Can Housing and Service Interventions Reduce Family Separations for Families Who Experience Homelessness?

Family break‐up is common in families experiencing homelessness. This paper examines the extent of separations of children from parents and of partners from each other and whether housing and service interventions reduced separations and their precursors among 1,857 families across 12 sites who participated in the Family Options Study. Families in shelters were randomized to offers of one of three interventions: permanent housing subsidies that reduce expenditures for rent to 30% of families’ income, temporary rapid re‐housing subsidies with some services directed at housing and employment, and transitional housing in supervised facilities with extensive psychosocial services. Each group was compared to usual care families who were eligible for that intervention but received no special offer. Twenty months later, permanent housing subsidies almost halved rates of child separation and more than halved rates of foster care placements; the other interventions did not affect separations significantly. Predictors of separation were primarily homelessness and drug abuse (all comparisons), and alcohol dependence (one comparison). Although housing subsidies reduced homelessness, alcohol dependence, intimate partner violence, and economic stressors, the last three variables had no association with child separations in the subsidy comparison; thus subsidies had indirect effects via reductions in homelessness. No intervention reduced partner separations.     

Predictors of mental distress and poor physical health among homeless women

Abstract

We tested a latent variable path model in which situational, personal, and social resources predicted several mediators and the key health outcomes of mental distress and poor physical health among 871 homeless women. Mental distress was predicted by risky sexual behavior, less social support, avoidant coping, less self-esteem, client abuse history, social support from deviant sources, less drug self-efficacy and health care utilization. Poor physical health was predicted by a client abuse history, less drug self-efficacy, fewer perceived rewards for drug use, higher perceived costs for drug use, and a doctor visit. Current risky sexual behavior was predicted by a parent drug abuse history, less drug self-efficacy, and more social support from deviant sources. Current drug use was predicted by parent drug abuse history, less drug self-efficacy, more social support from deviant sources and by high perceived costs for drug use. Implications of results for intervention and theory are discussed.     

Modeling cognitive adaptation: a longitudinal investigation of the impact of individual differences and coping on college adjustment and performance.

Drawing on cognitive adaptation theory, optimism, psychological control, and self-esteem were explored as longitudinal predictors of adjustment to college in a sample of 672 freshmen. Although a direct effect of optimism on adjustment was found, most of the predicted effects were mediated by coping methods. Controlling for initial positive and negative mood, the beneficial effects of optimism, control, and self-esteem on adjustment were mediated by the nonuse of avoidance coping, greater use of active coping, and greater seeking of social support. Alternative models of the causal relations among these variables did not fit the data as well as the a priori mediational model. The results of a 2-year follow-up indicated that self-esteem and control predicted greater motivation and higher grades, controlling for college entrance exam scores. Implications for cognitive adaptation theory and for interventions with populations under stress are discussed.     

Psychosocial correlates of emotional distress and risk behavior in african-american women at risk for hiv infection

We examined a model of stress and coping in 749 African-American women at risk for HIV infection. Women in the sample were either homeless, intravenous drug users (IVDUs) sexual partners of IVDUs, or prostitutes. A model was hypothesized based on stress and coping theory and research. Antecedents studied were personal resources, specifically self-esteem and available support. Mediators were threat appraisal and coping efforts. Outcomes studied were emotional distress and HIV risk behaviors. Structural equation modeling techniques were used to test hypothesized pathways between these variables. Forty-five percent of the variance in emotional distress in these women was explained by the model with self-esteem and avoidant coping the strongest predictors. Ten percent of the variance in risk behavior was explained by the model with emotional distress the strongest predictor. Direct and indirect pathways predicting risk behavior and distress are discussed. Implications of results for intervention and theory building are considered.     

Substance Use and Health and Safety among Homeless Youth

This study examines how substance use is associated with the health and safety of homeless youth using cross-sectional, self-report data from 285 homeless adolescents. Path models were used to examine concurrent relationships between youth’s substance use and multiple aspects of their health and safety, including measures of psychological distress, housing risk and instability, and medical problems. Substance use was examined with both global (i.e., a composite of days of use across various drugs and alcohol) and specific (i.e., rates of use of specific drugs, injection drug use) measures. After controlling for demographic and historical variables, number of days of use was significantly related to psychological distress, whereas injection drug use was significantly related to housing risk. Examination of specific drugs revealed relationships between psychological distress and the use of alcohol, cocaine, and amphetamines, and a specific relationship between housing risk and the use of heroin. None of the measures of substance use was significantly related to youth’s medical problems. Implications for interventions with homeless adolescents are discussed.     

Impact of parentification on long-term outcomes among children of parents with HIV/AIDS

Stein, Riedel, and Rotheram-Borus reported in 1999 that early parentification predicted maladaptive outcomes of more emotional distress, substance use, and conduct problems among adolescents of parents with HIV/AIDS (PWH) 6 months later. The current study assessed the adolescents ( N =213) 6 years later to assess whether there were continuing negative effects of parentification, or, rather, if there were some positive outcomes. Although the premature assumption of parental roles had negative effects in the short term, we hypothesized that such skills may have been adaptive in the long run, especially in the case of adolescents with major stressors in their lives, including dying or ill parents, impoverished environments, and family instability. We found that early parentification predicted better adaptive coping skills and less alcohol and tobacco use 6 years later. In addition, early parentification was not associated with later emotional distress and dysfunctional parenting attitudes, including expecting role reversals in their own children.     

Critical Time Intervention for Homeless People Making the Transition to Community Living: A Randomized Controlled Trial

To help create an evidence base in Europe for effective interventions that improve the well‐being of homeless people, we tested whether critical time intervention (CTI), a time‐limited intervention developed to support vulnerable people during times of transition, is effective outside the United States. For this multicenter, parallel‐group randomized controlled trial, 183 adults who were moving from shelters in the Netherlands to supported or independent housing were allocated to CTI or care‐as‐usual. The primary outcome was number of days rehoused, which was assessed by interviewing participants four times during a 9‐month follow‐up. Outcomes were analyzed with three‐level mixed‐effects models. The primary outcome did not differ between groups. CTI had a significant effect on family support and, for people experiencing less social support, psychological distress. Groups did not differ significantly on social support, fulfillment of care needs, quality of life, self‐esteem, excessive alcohol use, or cannabis use. Because few participants were homeless at 9 months, more research is needed to establish whether CTI can prevent long‐term recurrent homelessness. Given recent emphasis on informal support in public services and positive effects of CTI on family support and psychological distress, CTI is a fitting intervention for Dutch shelter services.     

Identifying Unmet Mental Health Needs in Children of Formerly Homeless Mothers Living in a Supportive Housing Community Sector of Care

This study reports psychosocial characteristics of a sample of 111 children (K to 2nd grade) and their mothers who were living in urban supportive housings. The aim of this study was to document the various types and degree of risk endemic to this population. First, we describe the psychosocial characteristics of this homeless sample. Second, we compared this homeless sample with a grade-matched, high-risk, school-based sample of children (n = 146) who were identified as showing early symptoms of disruptive behaviors. Third, we compared the parents in both samples on mental health, parenting practices, and service utilization. Results showed that children living in supportive housing were in the at-risk range and had comparable levels of externalizing problems, internalizing problems, school problems and emotional strengths with the school-based risk sample receiving prevention services at a family support community agency. Mothers in supportive housing reported significantly higher psychological distress, less optimal parenting practices and greater service utilization. These findings are among the first to provide empircal support for the need to deliver prevention interventions in community sectors of care.     

Escaping Homelessness: The Influences of Self-Efficacy and Time Perspective on Coping With Homelessness1

This study explored whether self-efficacy and time perspective of homeless adults (N= 82) living in a shelter affected their coping strategies related to obtaining housing and employment. Participants with high self-efficacy searched more for housing and employment and stayed at the shelter for a shorter duration, whereas participants with low self-efficacy were more likely to request an extension of their stay at the shelter. Those high on future orientation had shorter durations of homelessness and were more likely to enroll in school and to report gaining positive benefits from their predicament, whereas those with a high present orientation had more avoidant coping strategies. Despite the predictive power of self-efficacy and future orientation of proactive search behaviors, there were no predictors of obtaining stable housing, which is a scarce resource in the area. However, a high present orientation predicted obtaining temporary housing. A present temporal perspective may be adaptive in finding short-term solutions to an unstable situation, such as homelessness. The role of time perspective in crisis situations is discussed, as well as the severe environmental constraints on the exercise of personal control over reality dictated by social, economic, and political forces.     

Situational Determinants of Coping in Smoking Relapse Crises1

Interviews with 264 callers to a relapse prevention hotline were used to explore situational determinants of coping among exsmokers facing temptations to smoke. As hypothesized, subjects were more likely to perform cognitive and behavioral coping early in abstinence. Coping was also more likely in situations where subjects had habitually smoked. Discriminant function analyses were used to predict the performance of coping from situational variables. Cognitive coping could not be predicted. Performance of behavioral coping was predictable from six situational variables which accounted for 28% of the variance in coping performance. These situational variables also accounted for the decay of behavioral coping over time. The findings imply that individual differences play a limited role in coping performance and have implications for clinical efforts to enhance smoking cessation through coping interventions.     

Attributions to discrimination and self-esteem: Impact of group identification and situational ambiguity

This study examined group identification and situational ambiguity as moderators of attributions to discrimination and self-esteem following negative feedback. As predicted, high gender-identified women made more discrimination attributions than low identified women when situational prejudice cues were ambiguous, but not when prejudice cues were absent or overt. Also as predicted, women exposed to overt prejudice cues had higher self-esteem than those exposed to ambiguous cues or no prejudice cues. The relationship between discrimination attributions and self-esteem was positive among women exposed to overt prejudice but negative among those exposed to no prejudice. Across conditions, however, the more that women discounted ability as a cause of their negative feedback (i.e., blamed discrimination more than ability), the higher their self-esteem. Results qualify and extend prior research and demonstrate that personal and situational factors moderate both the tendency to make attributions to discrimination and the consequences of those attributions for self-esteem.     

Employee adjustment to stress: The role of coping resources, situational factors, and coping responses

Abstract The present study was designed to examine further the stress-adjustment relationship in employees. Specifically, the relations among employees' coping resources (self-esteem, generalized control beliefs, neuroticism, and social support), their appraisals of a recent stressful event experienced at work (appraised stress, self-efficacy, and situational control beliefs), the coping strategies (problem- and emotion-focused coping) used to deal with the event, and levels of employee adjustment (psychological well-being and job satisfaction) were examined. Data were collected from 153 male and female employees in a public sector department, employed in a range of middle-management administrative activities. The data provided support for a modified version of a model that proposed that both situational appraisals and coping strategies are mediating processes in the stress-adjustment relationship. There was evidence that employees' coping responses to the recent stressful event experienced at work were related to concurrent levels of adjustment. As predicted, the use of problem-focused coping, in general, had positive relationships with the measures of adjustment, whereas the effects of emotion-focused coping were generally negative (there was, however, some evidence that the effects of coping were dependent on event controllability). There was also evidence that coping resources had both direct and indirect effects (via coping and via situational appraisals) on employee adjustment. The latter effects were most marked for generalized control beliefs and self-esteem. Situational appraisals (in particular, efficacy expectancies) also had indirect effects on employee adjustment, through their effects on coping responses.     

Stress coping and the adjustment process among university freshmen

The purpose of the present study was to investigate causal relationships between dispositional and situational coping and health status in university freshmen. Two hundred and twenty-nine university freshmen completed questionnaires at Time 1 (immediately after university matriculation) and at Time 2 (approximately three months later) in a short-term, prospective study. Structural equation modeling was used to analyze causal relationships between four coping strategies (i.e., emotion expression, emotional support seeking, cognitive reinterpretation, and problem solving) and four health status variables (i.e., somatic symptoms, anxiety and insomnia, social dysfunction, and depression). Increases in dispositional coping predicted increases in situational coping at certain time points. In addition, increases in dispositional emotion-focused coping, such as emotion expression and emotional support seeking, predicted poor health status. This relationship was mediated by situational coping variables. Finally, increases in dispositional problem-focused coping, such as cognitive reinterpretation and problem solving, predicted better health status. This relationship was direct or indirectly mediated by situational coping variables. Our data suggest that the use of coping skills such as cognitive reinterpretation and problem solving may promote better health and adaptation in university freshmen.     

Religious coping,stigma, and psychological functioning among HIV-positive African American women

The present study examined the role of religious coping in psychological distress and adjustment both cross-sectionally and longitudinally among 141 HIV-positive African American women. Cross-sectional analyses showed that negative religious coping was associated with poorer mental health and functioning, and greater perceptions of stigma and discrimination. Longitudinal analyses revealed that greater negative religious coping at baseline significantly predicted greater changes in mental health in a negative direction 12 months later. Positive religious coping was not associated with any measures of psychological well-being, nor did it predict any mental health outcomes at 12 months. However, participants who experienced high levels of HIV-related stigma and reported high levels of positive religious coping were less depressed than those who reported lower levels of positive religious coping. These results suggest that for this population, negative religious coping was a more salient determinant of psychological distress than positive religious coping was of psychological health.     

Coping and Emotional Distress in Primary and Recurrent Breast Cancer Patients

The purpose of this study was to explore the emotional distress and coping strategies among women with primary as against recurrent (local or metastatic) breast cancer. The study sample consisted of 80 women, all 1 year postdiagnosis of primary or recurrent breast cancer. All women completed a demographic questionnaire, the Emotional Symptoms Checklist (SCL-90R) and the Ways of Coping Questionnaire (WCQ). Patients with recurrence reported higher levels of depression and anxiety as well as a higher global severity index (GSI). This group used significantly fewer problem-solving and positive-focus strategies. Emotion-focused coping predicted depression and the GSI, but only positive attitude predicted the level of anxiety. The state of disease was a major predictor of emotional symptoms, and to a lesser extent of the coping strategies used. Although emotion-focused coping had a deleterious effect on emotional well-being, our study highlighted the importance and relevance of positive attitude for reducing emotional distress in general and level of anxiety in particular. Promotion of positive-focus coping strategies should thus be a key element in psychological interventions with cancer patients.     

Relationships between Teachers' Occupational Stress and Their Burnout and Distress: Roles of Coping and Negative Mood Regulation Expectancies

Teaching school is a highly stressful occupation. Consequences of this stress are burnout, physical and emotional distress, and choosing to leave the profession. Research on teacher stress and burnout has largely focused on environmental and contextual factors while ignoring personality characteristics of teachers that may have an impact on relationships between job stress and its consequences. The current study has a cross-sectional self-report design, focusing on teachers' negative mood regulation (NMR) expectancies as predictors of their coping, burnout and distress, in response to occupational stress. NMR expectancies are people's beliefs that they can control the negative moods they experience. Participants were 86 primary and secondary school teachers, who filled out questionnaire measures of teacher stress, NMR expectancies, coping, burnout, and distress. Simultaneous regression analyses showed that higher stress on the job did indeed predict greater burnout and distress. Additionally, stronger NMR expectancies predicted more active coping. NMR expectancies also predicted less burnout and distress, independent of stress level and coping. Believing one could control one's negative moods was associated with more adaptive outcomes for teachers. Results argue for the value of examining individual difference variables in research on occupational stress, in particular negative mood regulation expectancies.     

Psychological adjustment of children in the pretransplant phase of bone marrow transplantation: Relationships with parent distress,parent stress,and child coping

Families of 22 children preparing to undergo bone marrow transplantation (BMT) provided information concerning parent-reported major negative life stress, child coping strategies, parental psychological symptomatology, and child adjustment. Immediately prior to BMT, children and families are confronted with multiple stresses which challenge the child's coping and strain the parents' ability to assist the child with coping. Hence, stress, parental adjustment (distress), and child coping may be important factors affecting the child's overall psychological adjustment. Results showed that 15–25% of children and parents experienced clinically significant levels of psychological distress. Parent and child psychological distress were closely related. Major negative life stresses experienced by the parent and use of avoidant coping by the child significantly predicted child adjustment problems in the pretransplant period. Coping skills interventions targeting avoidant coping and management of parental stress/distress may reduce child psychosocial risk prior to BMT.     

Homelessness as psychological trauma. Broadening perspectives.

Most mental health literature on homelessness has focused on characteristics that may be risk factors for homelessness. The authors of this article argue that homelessness itself is a risk factor for emotional disorder and use the construct of psychological trauma--focusing on social disaffiliation and learned helplessness--to understand the potential effects of homelessness. Psychological trauma is likely among homeless individuals and families for three reasons. (a) The sudden or gradual loss of one's home can be a stressor of sufficient severity to produce symptoms of psychological trauma. (b) The conditions of shelter life may produce trauma symptoms. (c) Many homeless people--particularly women--become homeless after experiencing physical and sexual abuse and consequent psychological trauma. Research suggests that negative psychological responses to traumatic events can be prevented or mitigated by a supportive and empowering posttrauma environment. The implications of trauma theory for improving the psychosocial conditions of homeless people are discussed.     

Prediction of symptoms of emotional distress by mood regulation expectancies and affective traits

Three studies examined negative mood regulation expectancies (NMRE) and affective traits as independent predictors of self‐reported symptoms of emotional distress. NMRE represent individuals' beliefs that they can alleviate unpleasant emotional states. Stronger NMRE are associated with more adaptive coping, more positive cognition during negative moods, more effective responses under stress and less emotional distress. Affective traits represent long‐term tendencies toward particular affective experiences; they confer risk for specific symptoms of emotional distress. In Study 1, NMRE, trait negative affect (TNA) and trait positive affect (TPA) were all independently associated with depression among students and staff of a German university. In Study 2, in prospective analyses among U.S. college students traits exhibited hypothesised relationships with anxiety and depressive symptoms, and NMRE uniquely predicted anhedonic depression. Study 3 revealed independent prediction of change in symptoms over time by NMRE among U.S. college students, whereas traits were not associated with change in distress, anxiety and depression symptoms. Results suggest independent roles for NMRE and traits in the development of depression and anxiety symptoms and highlight the importance of NMRE as a potential target of therapeutic intervention in the process of symptom change.     

A longitudinal study of psychosocial distress in breast cancer: prevalence and risk factors

This longitudinal study was conducted among 102 women with non-metastasic breast cancer to identify the time evolution and prevalence of distress at specific times through diagnosis and treatment of disease: preliminary diagnosis, surgery, definitive diagnosis and chemotherapy. Additionally, the study aimed to examine the role of demographic, medical and psychosocial factors on distress. The results indicated that prevalence of distress was higher at initial diagnosis (25%) than the following time points (approximately 17%). The differences inter-individuals in the levels of distress were observed over the four assessments. No relation between distress and demographic and medical factors was found. However, psychosocial aspects were significant risk factors. Patterns of emotional suppression and specific coping responses like helplessness/hopelessness, anxious preoccupation, cognitive avoidance and fatalism were positively related to distress, whereas fighting spirit and perceived social support showed a protective role. Moreover, helplessness/hopelessness and anxious preoccupation jointly predicted 75% of cases and 98% non-cases of distress. Finally, a mediational model between emotional suppression and distress through helplessness/hopelessness was tested. Results support the necessity of routine distress screening all through the illness. Implications of data for psychosocial interventions with breast cancer patients are highlighted.