NIH Public Access Author Manuscript J Health Care Poor Underserved. Author manuscript; available in PMC 2014 December 02.
NIH-PA Author Manuscript
Published in final edited form as: J Health Care Poor Underserved. 2014 August ; 25(3): 1201–1216. doi:10.1353/hpu.2014.0124.
Psychiatric Disorders, High-Risk Behaviors, and Chronicity of Episodes Among Predominantly African American Homeless Chicago Youth Anne L. Castro, BA1, Erika L. Gustafson, BA2, Ashley E. Ford, BS3, Dr. Jennifer P. Edidin, PhD4, Dr. Dale L. Smith, PhD5, Dr. Scott J. Hunter, PhD6, and Dr. Niranjan S. Karnik, MD, PhD7 1Medical
student at the University of Chicago Pritzker School of Medicine
2Research 3Medical
NIH-PA Author Manuscript
4Private
project manager at the University of Chicago Medical Center
student at Meharry Medical College School of Medicine
practice in Northfield, Illinois
5Associate
Professor in the Department of Psychology at Olivet Nazarene University
6Associate
Professor in the Departments of Psychiatry & Behavioral Neuroscience, and Pediatrics at the University of Chicago Medicine & Biological Sciences 7Associate
Professor in the Department of Psychiatry and the Department of Community, Systems and Mental Health Nursing at Rush University Medical Center
Abstract Objective—This cross-sectional study investigated the relationships between psychiatric and substance-related disorders, high-risk behaviors, and the onset, duration, and frequency of homelessness among homeless youth in Chicago.
NIH-PA Author Manuscript
Methods—Sixty-six homeless youth were recruited from two shelters in Chicago. Demographic characteristics, psychopathology, substance use, and risk behaviors were assessed for each participant. Results—Increased frequency and duration of homeless episodes were positively correlated with higher rates of psychiatric diagnoses. Increased number of psychiatric diagnoses was positively correlated with increased high-risk behaviors. Participants with diagnoses of Current Suicidality, Manic Episodes, Obsessive Compulsive Disorder, Substance Abuse, and Psychotic Disorder had a higher chronicity of homelessness than those without diagnoses. Conclusions—Significant differences were evident between the three time parameters, suggesting that stratification of data by different time variables may benefit homelessness research by identifying meaningful subgroups who may benefit from individualized interventions.
Inquiries may be addressed to Dr. Niranjan Karnik, Department of Psychiatry, 1645 West Jackson Blvd., Suite 600, Chicago, IL 60607. [email protected]. Disclosure The authors have no interests to disclose in relation to the research described here.
Castro et al.
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Keywords
NIH-PA Author Manuscript
Homelessness; youth; psychopathology; substance use Adolescents constitute 12% of the total U.S. homeless population and have the highest prevalence of homelessness among all age groups, at 9–15%.1,2 This translates to an estimated 1.6 to 2 million youth who are without stable housing each night. Youth homelessness (with youth defined as a person under age 25, due to the developmental nature of this experience) is associated with an array of adverse outcomes, including poorer physical and mental health, high rates of abuse and trauma, elevated rates of substance use and high-risk sexual behaviors, irregular nutrition and sleep, poorer cognitive and academic functioning, elevated school dropout rates, and high rates of mortality, especially from suicide, trauma, and overdose.3–5
NIH-PA Author Manuscript
Currently, 50% of homeless youth do not escape homelessness prior to adulthood.6 Improved understanding of homeless youth risk profiles would allow service providers to more effectively identify youth who require specialized support services in order to make a transition to stable housing.7 Some researchers have specifically highlighted the need for better characterization of the differences between those who tend to be short-term, longterm, or episodically homeless,8 in order to design more effective targeted interventions. The purpose of this study is to investigate more closely the relationships among psychiatric and substance-related disorders, high-risk behaviors, and the onset, duration, and frequency of homelessness among homeless youth in Chicago. Past studies have shown that increased cumulative time homeless correlates with increased substance use.3,9,10,21 Most of these studies have been able to distinguish between “newly” and “long-term” homeless youth, or those having experienced less or more than six months of homelessness, respectively. More detailed analytics of the chronicity of homelessness for youth populations have not been done in these studies.
NIH-PA Author Manuscript
Relatedly, research has demonstrated that substance-using homeless youth are more likely than their non-using peers to experience mental health problems, exacerbating the fact that homeless youth already exhibit high rates of anxiety and mood disorders at baseline.3,11 One study found that 89% of homeless 16–19 year olds met criteria for one or more mental health disorders, compared with 30% for the national population of the same age range.12 However, current research has yet to establish the relationship between length and frequency of homelessness and their impact on mental health functioning and substance use. In relation to sexual health, studies have shown that more than six months of homelessness correlates with an earlier onset of sexual activity as well as a higher likelihood of participation in and greater length of time during which the person engaged in high-risk sexual behaviors.3,13 Consistent homelessness for six months or longer has also been associated with more HIV-risk behaviors,14 which is unsurprising in light of homeless youth’s overall higher likelihood of multiple sexual partners and greater risk of STIs compared with national norms.4,15,16 HIV/AIDS prevalence among U.S. homeless and runaway youth is estimated to be up to 11.5%.17,18 Nonetheless, some studies have failed to
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Castro et al.
Page 3
find a correlation between length of homelessness and sexual risk behaviors,15 indicating a need for further research.
NIH-PA Author Manuscript
Finally, age of onset of first homeless episode seems to play a role, as early experience of homelessness, specifically by running away from home, is associated with elevated rates of high risk behaviors, including survival sex, theft, and using and selling drugs.19 Younger homeless youth are also at greater likelihood of having experienced domestic violence and to continue experiencing violence when homeless. In addition, earlier age of homelessness is associated with an elevated risk of depression and adverse mental health sequelae.19
NIH-PA Author Manuscript
Yet, due to the transient nature of homeless populations, ethical issues surrounding their study, as well as a lack of funding for research, prevention, and intervention, there are significant knowledge gaps about the cycles of violence and developmental trauma faced by these youth.3 A more specific understanding of length of time and frequency of homelessness in relation to mental health, along with substance use and high-risk sexual behaviors, will better inform the development of interventions. In this study of Chicago homeless youth, it is hypothesized that rates of psychiatric disorders, substance use disorders, and other self-reported high-risk behaviors will be correlated with increased duration, frequency, and early onset of homelessness episodes.
Methods Recruitment Sixty-six homeless youth were recruited from two shelters in Chicago: the Night Ministry and Teen Living Program. To meet criteria for homelessness in our study, youth had to meet the U.S. Department of Education definition of homelessness. The Night Ministry (NM) is a non-profit organization providing short-term and emergency housing to youth ages 14–20 in West Town. Case managers at this site were responsible for initiating contact with potential participants. Teen Living Program (TLP), located on the south side of Chicago in Bronzeville, provides transitional housing and services to help youth ages 17–24 acquire stable housing and self-sufficiency. Recruitment at TLP involved a research team member visiting the shelter weekly and asking residents if they would be interested in participating in a study about homeless youth.
NIH-PA Author Manuscript
Human subject protections A research team member met with all interested youth to provide a full description of the study, and written informed consent was obtained. The research protocol was approved by the University of Chicago Institutional Review Board. Eligibility Participants were 18–24 year-old homeless youth living in Chicago without “a fixed, regular, and adequate nighttime residence.”20 Youth younger than 18 were not recruited because underage youth in Illinois are removed from homeless shelters by the Department of Child & Family Services and placed in foster care. Individuals of any ethnic or cultural groups, or gender or gender-identification were considered eligible for this study. Youth
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with IQ 0.1 indicates a small effect, r > 0.3 indicates a medium effect, and r > 0.5 indicates a large effect.
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Castro et al.
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Table 1
NIH-PA Author Manuscript
Study population characteristics Demographic data, N=66 Average age, yrs.
19.26 (SD 0.87)
Age range, yrs.
18–21
Female, %
56.1
Male, %
43.9
African American, %
80.3
Caucasian, %
3.0
Latino, %
3.0
Multiracial, %
7.6
Other, %
6.1
Highest grade completed, avg.
11.2 (SD 1.5)
IQ, avg.
86 (Range 61–117)
Experiences of homelessness
NIH-PA Author Manuscript
Age at first experience, avg.
16.4 (SD 3.1)
No. of times in past year, avg.
1.9 (SD 1.8)
Length of longest experience, avg.
15.2 mos. (SD 15.7 mos.)
Current length of homelessness, avg.
10.6 mos. (SD 13.7 mos.)
Total lifetime times homeless 1–3 (%)
87.9
4–6 (%)
7.6
7–9 (%)
3.0
>9 (%)
1.5
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Table 2
NIH-PA Author Manuscript
Prevalence of Psychiatric Disorders in Youth, N = 66
NIH-PA Author Manuscript NIH-PA Author Manuscript
Diagnosis
N
% **
Any psychiatric disorder*
53
81.5
Any mood disorder
43
66.2
Any anxiety disorder
22
34.4
Any psychotic disorder
5
7.9
Major Depressive Episode
35
53.8
Major Depressive Episode, Current
15
23.1
Major Depressive Episode, Past
29
44.6
Major Depressive Episode, Recurrent
13
20.0
Suicidality, Current
41
63.1
Manic Episode
12
19.0
Manic Episode, Current
5
7.9
Manic Episode, Past
11
17.5
Hypomanic Episode Current
0
0
Hypomanic Episode, Past
8
12.7
Hypomanic Symptoms, Current
2
3.2
Hypomanic Symptoms, Past
6
9.5
Panic Disorder w/Agoraphobia Current
2
3.1
Agoraphobia w/o history of Panic Disorder
10
15.6
Social Phobia Current (Social Anxiety Disorder)
8
12.5
Social Phobia Current (Generalization)
3
4.6
Obsessive Compulsive Disorder
5
7.8
Posttraumatic Stress Disorder
8
12.5
Psychotic Disorder
3
4.8
Mood Disorder, with psychotic features
2
3.1
Anorexia Nervosa
0
0
Bulimia Nervosa
2
3.1
Generalized Anxiety Disorder
7
11.1
Anti-Social Personality Disorder
14
21.9
Substance Dependence (non-alcohol)
10
15.6
Substance Abuse (non-alcohol)
8
12.5
Alcohol Dependence
5
7.8
Alcohol Abuse
7
10.9
Comorbid Substance or Alcohol Abuse and/or Dependence
11
18.0
*
Any positive screen on M.I.N.I
**
Percentages are calculated based upon all respondents, and so any questions unanswered or not applicable are left out of calculations.
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Table 3
NIH-PA Author Manuscript
Prevalence of Self-reported High Risk Behaviors in Youth, N = 66
NIH-PA Author Manuscript NIH-PA Author Manuscript
Self-reported risk behaviors
N
%
Has tried cigarette smoking
48
72.7
Daily cigarette smoker (lifetime)
23
34.8
Never
11
17.4
17
18
28.6
Recent* alcohol use
32
48.5
Recently* consumed >5 drinks of alcohol in a row
14
22.2
Marijuana use
46
73.0
Never
15
23.8
17
19
30.2
Recent* marijuana use
29
46.0
Cocaine use
1
1.6
Inhalant use
1
1.6
Heroin use
0
0
Methamphetamine use
0
0
Ecstasy use
11
17.5
Hallucinogenic drugs use
3
4.8
Steroid pill/shot use
1
1.6
Prescription drug misuse
8
12.7
Age of first alcohol use
Age of first marijuana use
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NIH-PA Author Manuscript
Self-reported risk behaviors
N
%
Injection drug use
1
1.6
Has engaged in sexual intercourse
55
87.3
Never
4
6.3
NIH-PA Author Manuscript
Published in final edited form as: J Health Care Poor Underserved. 2014 August ; 25(3): 1201–1216. doi:10.1353/hpu.2014.0124.
Psychiatric Disorders, High-Risk Behaviors, and Chronicity of Episodes Among Predominantly African American Homeless Chicago Youth Anne L. Castro, BA1, Erika L. Gustafson, BA2, Ashley E. Ford, BS3, Dr. Jennifer P. Edidin, PhD4, Dr. Dale L. Smith, PhD5, Dr. Scott J. Hunter, PhD6, and Dr. Niranjan S. Karnik, MD, PhD7 1Medical
student at the University of Chicago Pritzker School of Medicine
2Research 3Medical
NIH-PA Author Manuscript
4Private
project manager at the University of Chicago Medical Center
student at Meharry Medical College School of Medicine
practice in Northfield, Illinois
5Associate
Professor in the Department of Psychology at Olivet Nazarene University
6Associate
Professor in the Departments of Psychiatry & Behavioral Neuroscience, and Pediatrics at the University of Chicago Medicine & Biological Sciences 7Associate
Professor in the Department of Psychiatry and the Department of Community, Systems and Mental Health Nursing at Rush University Medical Center
Abstract Objective—This cross-sectional study investigated the relationships between psychiatric and substance-related disorders, high-risk behaviors, and the onset, duration, and frequency of homelessness among homeless youth in Chicago.
NIH-PA Author Manuscript
Methods—Sixty-six homeless youth were recruited from two shelters in Chicago. Demographic characteristics, psychopathology, substance use, and risk behaviors were assessed for each participant. Results—Increased frequency and duration of homeless episodes were positively correlated with higher rates of psychiatric diagnoses. Increased number of psychiatric diagnoses was positively correlated with increased high-risk behaviors. Participants with diagnoses of Current Suicidality, Manic Episodes, Obsessive Compulsive Disorder, Substance Abuse, and Psychotic Disorder had a higher chronicity of homelessness than those without diagnoses. Conclusions—Significant differences were evident between the three time parameters, suggesting that stratification of data by different time variables may benefit homelessness research by identifying meaningful subgroups who may benefit from individualized interventions.
Inquiries may be addressed to Dr. Niranjan Karnik, Department of Psychiatry, 1645 West Jackson Blvd., Suite 600, Chicago, IL 60607. [email protected]. Disclosure The authors have no interests to disclose in relation to the research described here.
Castro et al.
Page 2
Keywords
NIH-PA Author Manuscript
Homelessness; youth; psychopathology; substance use Adolescents constitute 12% of the total U.S. homeless population and have the highest prevalence of homelessness among all age groups, at 9–15%.1,2 This translates to an estimated 1.6 to 2 million youth who are without stable housing each night. Youth homelessness (with youth defined as a person under age 25, due to the developmental nature of this experience) is associated with an array of adverse outcomes, including poorer physical and mental health, high rates of abuse and trauma, elevated rates of substance use and high-risk sexual behaviors, irregular nutrition and sleep, poorer cognitive and academic functioning, elevated school dropout rates, and high rates of mortality, especially from suicide, trauma, and overdose.3–5
NIH-PA Author Manuscript
Currently, 50% of homeless youth do not escape homelessness prior to adulthood.6 Improved understanding of homeless youth risk profiles would allow service providers to more effectively identify youth who require specialized support services in order to make a transition to stable housing.7 Some researchers have specifically highlighted the need for better characterization of the differences between those who tend to be short-term, longterm, or episodically homeless,8 in order to design more effective targeted interventions. The purpose of this study is to investigate more closely the relationships among psychiatric and substance-related disorders, high-risk behaviors, and the onset, duration, and frequency of homelessness among homeless youth in Chicago. Past studies have shown that increased cumulative time homeless correlates with increased substance use.3,9,10,21 Most of these studies have been able to distinguish between “newly” and “long-term” homeless youth, or those having experienced less or more than six months of homelessness, respectively. More detailed analytics of the chronicity of homelessness for youth populations have not been done in these studies.
NIH-PA Author Manuscript
Relatedly, research has demonstrated that substance-using homeless youth are more likely than their non-using peers to experience mental health problems, exacerbating the fact that homeless youth already exhibit high rates of anxiety and mood disorders at baseline.3,11 One study found that 89% of homeless 16–19 year olds met criteria for one or more mental health disorders, compared with 30% for the national population of the same age range.12 However, current research has yet to establish the relationship between length and frequency of homelessness and their impact on mental health functioning and substance use. In relation to sexual health, studies have shown that more than six months of homelessness correlates with an earlier onset of sexual activity as well as a higher likelihood of participation in and greater length of time during which the person engaged in high-risk sexual behaviors.3,13 Consistent homelessness for six months or longer has also been associated with more HIV-risk behaviors,14 which is unsurprising in light of homeless youth’s overall higher likelihood of multiple sexual partners and greater risk of STIs compared with national norms.4,15,16 HIV/AIDS prevalence among U.S. homeless and runaway youth is estimated to be up to 11.5%.17,18 Nonetheless, some studies have failed to
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Castro et al.
Page 3
find a correlation between length of homelessness and sexual risk behaviors,15 indicating a need for further research.
NIH-PA Author Manuscript
Finally, age of onset of first homeless episode seems to play a role, as early experience of homelessness, specifically by running away from home, is associated with elevated rates of high risk behaviors, including survival sex, theft, and using and selling drugs.19 Younger homeless youth are also at greater likelihood of having experienced domestic violence and to continue experiencing violence when homeless. In addition, earlier age of homelessness is associated with an elevated risk of depression and adverse mental health sequelae.19
NIH-PA Author Manuscript
Yet, due to the transient nature of homeless populations, ethical issues surrounding their study, as well as a lack of funding for research, prevention, and intervention, there are significant knowledge gaps about the cycles of violence and developmental trauma faced by these youth.3 A more specific understanding of length of time and frequency of homelessness in relation to mental health, along with substance use and high-risk sexual behaviors, will better inform the development of interventions. In this study of Chicago homeless youth, it is hypothesized that rates of psychiatric disorders, substance use disorders, and other self-reported high-risk behaviors will be correlated with increased duration, frequency, and early onset of homelessness episodes.
Methods Recruitment Sixty-six homeless youth were recruited from two shelters in Chicago: the Night Ministry and Teen Living Program. To meet criteria for homelessness in our study, youth had to meet the U.S. Department of Education definition of homelessness. The Night Ministry (NM) is a non-profit organization providing short-term and emergency housing to youth ages 14–20 in West Town. Case managers at this site were responsible for initiating contact with potential participants. Teen Living Program (TLP), located on the south side of Chicago in Bronzeville, provides transitional housing and services to help youth ages 17–24 acquire stable housing and self-sufficiency. Recruitment at TLP involved a research team member visiting the shelter weekly and asking residents if they would be interested in participating in a study about homeless youth.
NIH-PA Author Manuscript
Human subject protections A research team member met with all interested youth to provide a full description of the study, and written informed consent was obtained. The research protocol was approved by the University of Chicago Institutional Review Board. Eligibility Participants were 18–24 year-old homeless youth living in Chicago without “a fixed, regular, and adequate nighttime residence.”20 Youth younger than 18 were not recruited because underage youth in Illinois are removed from homeless shelters by the Department of Child & Family Services and placed in foster care. Individuals of any ethnic or cultural groups, or gender or gender-identification were considered eligible for this study. Youth
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Page 4
with IQ 0.1 indicates a small effect, r > 0.3 indicates a medium effect, and r > 0.5 indicates a large effect.
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Page 13
Table 1
NIH-PA Author Manuscript
Study population characteristics Demographic data, N=66 Average age, yrs.
19.26 (SD 0.87)
Age range, yrs.
18–21
Female, %
56.1
Male, %
43.9
African American, %
80.3
Caucasian, %
3.0
Latino, %
3.0
Multiracial, %
7.6
Other, %
6.1
Highest grade completed, avg.
11.2 (SD 1.5)
IQ, avg.
86 (Range 61–117)
Experiences of homelessness
NIH-PA Author Manuscript
Age at first experience, avg.
16.4 (SD 3.1)
No. of times in past year, avg.
1.9 (SD 1.8)
Length of longest experience, avg.
15.2 mos. (SD 15.7 mos.)
Current length of homelessness, avg.
10.6 mos. (SD 13.7 mos.)
Total lifetime times homeless 1–3 (%)
87.9
4–6 (%)
7.6
7–9 (%)
3.0
>9 (%)
1.5
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Table 2
NIH-PA Author Manuscript
Prevalence of Psychiatric Disorders in Youth, N = 66
NIH-PA Author Manuscript NIH-PA Author Manuscript
Diagnosis
N
% **
Any psychiatric disorder*
53
81.5
Any mood disorder
43
66.2
Any anxiety disorder
22
34.4
Any psychotic disorder
5
7.9
Major Depressive Episode
35
53.8
Major Depressive Episode, Current
15
23.1
Major Depressive Episode, Past
29
44.6
Major Depressive Episode, Recurrent
13
20.0
Suicidality, Current
41
63.1
Manic Episode
12
19.0
Manic Episode, Current
5
7.9
Manic Episode, Past
11
17.5
Hypomanic Episode Current
0
0
Hypomanic Episode, Past
8
12.7
Hypomanic Symptoms, Current
2
3.2
Hypomanic Symptoms, Past
6
9.5
Panic Disorder w/Agoraphobia Current
2
3.1
Agoraphobia w/o history of Panic Disorder
10
15.6
Social Phobia Current (Social Anxiety Disorder)
8
12.5
Social Phobia Current (Generalization)
3
4.6
Obsessive Compulsive Disorder
5
7.8
Posttraumatic Stress Disorder
8
12.5
Psychotic Disorder
3
4.8
Mood Disorder, with psychotic features
2
3.1
Anorexia Nervosa
0
0
Bulimia Nervosa
2
3.1
Generalized Anxiety Disorder
7
11.1
Anti-Social Personality Disorder
14
21.9
Substance Dependence (non-alcohol)
10
15.6
Substance Abuse (non-alcohol)
8
12.5
Alcohol Dependence
5
7.8
Alcohol Abuse
7
10.9
Comorbid Substance or Alcohol Abuse and/or Dependence
11
18.0
*
Any positive screen on M.I.N.I
**
Percentages are calculated based upon all respondents, and so any questions unanswered or not applicable are left out of calculations.
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Table 3
NIH-PA Author Manuscript
Prevalence of Self-reported High Risk Behaviors in Youth, N = 66
NIH-PA Author Manuscript NIH-PA Author Manuscript
Self-reported risk behaviors
N
%
Has tried cigarette smoking
48
72.7
Daily cigarette smoker (lifetime)
23
34.8
Never
11
17.4
17
18
28.6
Recent* alcohol use
32
48.5
Recently* consumed >5 drinks of alcohol in a row
14
22.2
Marijuana use
46
73.0
Never
15
23.8
17
19
30.2
Recent* marijuana use
29
46.0
Cocaine use
1
1.6
Inhalant use
1
1.6
Heroin use
0
0
Methamphetamine use
0
0
Ecstasy use
11
17.5
Hallucinogenic drugs use
3
4.8
Steroid pill/shot use
1
1.6
Prescription drug misuse
8
12.7
Age of first alcohol use
Age of first marijuana use
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NIH-PA Author Manuscript
Self-reported risk behaviors
N
%
Injection drug use
1
1.6
Has engaged in sexual intercourse
55
87.3
Never
4
6.3
