This study examined temporal relationships between relative onsets of mental illness and homelessness in a cross-sectional study of 900 homeless people compared with a matched, never-homeless sample from the Epidemiologic Catchment Area study. All psychiatric disorders preceded homelessness in the majority. Only one disorder, alcohol use disorder (in men only), had significantly earlier onset in homeless subjects. Regarding number of symptoms or earlier age of onset of psychiatric disorders, earlier onset of homelessness was associated with several diagnoses: schizophrenia, major depression, generalized anxiety disorder, alcohol and drug use disorders, and antisocial personality. In multiple regression models, history of dysfunctional family background and maternal psychiatric illness were also associated with earlier onset of homelessness, whereas education was protective. Chronicity of homelessness was associated with number of symptoms of alcohol use disorder and earlier age of onset of drug use disorder, presence and number of symptoms of schizophrenia and antisocial personality, and earlier onset of major depression and conduct disorder. In multiple regression models, more education, but not family background problems, was associated with shorter lifetime duration of homelessness. These findings provide information relevant to the roles of mental illness and personal vulnerability factors in the onset and chronicity of homelessness.
Compared with nonhomeless populations, the homeless have not only disproportionately higher rates of substance abuse and other psychiatric disorders (Breakey et al., 1989; Herrman et al., 1989; Koegel et al., 1988; Smith et al., 1992, 1993; Susser et al., 1989a) and greater psychiatric comorbidity (Koegel and Burnam 1988), but also earlier onset and greater number of alcohol (Castaneda et al., 1993; Caton et al., 1994; Koegel and Burnam 1988) and drug (Caton et al., 1994) use disorder symptoms. In addition, research has documented preexisting vulnerability factors to homelessness including family disorganization (Koegel and Burnam 1988; Koegel et al., 1995), learning disorders (Koegel and Burnam 1988), history of foster or group home placement, and running away (Susser et al., 1987, 1991). These observations suggest the potential role for these risk factors in the generation of homelessness.
Only a small body of research has examined risk and protective factors for homelessness relative to psychiatric and social variables. These studies have tended to examine individual factors predicting either chronicity of homelessness or loss of housing among those who had regained it. In these studies, chronicity of homelessness has been found to be associated with presence and earlier onset of alcohol problems (Castaneda et al., 1993; Geissler et al., 1995), other drug use, psychosis (Susser et al., 1989b), victimization by assault, suicide attempts (Geissler et al., 1995), childhood running away, expulsion from school, and placement in reform school or jail (Susser et al., 1987). Prospective predictors of returning to homelessness among mentally ill men placed in community housing include subsequent drug abuse and return to family rather than to supported housing (Caton et al., 1993).
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