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American Journal of Public Health Dec 2013Family homelessness emerged as a major social and public health problem in the United States during the 1980s. We reviewed the literature, including journal articles,... (Review)
Review
Family homelessness emerged as a major social and public health problem in the United States during the 1980s. We reviewed the literature, including journal articles, news stories, and government reports, that described conditions associated with family homelessness, the scope of the problem, and the health and mental health of homeless children and families. Much of this literature was published during the 1980s and 1990s. This raises questions about its continued applicability for the public health community. We concluded that descriptions of the economic conditions and public policies associated with family homelessness are still relevant; however, the homeless family population has changed over time. Family homelessness has become more prevalent and pervasive among poor and low-income families. We provide public health recommendations for these homeless families.
Topics: Child; Diet; Family; Health Status; Ill-Housed Persons; Homeless Youth; Humans; Mental Health; Poverty; Prevalence; Public Health; Stress, Psychological; United States; Vulnerable Populations
PubMed: 24148055
DOI: 10.2105/AJPH.2013.301618 -
Canadian Journal of Public Health =... Jun 2022Homelessness is increasingly recognized as a crisis beyond Canada's largest cities where it is most visible, yet little is known about the experience and outcomes...
OBJECTIVES
Homelessness is increasingly recognized as a crisis beyond Canada's largest cities where it is most visible, yet little is known about the experience and outcomes associated with rural homelessness. The aims of this study were to explore the experience of housing insecurity and its impact on the health of rural residents, identify the various factors contributing to homelessness in a rural Ontario context, and give voice to people with lived experience about their needs, challenges, and potential solutions to the housing crisis.
METHODS
This exploratory qualitative study used interpretive description and a critical theory lens. Interviews were conducted with people who were currently experiencing homelessness and key informants in a rural community experiencing a housing crisis. Data collection took place between August 2020 and May 2021. Analysis was inductive and concurrent.
RESULTS
Findings from interviews with 27 participants (16 with lived experience and 11 key informants) revealed how the structural and social context contributed to rural homelessness. Barriers to securing rental housing in a tight market were influenced by small-town dynamics and discrimination. These experiences led to feelings of hopelessness, which combined with daily stressors of managing unsuitable living conditions to contribute to deteriorating physical and mental health. Opportunities for tailoring interventions to the rural context include increasing awareness, expanding transportation, improving access to local services, and applying Housing First principles.
CONCLUSION
Interventions to prevent and manage homelessness must be tailored to the unique rural context.
Topics: Cities; Ill-Housed Persons; Housing; Humans; Rural Population; Social Environment; Social Problems
PubMed: 35325443
DOI: 10.17269/s41997-022-00625-9 -
Psychiatry and Clinical Neurosciences Mar 2017Many studies have reported that the prevalence of mental illness and cognitive disability is higher among homeless individuals compared to the general population, and...
AIM
Many studies have reported that the prevalence of mental illness and cognitive disability is higher among homeless individuals compared to the general population, and the rates of mental illness among the homeless population have recently increased. This study: (i) compares causes of homelessness or barriers to escaping homelessness for people with/without mental illness/cognitive disability; (ii) reveals problems with the Japanese homeless policy; and (iii) proposes an effective and necessary support system.
METHODS
The participants were 114 homeless individuals. A psychiatric diagnostic interview and the Wechsler Adult Intelligence Scale, version III were used to measure participants' mental health and cognitive abilities. A questionnaire was administered comprising 17 items related to the causes of their homelessness and barriers to escaping from it. Participants were divided into four groups - with/without mental illness or cognitive disability - and Fisher's exact test was used to compare the questionnaire results.
RESULTS
Individuals with cognitive disabilities considered bad relationships with their family members to be the cause of their homelessness. Conversely, normal individuals considered their homelessness to be the result of debt more so than did individuals with mental problems. Individuals with mental illness had more difficulties escaping homelessness than did either normal individuals or individuals with cognitive disability. This tendency was observed most strongly among individuals with both mental illness and cognitive disability.
CONCLUSION
Most homeless individuals considered economic problems to be the cause of their homelessness; however, difficulties with human relationships were also important factors and were more difficult for participants to acknowledge. Furthermore, these difficulties were exacerbated among those individuals with mental problems.
Topics: Adult; Aged; Female; Ill-Housed Persons; Humans; Intellectual Disability; Interpersonal Relations; Male; Mental Disorders; Middle Aged; Prevalence; Social Problems; Surveys and Questionnaires; Young Adult
PubMed: 27778418
DOI: 10.1111/pcn.12469 -
Demography Dec 2013We exploited an exogenous health shock-namely, the birth of a child with a severe health condition-to investigate the effect of a life shock on homelessness in large...
We exploited an exogenous health shock-namely, the birth of a child with a severe health condition-to investigate the effect of a life shock on homelessness in large cities in the United States as well as the interactive effects of the shock with housing market characteristics. We considered a traditional measure of homelessness, two measures of housing instability thought to be precursors to homelessness, and a combined measure that approximates the broadened conceptualization of homelessness under the 2009 Homeless Emergency Assistance and Rapid Transition to Housing Act (2010). We found that the shock substantially increases the likelihood of family homelessness, particularly in cities with high housing costs. The findings are consistent with the economic theory of homelessness, which posits that homelessness results from a conjunction of adverse circumstances in which housing markets and individual characteristics collide.
Topics: Disabled Children; Educational Status; Family Characteristics; Female; Ill-Housed Persons; Housing; Humans; Infant Welfare; Infant, Newborn; Life Change Events; Male; Maternal Age; Mothers; Parturition; Socioeconomic Factors; Time Factors; Unemployment; United States; Urban Population
PubMed: 23868747
DOI: 10.1007/s13524-013-0230-4 -
BMC Public Health Jul 2022Appropriate and acceptable recruitment strategies and assessment tools are essential to determine the health needs for people experiencing homelessness. Based on a...
BACKGROUND
Appropriate and acceptable recruitment strategies and assessment tools are essential to determine the health needs for people experiencing homelessness. Based on a systematic review and known feasible community-based health assessments for people who are not homeless, a set of health assessments were trialled with people experiencing homelessness.
METHODS
Participants were recruited via support agencies. They completed a health risk assessment, demographic and self-report health questionnaires, and objective assessments across 17 domains of health.
RESULTS
Fifty-three participants (43.3% female, mean age 49.1 years) consented and completed 83-96% of assessments. Consent was reversed for assessments of grip, foot sensation, body measures (11%), and walking (30%), and initially refused for stress, sleep, cognition (6%); balance, walk test (9%) and oral examination (11%). There was one adverse event. Most assessments were both appropriate and acceptable. Some required modification for the context of homelessness, in particular the K10 was over-familiar to participants resulting in memorised responses. Recruitment strategies and practices must increase trust and ensure participants feel safe.
CONCLUSIONS
This set of health assessments are appropriate and acceptable for administration with people experiencing homelessness. Outcomes of these assessments are essential to inform public and primary health service priorities to improve the health of people experiencing homelessness.
Topics: Cognition; Emotions; Female; Ill-Housed Persons; Humans; Male; Middle Aged; Self Report; Social Problems
PubMed: 35788198
DOI: 10.1186/s12889-022-13723-7 -
Health & Social Care in the Community Jul 2019This paper reports the findings of a scoping review designed to identify research which has explored the relationship between cognitive impairment and homelessness. A...
This paper reports the findings of a scoping review designed to identify research which has explored the relationship between cognitive impairment and homelessness. A systematic search of databases for articles published between 2007 and 2017 was conducted using keywords relating to cognitive impairments and homelessness. Sources were expanded using manual searches of citations and grey literature. Forty studies represented in 45 papers were selected for review using predefined inclusion criteria. Sources were subject to quality appraisal and data were extracted in line with review questions. Prevalence studies were over-represented in the review, while qualitative data were lacking. Aetiology of impairments was delineated by acquired and developmental causes. A variety of measures were employed by studies which were not validated in homeless populations. Studies did not give sufficient consideration to co-occurring disorders and overlapping symptoms between aetiologies. Because of these factors, it was difficult to conclude that all studies had accurately measured what they set out to; however, the evidence suggested that cognitive impairment was disproportionately over-represented in homeless populations. Cognitive impairment was found to be both a risk factor to and perpetuator of homelessness. Risk factors for homelessness were similar to those of the general population, though exaggerated by sequelae of certain cognitive impairments. The results of this review suggest that more attention needs to be paid to the underlying socioeconomic disadvantages, persons with cognitive impairments face which may lead to homelessness. Further research should prioritise the voice of homeless persons with cognitive impairments, to better understand both causes of homelessness and effective methods of rehabilitation.
Topics: Cognitive Dysfunction; Cross-Sectional Studies; Ill-Housed Persons; Humans; Risk Factors; Socioeconomic Factors
PubMed: 30421478
DOI: 10.1111/hsc.12682 -
WMJ : Official Publication of the State... Jul 2022This project aims to assess the needs and barriers to care from the people experiencing homelessness in a large Midwestern city from their perspective.
BACKGROUND
This project aims to assess the needs and barriers to care from the people experiencing homelessness in a large Midwestern city from their perspective.
METHODS
This survey was advised by those with lived experience of homelessness and those who work in the space. Surveys were disseminated during outreach around the city of Milwaukee, Wisconsin. Data were transcribed, reviewed, and analyzed.
RESULTS
Results indicated that 68% of participants perceive their health as "poor" or "fair." Fifty-five percent indicated they had primary care, and 64% reported possessing active health care insurance. There were many perceived barriers to care including lack of transportation, money, and inadequate clinic hours.
CONCLUSIONS
Survey results indicate that the needs and barriers to care for those experiencing homelessness are broad and complex and should be factored when considering solutions and aiming to provide more equitable care.
Topics: Ill-Housed Persons; Humans; Needs Assessment; Surveys and Questionnaires; Wisconsin
PubMed: 35857692
DOI: No ID Found -
The Lancet. Public Health Nov 2021
Topics: Adverse Childhood Experiences; Ill-Housed Persons; Humans; Risk Factors
PubMed: 34599893
DOI: 10.1016/S2468-2667(21)00210-3 -
The Lancet. Public Health Jun 2020Homelessness is associated with crime victimisation, which is a leading cause of death, exacerbates health problems, and increases the risk of violence. We aimed to...
BACKGROUND
Homelessness is associated with crime victimisation, which is a leading cause of death, exacerbates health problems, and increases the risk of violence. We aimed to study the risk of police-recorded crime victimisation in individuals with experiences of homelessness compared with the general population.
METHODS
We did a nationwide, register-based cohort study of people aged 15 years or older, who were alive in 2001 and born in Denmark between 1980 and 2001. The cohort was constructed using the Danish Civil Registration System, with data linked across other registries (including the Danish Homeless Register, Danish Psychiatric Central Research Register, and the Danish Central Crime Register) by use of personal identification numbers. The exposure, experience of homelessness, was defined as at least one contact with a homeless shelter. The outcome was the date of first police-recorded crime victimisation. We calculated incidence rates per 1000 person-years, incidence rate ratios (IRRs), and cumulative probability of any crime victimisation and of violent crime victimisation. Psychiatric disorders, socioeconomic markers, and history of criminal offences were included as confounders.
FINDINGS
Within the study period (Jan 1, 2001, to Dec 31, 2015), 1 182 749 individuals (9 831 776 person-years) aged 15-35 years were included, of which 184 813 (15·6%) had at least one crime victimisation incident (73 999 [40%] of which were violent victimisations). 4286 individuals (22 240 person-years) had at least one homeless shelter contact. Relative to the general population, and adjusting for age and calendar year, individuals with experience of homelessness had an increased risk of any crime victimisation (IRR 2·7 [95% CI 2·4-3·0]) in females and 2·3 [2·1-2·5] in males), and especially of violent crime victimisation (7·2 [6·3-8·2] in females and 3·6 [3·2-4·0] in males). This increased risk remained significant after further adjustments for potential confounders. People with both a psychiatric diagnosis and experience of homelessness had the highest risk of violent victimisation (IRR 10·1 [95% CI 8·6-11·9] in females and 4·3 [3·8-4·9] in males), while people with no psychiatric diagnosis or experience of homelessness (the reference group) had the lowest risk. In the 5 years after an individual's first homeless shelter contact, the cumulative probabilities of any crime victimisation were 23% (95% CI 21-26) in females and 16% (15-18) in males, which were substantially higher than those of the general population.
INTERPRETATION
Homeless populations are at substantially increased risk of crime victimisation, highlighting the need for strategic and targeted approaches to prevent homelessness and to help people out of homelessness. Improvements in multiagency working (such as between homeless shelters, health-care services, substance misuse services, and police forces) might be important to reduce the risk of victimisation in marginalised populations, such as those with complex psychiatric or social problems, with experience of homelessness.
FUNDING
Lundbeck Foundation.
Topics: Adolescent; Adult; Cohort Studies; Crime Victims; Denmark; Female; Ill-Housed Persons; Humans; Male; Police; Registries; Young Adult
PubMed: 32504586
DOI: 10.1016/S2468-2667(20)30075-X -
Epidemiologic Reviews 2015Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)... (Review)
Review
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.
Topics: Ill-Housed Persons; Humans; Risk Factors; United States; Veterans
PubMed: 25595171
DOI: 10.1093/epirev/mxu004