Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data

This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988–1995) and Philadelphia (1991–1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to overrepresent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non-White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non-White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long-term care programs.     

Suicide attempts and stressful life events among homeless people in Madrid (Spain)

The article describes a study carried out with a representative sample of homeless people in Madrid (Spain; N = 188). This study aims to corroborate the relationship identified in the literature between stressful life events and suicidal behaviour in a group in a situation of social exclusion, to assess the differences in the number and characteristics of stressful life events experienced by homeless people who are attempters and non‐attempters, and to identify which combination of stressful life events enables discrimination for suicide attempts among homeless people. The results show that 30% of homeless people in Madrid had attempted suicide, and 57.9% of them had done so for the first time when they were homeless. The interviewees are shown to have experienced a large amount of stressful life events, with substantially more stressors experienced by the homeless people who tried to commit suicide, during both their childhood and adolescence and throughout their life. Finally, we found that the combination of 7 stressful life events provided the best possible discrimination between homeless attempters and non‐attempters.     

Violent offenses associated with co‐occurring substance use and mental health problems: Evidence from CJDATS

The present study examines the relationship between substance use, mental health problems, and violence in a sample of offenders released from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,349) in a federally funded cooperative, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self‐reports for the six‐month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. For most offenders with substance use problems, the quantity of alcohol consumed and the frequency of drug use were associated with a greater probability of self‐reported violence. Mental health problems were not indicative of increases in violent behavior, with the exception of antisocial personality problems, which were associated with violence. The paper emphasizes the importance of providing substance abuse treatment in relation to violent behavior among offenders with mental health problems being discharged to the community. Copyright © 2009 John Wiley & Sons, Ltd.     

A Risk-Amplification Model of Victimization and Depressive Symptoms Among Runaway and Homeless Adolescents

This report is an examination of a theoretical model of risk amplification within a sample of 255 homeless and runaway adolescents. The young people were interviewed on the streets and in shelters in urban centers of four Midwestern states. Separate models were examined for males (n = 102) and females (n = 153). Results indicated that street experiences such as affiliation with deviant peers, deviant subsistence strategies, risky sexual behaviors, and drug and/or alcohol use amplified the effects of early family abuse on victimization and depressive symptoms for young women. These street adaptations significantly increased the likelihood of serious victimization over and above the effects of early family history for both young men and women. Similarly, street behaviors and experiences increased the likelihood of depressive symptoms for young women over the effects of early family abuse, but not for young men. The risk-amplification model from the life course theoretical perspective is discussed as an example of the cumulative continuity of maladaptive behaviors.     

Homeless Youths and Young Adults in Los Angeles: Prevalence of Mental Health Problems and the Relationship Between Mental Health and Substance Abuse Disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults is increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems, as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorder included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Perceptions of stressful life events as turning points are associated with self-rated health and psychological distress

Abstract

We test the hypothesis that changes in physical and psychological health are associated with construals of stressful life events. At two points in time, approximately 10 years apart, participants (n=1038) rated their physical health and psychological distress. At the second assessment, participants also reported their most stressful life event since the first assessment and indicated whether they considered the event a turning point and/or lesson learned. Lower self-ratings of health and higher ratings of psychological distress, controlling for baseline health and distress, and relevant demographic factors, were associated with perceiving the stressful life event as a turning point, particularly a negative turning point. The two health measures were primarily unrelated to lessons learned. How individuals construe the most stressful events in their lives are associated with changes in self-rated health and distress.     

Long-Term stress reactions in new immigrants to israel exposed to the chernobyl accident

Abstract

This comparison study examined the relation between presumed level of exposure to the accident at Chernobyl in 1986 to symptoms of post-traumatic stress disorder (PTSD) and other psychological symptoms (depression, somatization, anxiety, obsessive-compulsive style and interpersonal sensitivity), life events and the negative appraisal of the events surrounding the accident. The sample (N = 708) included new immigrants from the former Soviet Union (Confederation of Independent States) who arrived in Israel since 1989 from more exposed areas (n = 137), less exposed (n = 240) and a comparison sample (n = 331) who immigrated from other republics. The exposed groups had higher mean scores on all psychological outcome measures than the comparison group, particularly symptoms of PTSD. Both subsequent stressful life events and a negative, cognitive assessment of events contributed to present psychological distress, independent of exposure.     

Non-binary and binary transgender youth: Comparison of mental health,self-harm,suicidality, substance use and victimization experiences

ABSTRACT

?Background: Little research has compared the mental health and victimization experiences of non-binary youth depending on their sex assigned at birth (SAAB), or compared these two groups with binary transgender youth.

Aims: To compare mental health, self-harm and suicidality, substance use and victimization experiences between non-binary and binary transgender young adults, both male assigned at birth (MAAB) and female assigned at birth (FAAB).

Methods: Online survey data from 677 participants from the “Youth Chances” community study of 16 to 25 year olds in the United Kingdom was analyzed, comparing across binary participants (transgender females (n = 105) and transgender males (n = 210)) and non-binary participants (MAAB (n = 93) and FAAB (n = 269)).

Results: Female SAAB participants (binary and non-binary) were more likely to report a current mental health condition and history of self-harm than male SAAB participants (binary and non-binary). Similarly, female SAAB participants (binary and non-binary) were more likely to report childhood sexual abuse than male SAAB participants (binary and non-binary); the reverse pattern was found for lifetime physical assault relating to being LGBTQ. Non-binary MAAB participants were less likely than the other groups to report past suicide attempts and previous help-seeking for depression/anxiety. Binary participants reported lower life satisfaction than non-binary participants. For all four groups, mental health problems, self-harm, suicidality, alcohol use and victimization experiences were generally higher than that of youth in general population studies.

Conclusions: These findings highlight the importance of considering both non-binary versus binary gender identity and SAAB in relation to mental health problems, self-harm, suicidality and substance use in transgender youth. The roles of sexual abuse, other abuse and discrimination in contributing to increased rates of mental illness and self-harm in non-binary and binary transgender individuals, particularly those who were assigned female at birth, relative to those assigned male, require investigation.     

Social Anxiety and Specificity of Positive Alcohol Expectancies: Preliminary Findings

This preliminary study examined the relationship between social anxiety and specificity of positive alcohol outcome expectancies (AOE) in a community sample of 62 drinking adults. The sample was divided into subsets of socially anxious (n = 17) and nonsocially anxious (n = 45) men and women. The Drinking Expectancy Questionnaire (DEQ) and Alcohol Expectancies in Social Evaluative Situations Scale (AESES) were used to determine if groups differed in the general positive AOE they hold, or only in AOE specific to social situations. ANOVAs revealed that socially anxious individuals had greater positive AOE specific to social situations (DEQ—Assertion scale and AESES) than nonsocially anxious individuals, with no differences in other positive AOE. Partial correlations controlling for social anxiety revealed that AOE specific to social situations correlated with greater drinking and alcohol dependency levels. Findings indicate that identification of AOE specific to social situations may be useful in classifying socially anxious individuals at risk for alcoholism and as a focus of expectancy challenge strategies for individuals with co-occurring social anxiety and drinking problems.     

Multiaxial taxonomy of fibromyalgia syndrome patients

Pain, disability, and depression are present in various degrees in patients with fibromyalgia syndrome. Cluster analysis was used in this research to ascertain the existence of subgroups of patients in a fibromyalgia sample based on these variables. Two clusters were defined: one characterized by high levels of pain, disability, and depression (n=51) and another characterized by low levels of pain, disability, and depression (n=67). Multivariate analysis of variance (MANOVA) confirmed differences between clusters on these health status factors and a second MANOVA revealed that the subgroup with a poorer health status reported greater passive coping, helplessness, and stress, and less satisfaction with social support, than the subgroup with better health status. Logistic regression indicated that the best discriminator of subgroup membership was helplessness. These results suggest that different approaches to patient management, particularly intervention strategies aimed at reducing helplessness, may be beneficial for patients with high levels of pain, disability, and depression.     

Occupational Stressors, Stress Responses, and Alcohol Consumption Among Professional Firefighters: A Prospective, Longitudinal Analysis

This dual-site longitudinal prospective study monitored and measured change in self-reported occupational stressors, emotional trauma, symptoms of stress, and alcohol consumption in urban firefighters. Study participants were 188 firefighters employed by two urban fire departments. The results showed that of 19 occupational stressors examined, only 5 (26%) changed significantly over time, and of those 5, only two—job skill concerns and concerns regarding reduction in force and benefits—decreased, reflecting less bothersome subjective ratings. Of the 12 measures of posttraumatic and other symptoms of stress, 9 (75%) increased significantly over time and none decreased significantly, whereas alcohol consumption was stable over time. Job stressors, trauma caseness, and stress response symptoms at baseline were strongly and significantly associated with the same measures at the two-year follow-up. The implications of the findings for prevention and remediation of stress disorders in fire service personnel are considered. It can be concluded that the stressful nature of urban firefighting is significantly associated with negative health outcomes, including the potential overreliance on alcohol use.     

The Nature of Generalized Anxiety in Older Primary Care Patients: Preliminary Findings

Clinical features of older primary care patients with GAD (PC-GAD; n = 22) were examined relative to older patients with GAD recruited for two academic clinical trials (M. A. Stanley, J. G. Beck, et al., 2003; J. L. Wetherell, M. Gatz, & M. G, Craske, 2003) and to a sample of older primary care patients without psychiatric diagnoses (No Dx; n = 10). Comparisons revealed similar levels of worry, anxiety, depressive symptoms, quality of life, and functional status between the PC-GAD subsample and patients recruited for academic trials, although primary care patients were older, less well educated, and more ethnically diverse. The PC-GAD subgroup, however, reported greater symptom severity, reduced quality of life, and poorer perceived general health, mental health, and vitality than the No Dx subgroup (² = .23–.43). Service utilization was not different between PC-GAD and No Dx subgroups, with the exception of psychotropic medication use. The Penn State Worry Questionnaire (PSWQ) and an abbreviated version of this measure may be useful for identifying late-life GAD in primary care. Cutoff scores of 50 and 22 on the full and abbreviated versions of the PSWQ, respectively, demonstrated excellent specificity, sensitivity, and positive predictive value. Negative predictive value was less impressive, probably as a result of high base rates for GAD in this sample.     

Predicting high risk sexual behaviour in heterosexual and homosexual men: the roles of impulsivity and sensation seeking

Impulsivity and sexual sensation seeking were examined as personality correlates of high risk sexual behaviour — unprotected sex with multiple partners — in samples of heterosexual (n=112) and homosexual (n=104) men. Among heterosexuals, both personality variables were associated with frequency of unprotected sex but only sexual sensation seeking was associated with number of sex partners. Sexual sensation seeking also mediated the association between use of drugs other than alcohol and number of sex partners. Among homosexuals, no personality or substance use variables predicted high risk sexual behaviour. Implications of the findings for the study of determinants of sexual risk-taking are discussed.     

WOMEN, HOMELESSNESS, AND SUBSTANCE ABUSE Moving Beyond the Stereotypes

This study examined the characteristics of homeless women with sub stance abuse problems. Data were collected on a sample of 323 home less substance abusers. First, 49 women and 274 men were compared to demonstrate distinct problems and treatment needs of the women. Results showed that the women were more likely than the men to abuse drugs, but less likely to receive substance abuse treatment. In addition, women spent more time in doubled-up living arrangements, and were more likely to receive outpatient psychiatric treatment. Second, two subgroups of women were compared: those who had been homeless for 6 months or less, and those who had been homeless longer than 6 months during their lifetime. The women who had been homeless longer were less educated, younger when they first became homeless, and were more likely to abuse alcohol, to have been assaulted, and to have attempted suicide. Implications for research and treatment are discussed.     

Social Problem-Solving and Suicidal Ideation Among Homeless Youth Receiving a Cognitive Therapy Intervention: A Moderated Mediation Analysis

Despite the high prevalence of suicidal ideation and attempts among homeless youth, little research has examined how suicide prevention interventions influence suicide-related risk and protective factors, and ultimately produce positive outcome in suicidality in this population. Drawing on the Diathesis-Stress Model and the Interpersonal Theory of Suicide, the current study examined whether participation in Cognitive Therapy for Suicide Prevention (CTSP) moderated the mediation link between social problem-solving, perceived burdensomeness and thwarted belongingness, and suicidal ideation among a sample of homeless youth experiencing suicidal ideation. Social problem-solving refers to a set of cognitive, emotional, and behavioral coping responses in the face of stressful situations, and it is identified as a potent protective factor in alleviating perceived burdensomeness and thwarted belongingness, and reducing suicidal ideation. Participants included 150 homeless youth (M age = 20.99, range = 18-24; 41% female) who were randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Treatment as Usual (TAU) (n = 75) or Treatment as Usual alone (n = 75). Participants were assessed at baseline, 3, 6, and 9 months post-baseline. Findings showed that perceived burdensomeness mediated the association of social problem-solving with suicidal ideation only among youth participating in the CTSP condition. These findings provide evidence to support the promising effects of CTSP in enhancing the protective effects of social problem-solving on suicidal ideation through the mediating effects of perceived burdensomeness. Findings also have implications for improving intervention effectiveness with a community-based population at high risk of suicide.     

Gender differences in victimized homeless adolescents

Most of what we know about sexual abuse comes from efforts to examine female children victimized by men. Although some researchers have identified similarities between male and female victims of sexual abuse, few studies have examined gender-specific factors associated with sexual health practices among homeless adolescents. The aim of this study was to explore how gender and history of sexual abuse influence cognitive-perceptual and behavioral factors associated with sexual health practices of homeless adolescents. This study was a secondary analysis of data collected for a cross-sectional study of the sexual health practices of homeless adolescents. The sample consisted of 414 youths (104 males who reported sexual abuse and 124 who did not; and 95 females who reported sexual abuse and 75 who did not; 16 did not provide these data). Homeless adolescent females with a history of sexual abuse scored higher (indicating a shorter perspective) on a measure of future time perspective than females with no sexual abuse. Males who reported no sexual abuse scored higher than abused females on perceived health status and higher than abused males on assertive communication. With respect to perceived health status, males who reported no sexual abuse scored significantly higher than females who reported sexual abuse (p = .04). Males with no sexual abuse had significantly higher assertive communication scores than did males who had experienced sexual abuse (p = .015). We found that male and female abuse victims differ in terms of their cognitive-perceptual and behavioral factors associated with sexual health practices. Early identification of those who have been abused is critical so that interventions can be developed. Effective short-term interventions are needed for the adolescent victims of Child Sexual Abuse (CSA), particularly those who are homeless and prone to further sexual victimization.     

Patterns of friendship among girls with and without attention-deficit/hyperactivity disorder

Examined patterns of friendship participation, stability, and quality among previously unfamiliar, ethnically diverse girls with attention-deficit/hyperactivity disorder (ADHD; n = 140) and comparison (n = 88) girls, aged 6–12 years, who attended 5-week naturalistic summer camps. Each girl completed sociometric nominations during Weeks 1, 3, and 5 of the camps; friendships were indexed by examining patterns of reciprocal nominations. At each assessment point, girls with ADHD had fewer mutual friends and were more likely to have no friends. Girls with Combined-type ADHD exhibited difficulties maintaining friendships from the beginning to middle of camp, whereas girls with Inattentive-type ADHD demonstrated poor friendship stability from the middle to end of camp. In general, girls with ADHD had higher levels of negative relationship features—including conflict and relational aggression—than did comparison girls, but levels of positive relationship features did not differ across subgroups. Friendship status predicted positive and negative peer regard, controlling for Verbal IQ and diagnostic status. Overall, although girls with ADHD were able to make friends to some extent, they differed from comparison girls in terms of the likelihood of doing so, the ability to maintain the friendships that they did form, and the levels of negative features found in their friendships.     

Sequential validation of cluster analytic subtypes of homeless veterans

To identify subgroups within the homeless population, a number of researchers have employed cluster analytic statistical procedures. Although this is an appropriate application of cluster analysis, many studies have not employed important statistical safeguards against arbitrary results. This study demonstrates a cluster analytic procedure—sequential validation—that enhances the replicability, external validity, and cross-validity of cluster solutions. The procedure is applied to a nationwide sample of 745 homeless veterans. After 12 different clustering procedures were subjected to derivation, replication, external validation, and cross-validation phases, a 4-cluster Ward solution emerged as the most sound. Substantively, the clusters were an alcoholic subtype, a psychiatrically impaired subtype, a best functioning subtype, and a multiproblem subtype. The generalizability of these subgroups to other contexts was assessed by comparing them to subgroups identified in other homelessness research. Suggestions were made for improving the quality of cluster analytic research in community psychology.     

Five-Factor Measure of Borderline Personality Traits

This study provides psychometric data for a new self-report measure of borderline personality traits from the perspective of the Five-factor model (FFM) of general personality. Subscales were constructed in an undergraduate sample (n = 109) to assess maladaptive variants of 12 FFM traits (e.g., Affective Dysregulation as a maladaptive variant of FFM Vulnerability). On the basis of data from a second undergraduate sample (n = 111), the Five Factor Borderline Inventory (FFBI) subscales were shown to have good internal consistency, convergent, discriminant, and incremental validity. These psychometric results were replicated in a clinical sample of female residents at a substance abuse treatment facility (n = 94).