance factors, the findings have important implications for the prevention of homelessness as well as intervention and service provision.
In assessing the role of a range of factors related to babyhood arduousness, our findings indicated that events that capture the separation or exit of a child from his or her family unit or from a parent (being ordered to exit habitation, running away, being placed in foster care, and having a biological father who was incarcerated) were most strongly associated with homelessness. These results, obtained in a population-based data set, are in understanding with findings from earlier studies based on more than highly selected samples ( 5 , 8 , 16 , 39 ). It is noteworthy that indicators of separation from parents or caregivers subsumed other adverse events that were included equally hazard factors in this study (physical and sexual abuse). This does not necessarily mean that the separation experiences were causal. Rather, they may be regarded equally proxy indicators of dysfunctional family processes (including abuse) and individual problems that increased the likelihood of homelessness ( 8 , 25 , 39 ).
Neglect and adoption were also linked to homelessness, merely less strongly than other factors (p<.05). It might seem paradoxical that our findings signal that risk of homelessness appears increased amongst individuals most probable to come to the attention of the authorities during childhood (including placement for adoption or foster intendance). Still, the involvement of exterior agencies is likely to exist an indicator of a history of arduousness or of an exceptionally serious issue that places individuals at take a chance. The pattern of associations between the indicators of babyhood arduousness and the other domains of life experiences considered in this study (mental disease, criminal beliefs, and addiction bug) lends some support to this idea. The findings are consistent with the view that immature people at the greatest risk of condign homeless should, and probably could, be identified early, through schools, pediatricians' offices, or social service agencies ( xl ).
Consistent with previous inquiry, academic underachievement and early socioeconomic difficulty were significantly and independently related to homelessness ( 5 , 41 , 42 , 43 ). Economic hardship in childhood, including homelessness, may perpetuate and heighten the risk of homelessness later in life. Similarly, lack of educational qualifications will reduce the prospect of individuals' reintegrating into society and thereby increase risk of chronic homelessness. Forth with the findings for indicators of childhood adversity, investment in prevention efforts should be directed toward factors that occur comparatively early in the life course that appear to predispose young people to episodes of homelessness.
After controlling for other factors, nosotros found that a diagnosis of depression and receiving psychiatric care in the by five years were associated with homelessness. Enquiry with homeless groups suggests that in nearly cases, psychopathology and substance abuse precede the onset of homelessness, supporting a view of mental disorders every bit take chances factors for homelessness amidst young people, but it must be best-selling that disorders can also follow a period of homelessness ( 8 , xiv , 42 , 44 , 45 ). Persons who have been or are currently homeless appear vulnerable to mental illness, withal the economic circumstances of these individuals are probable to obstruct their ability to access treatment. The evolution of a public health policy that facilitates access to treatment in a sustained way and in a diverseness of settings (such as shelters and community centers) is needed ( 46 ).
Drug use was independently associated with homelessness. In one case a person becomes homeless, contact with other homeless people may increase the opportunities to obtain drugs, and drug use may serve as a means of coping with a very challenging lifestyle ( 47 ). Research suggests that in that location are bidirectional processes underlying the link betwixt drug utilise and homelessness, such that the presence of one may predispose an individual to the other ( 24 , 47 ). Prospective, longitudinal enquiry is therefore required to uncrease this possibility in a population-based sample. When assessed in the context of other hypothesized correlates, alcohol-related problems were not associated with homelessness. Information technology is possible that past virtue of beingness a population-based sample (in which the definition of ever homeless included those who had been or were currently homeless) this report had a lower proportion of respondents with booze dependence than is typically included in studies of homeless people ( xi , 12 , 48 ). On the other hand, contempo work has found that drug corruption is more than strongly associated than alcohol abuse with a first homeless episode, indicating that drug abuse may accept become a more than of import gamble factor for homelessness among immature people in the United States ( 47 ).
Nonresponse is likely to have affected the pattern of derived results. Factors contributing to nonresponse included the respondent'due south being incarcerated, institutionalized, physically or mentally incapable, or untraceable ( www.cpc.unc.edu/projects/addhealth ). These factors may have produced an underrepresentation of respondents with dependence on drugs and booze, criminal backgrounds, mental wellness bug, and homelessness itself. The hidden and mobile nature of the homeless population means that their numbers and characteristics cannot exist readily determined ( five ). The evolution of truly representative samples of homeless people, therefore, poses challenges that may be impossible to overcome. Nevertheless, replication of these findings with other population-based samples is needed.
Rates of confidence (or pleading guilty) in a juvenile (seven%) or adult (fifteen%) court were low in the sample with a history of homelessness compared with rates in some reports. Moreover, when assessed in the context of other correlates, involvement in crime (as victim or every bit perpetrator) was not significantly associated with homelessness. The association betwixt criminality and issues with drugs (which remained a significant predictor) may account for this effect. This grouping of findings highlights the value of using population-based samples to examine the etiology of homelessness. Criminality and antisocial behavior, when assessed in conjunction with events occurring in childhood and with mental health issues, may not exist of main importance. With regard to the temporal human relationship between crime and homelessness, it is interesting that a recent written report of 14- to 25-year-olds plant that criminal beliefs followed, rather than preceded, homelessness ( 49 ).
Our study is based on cross-sectional information. Several of the variables pertinent to our piece of work (indicators of kid abuse and neglect, for example) were not assessed during adolescence (waves i and 2 of the Add together Wellness written report), and the assessment of homelessness did not include the appointment it was first experienced. This information set, therefore, did non permit usa to test temporal relationships between risk factors and homelessness. An of import direction for future enquiry will be to include more detailed, dated information regarding housing and homelessness as part of prospective, population-based studies ( 17 ). A second limitation was a reliance on self-report and retrospective data collection about critical events occurring in babyhood. Nonetheless, respondents provided information knowingly for enquiry purposes only were not informed of our hypotheses virtually associations betwixt early on babyhood experiences and later experiences and events. This aspect of the design may have reduced the possibility of a reporting bias for this material. Inquiry too shows that runaway and young homeless people are able to provide accurate accounts of babyhood corruption and poor family unit functioning ( 39 ).
Conclusions
This written report is among the first to investigate the role of hypothesized take chances factors for homelessness in a nationally representative, population-based sample.
The findings indicate that experiences related to the separation of children from their parents or caregivers were associated with homelessness. Factors that reflect the provision of emotional and cloth support by parents (or lack thereof) were also associated with homelessness. Other domains that were linked to homelessness included socioeconomic disadvantage, indicators of mental illness, and problems with drugs. The results are consistent with previous enquiry investigating the etiology of homelessness, nevertheless this written report advances understanding by considering the relative part of several factors thought to precede, accompany, or follow episodes of homelessness. Based as they are on a nationally representative U.S. sample, the findings provide of import insights into the relative role of various life experiences and their human relationship to homelessness, and they highlight the demand to sympathise the temporal nature of these links. Closer attending to meeting the emotional and material needs of individuals identified in childhood as experiencing dysfunctional family relations may reduce the burden of social treat a homeless population.
Acknowledgments and disclosures
This inquiry used data from Add Health, a program project designed past J. Richard Udry, Ph.D., Peter Due south. Bearman, Ph.D., and Kathleen Mullan Harris, Ph.D., and funded past grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due Ronald R. Rindfuss, Ph.D., and Barbara Entwisle, Ph.D., for assistance in the original design. Persons interested in obtaining information files from Add together Wellness should contact Add Health, Carolina Population Center, 123 W. Franklin St., Chapel Hill, NC 27516-2524 ( [email protected] ).
The authors report no competing interests.
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Source: https://ps.psychiatryonline.org/doi/10.1176/ps.2009.60.4.465
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