Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study

Chuan Mei Lee; Christina Mangurian; Lina Tieu; Claudia Ponath; David Guzman; Margot Kushel

doi:10.1016/j.jagp.2016.07.019

Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study

Am J Geriatr Psychiatry. 2017 Feb;25(2):107-117. doi: 10.1016/j.jagp.2016.07.019. Epub 2016 Aug 17.

Authors

Chuan Mei Lee¹, Christina Mangurian², Lina Tieu³, Claudia Ponath⁴, David Guzman³, Margot Kushel³

Affiliations

¹ Department of Psychiatry, University of California, San Francisco, CA. Electronic address: ChuanMei.Lee@ucsf.edu.
² Department of Psychiatry, University of California, San Francisco, CA; Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA.
³ Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA; Division of General Internal Medicine, University of California, San Francisco General Hospital and Trauma Center, San Francisco, CA.
⁴ Division of General Internal Medicine, University of California, San Francisco General Hospital and Trauma Center, San Francisco, CA.

Abstract

Objective: To examine whether childhood adversity is associated with depressive symptoms, suicide attempts, or psychiatric hospitalization.

Methods: History of seven childhood adversities (physical neglect, verbal abuse, physical abuse, sexual abuse, parental death, parental incarceration, and child welfare system placement) was gathered through in-person interviews. Multivariate models examined associations between history of childhood adversities and moderate to severe depressive symptoms, lifetime history of suicide attempt, or lifetime history of psychiatric hospitalization. The study enrolled 350 homeless adults, aged 50 and older, in Oakland, California, using population-based sampling methods. Moderate to severe depressive symptoms were measured on a Center for Epidemiologic Studies-Depression Scale (≥22), self-reported lifetime history of suicide attempt, and self-reported lifetime history of psychiatric hospitalization.

Results: Participants with exposure to one childhood adversity had elevated odds of reporting moderate to severe depressive symptoms (adjusted odds ratio [AOR]: 2.0; 95% confidence interval [CI]: 1.1-3.7) and lifetime history of suicide attempt (AOR: 4.6; 95% CI: 1.0-21.6) when compared with those who had none; the odds of these two outcomes increased with exposure to additional childhood adversities. Participants with four or more childhood adversities had higher odds of having a lifetime history of psychiatric hospitalization (AOR: 7.1; 95% CI: 2.8-18.0); no increase with fewer adversities was found.

Conclusion: Childhood adversities are associated with poor mental health outcomes among older homeless adults. Clinicians should collect information about childhood adversities among this high-risk population to inform risk assessment and treatment recommendations.

Keywords: depression; epidemiology; geriatrics; homeless persons; mental health services; suicide.

MeSH terms

Adult Survivors of Child Abuse / psychology*
Aged
California / epidemiology
Cross-Sectional Studies
Depression / epidemiology*
Female
Health Status
Humans
Ill-Housed Persons / psychology*
Life Change Events
Logistic Models
Male
Mental Health Services / statistics & numerical data
Middle Aged
Multivariate Analysis
Psychiatric Status Rating Scales
Risk Factors
Self Report
Suicide, Attempted / statistics & numerical data*

Abstract

MeSH terms

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