文章基本信息

标题：Risk Factors for Long-Term Homelessness: Findings From a Longitudinal Study of First-Time Homeless Single Adults
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作者：Carol L. M. Caton ; Boanerges Dominguez ; Bella Schanzer 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2005
卷号：95
期号：10
页码：1753-1759
DOI：10.2105/AJPH.2005.063321
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined risk factors for long-term homelessness among newly homeless men and women who were admitted to New York City shelters in 2001 and 2002. Methods. Interviews were conducted with 377 study participants upon entry into the shelter and at 6-month intervals for 18 months. Standardized assessments of psychiatric diagnosis, symptoms, and coping skills; social and family history; and service use were analyzed. Kaplan—Meier survival analysis and Cox regression were used to examine the association between baseline assessments and duration of homelessness. Results. Eighty-one percent of participants returned to community housing during the follow-up period; the median duration of homelessness was 190 days. Kaplan—Meier survival analysis showed that a shorter duration of homelessness was associated with younger age, current or recent employment, earned income, good coping skills, adequate family support, absence of a substance abuse treatment history, and absence of an arrest history. Cox regression showed that older age group P <.05) and arrest history ( P <.01) were the strongest predictors of a longer duration of homelessness. Conclusions. Identification of risk factors for long-term homelessness can guide efforts to reduce lengths of stay in homeless shelters and to develop new preventive interventions. Homelessness is a social problem that has enormous public health significance. It has been estimated that about 1% of Americans—some 2 to 3 million people in a given year—experience an episode of homelessness that puts them in contact with a homeless assistance provider. 1 Administrative data on those who use services for the homeless show that the majority of people who use these services use them on a temporary or short-term basis. Approximately 10% have been termed chronically homeless because they use the system for extended periods of time and are the greatest users of shelter care services. 2 ^, 3 Little is known about the characteristics of people who stop using homeless services after a short time and are no longer tracked administratively, which is in contrast to those who repeatedly use homeless services or use them for an extended period of time. The impact of being homeless on the life course of people who experience homelessness has been poorly understood, partly because longitudinal data on homeless populations have been sparse and have been limited to specific subgroups of the homeless population, such as those who are severely mentally ill. 4 ^, 5 Efforts to understand the course of homelessness from cross-sectional data 6 ^, 7 have been limited by the likelihood that short-term users of services for the homeless are under-represented in favor of those who use such services on a frequent or long-term basis. 8 However, cross-sectional studies of risk and protective factors for the occurrence of homelessness have identified factors that distinguish homeless people from their housed counterparts, but it is not known whether these same factors also play a role in determining the course of homelessness. Substance abuse ranks high among factors that distinguish homeless people from those who have never been homeless. 7 ^, 9 ^– 14 Among people who suffer from illnesses for which ongoing use of services is indicated, such as schizophrenia, homelessness has been associated with less use of needed services compared with the situation of being stably housed. 11 Family experiences, such as out-of-home placement during childhood, 10 ^, 11 ^, 15 parental instability, 11 poor care from a parent, 16 and inadequate family support during adulthood, 11 ^, 12 ^, 14 are another domain that has distinguished homeless people from stably housed people. Finally, opportunity differences, such as educational achievement, 7 ^, 14 have distinguished homeless people from never homeless people in cross-sectional studies. When a person is dependent on family or friends for housing, the availability of a supportive social network and the absence of violent or aggressive behavior would seem to be conceptually important. For those who seek housing in their own apartments, employment and earned income would seem to be essential. Therefore, we expected that these processes would underlie the duration of time that a person remains homeless. This is the initial report of a longitudinal study of 377 newly homeless single adult men and women who were admitted to shelters in New York City and for whom follow-up data were available. The study was designed to examine the course of homelessness during an 18-month follow-up period. It focused on adult men and women who were homeless without kin, which is the largest subgroup of the contemporary homeless (about 75%). 1 The study facilitated an investigation of the possible impact of risk factors for homelessness on the longitudinal course of homelessness. This article (1) describes the demographic, social, and clinical characteristics of study participants, including their living arrangements before they were homeless and their reasons for becoming homeless; (2) examines the association between demographic, family, illness, and service use characteristics and the duration of homelessness; and (3) identifies predictors of duration of homelessness during the study period. We hypothesized that a shorter duration of homelessness would be associated with personal assets, such as recent employment, educational achievement, coping skills, and family support, and a longer duration of homelessness would be associated with conditions that might compromise personal assets, such as substance use disorder and psychiatric disability.