Intersection of homelessness and mental health: A mixed methods study of young adults who accessed psychiatric emergency services

Young adults who experience homelessness have high rates of mental disorders, yet low rates of outpatient mental health service use. This mixed methods study examined the intersection of homelessness and mental health in a sample of 54 young adults (ages 18–25) who were hospitalized on a short-term, inpatient psychiatric unit. Nearly half (n = 26) reported being homeless in the prior year and more than a quarter were homeless at the time of admission (n = 15). Qualitative analyses identified key factors that contributed to both mental health problems and homelessness including disrupted support networks, fragile family relationships, foster care involvement, substance use and traumatic events. Homelessness was both a facilitator and a barrier to successfully accessing mental health services to manage mental health symptoms. Findings highlight the interconnection of homelessness and mental health and their common relationship with additional underlying risk factors. Providers across service settings need to recognize the overlap of client populations and provide integrated, trauma informed care to address housing instability, mental health, and substance use together.     

A Normative Approach to Parent-Young Adult Child Communication in the Context of Substance Use Disorders: Explicating Parents’ Communication Challenges and Strategies

ABSTRACT

Despite a decrease in substance use among teens, alcohol and substance use has remained high among young adults. Young adult use of illicit substances is particularly concerning. Parents can play an important role in substance use intervention and prevention, but their efforts are sometimes unsuccessful. Therefore, it is important to consider how parents respond to and communicate about their young adult children’s substance use disorder. Most research has privileged confrontation and direct communication as effective coping responses, but evidence suggests that effectiveness hinges on the meanings interactants ascribe to behavior. Through qualitative interviews, the current study develops normative theory regarding parents’ communication challenges and strategies in response to their young adult child’s substance use disorder. Parents’ challenges center on the intersection of support with their own substance use history; others’ divergent views on substance use; uncertainty in illness; relational closeness and harmony; and illness features. Results are discussed in terms of implications for helping parents respond to their young adult child’s substance use disorder.     

Comparing American college and noncollege young adults on e-cigarette use patterns including polysubstance use and reasons for using e-cigarettes

Abstract

Objective: Existing literature on young adults’ e-cigarette and polysubstance use focused on college students. This study examined the differences between college and noncollege groups on prevalence and patterns of e-cigarette and other substance use using data from a national survey. Participants: Adults aged 18–24 from the 2013–2014 Population Assessment of Tobacco and Health Study (n?=?6,608). Methods: Independent sample t-tests and Chi-square tests were conducted to examine group differences. Results: Noncollege young adults had higher prevalence of cigarette, e-cigarette, and marijuana use; college students had higher prevalence of alcohol use. Among current e-cigarette users, college students had higher prevalence of polysubstance use of alcohol and marijuana. College students used e-cigarettes for socializing purposes more. Conclusions: Differences in prevalence and patterns of e-cigarette and other substance use between college and noncollege groups exist. Future interventions should target the social context of college life and reach out to noncollege young adults in workplaces.     

Adolescents’ experiences of therapeutic relationships at high and low levels of risk and resilience

Abstract

Engaging adolescents in treatment requires professionals to negotiate relationship boundaries in ways that young people experience as therapeutic. For this study, we used qualitative data from a mixed methods investigation of 85 young people ages 12-19 who were either clients of two or more human services (n=61) or selected from a convenience sample of young people attending school in the same communities as the service users (n=24). By sorting participants into four groups based on their risk and resilience scores calculated during the quantitative phase of the research, patterns emerged in the quality of the relationships young people reported as the most therapeutic. Findings show that youth at higher levels of risk exposure preferred looser professional boundaries (a real relationship) in their interactions with their workers while those with higher resilience scores described positive relationships with professionals that included more structure, greater expectations and firmer boundaries. Findings suggest that the quality of adolescent client-professional relationships should vary depending on the risk and resilience profiles of the youth.     

Postmigration Living Difficulties,Help-Seeking and Community Resilience in the Initial Stages of Migration: Coproducing Community Practice with Recent Irish Migrants to London

This article describes a community-based participatory action research (CBPAR) project that examined the postmigration living difficulties (PMLD), help-seeking and community resilience of recent Irish migrants to London (n = 176). The majority of respondents were young adults, in managerial or professional occupations and in good or very good health. Mixed methods indicate inadequate planning for relocation and poor social support as the main difficulties in the initial stages of migration. Community factors promoting resilience included employment opportunities, local and transnational supports, and cultural familiarity and acceptance. Community participation in the action orientated phase of this CBPAR is discussed.     

DSM-5 substance use disorders among college-age young adults in the United States: Prevalence,remission and treatment

Abstract

Objective: To determine the prevalence, remission, and treatment associated with DSM-5 substance use disorders (SUDs) among young adults based on college attendance. Participants: The population-based sample included 2,057 young adults aged 19–23 in college/school and 1,213 not currently attending college/school who participated from April 2012 through June 2013. Methods: Face-to-face interviews were conducted as part of a cross-sectional national survey. Results: The prevalence of any past-year DSM-5 SUD was 39.6% among young adults in college and 44.5% among those not attending college. Past-year tobacco use disorder and multiple DSM-5 SUDs were more prevalent among those not attending college. Among those with prior-to-past-year SUDs, abstinent remission was low among college (1.0%) and noncollege (1.9%) young adults. Conclusions: Approximately two in five U.S. college students had at least one past-year DSM-5 SUD. Sustained abstinent remission from SUDs is extremely rare (1–2%) and the majority of those with SUDs do not receive treatment.     

Qualitative accounts of young-people,parents and staff involved with a purpose-designed,pilot short-break service for 18–24 year olds with life-limiting conditions

PurposeTransition to adult health and social-care services is a time of great uncertainty for young adults with life-limiting conditions; due to improved management, many who would have previously died before they were 18 years old are now surviving into early adulthood. Nevertheless, few services exist to meet their specific needs for specialist short breaks away from home. The purpose of this research was to determine the views and perspectives of young adults' parents/carers and staff engaged with a purpose-designed, pilot short-break service for 18–24 year olds with life-limiting conditions. Data were gathered through qualitative individual or focus group interviews involving two young adults, four mothers and fifteen health or social-care staff associated with the service. Data were analysed using Framework Analysis.Principal resultsEmergent themes: (i) The need for a specialist short-break service; (ii) Decision making when using or delivering the service; (iii) Challenges of staffing and financing the service (iv) Meeting young adults' complex needs and preferences (v) Suggestions for how to improve the service.The young adults described how they benefitted from access to specialist, age-appropriate, on-site clinical skills facilities and opportunities to socialise with peers. Mothers said they benefitted from time alone or with other family members in the knowledge that the specialist short break service met the needs and preferences of their child as they made the transition to adult services. However, all participating mothers and staff expressed concern about the future well-being of young adults when they left the service at 24 years old.Major conclusionsThis study provides new information to inform ongoing development of short-break services for the increasing number of young adults with life-limiting conditions who are surviving longer than they would previously have done. This will help to ensure that UK services are responsive to users' needs and preferences.     

The Influence of Parental Separation and Divorce on Father–Child Relationships

ABSTRACT

Using a risk and resilience theoretical framework, this study examined the influence of parental divorce during childhood on father–child relationship quality in young adulthood. Relationship quality was measured using nurturant fathering and modified father involvement scales, and self-reports of current amount of face-to-face and verbal father–child contacts. Comparisons on these measures were made between 107 young adults from intact and 96 from divorced family backgrounds. The divorce group was also examined in isolation to explore how divorce-related factors—including structural, early contact, and interparental relationship factors—predict young adults' perceptions of their father–child relationship. Results demonstrate young adults from intact family backgrounds report a comparatively stronger father–child relationship. Among divorce group participants, structural factors (higher father socioeconomic status and joint custody) and early contact (greater percentage of time spent with father postdivorce) were predictors of higher scores on combined nurturant fathering and involvement measures. Greater early contact and stronger interparental relationship factors (low conflict and high contact and cooperativeness) similarly predicted current contact.     

Prevalence of Metabolic Syndrome and Individual Criteria in College Students

Abstract

Metabolic syndrome (MetS) is present in young adults and because coronary heart disease (CHD) is likely, screening to determine MetS prevalence and its criteria is critical. Objective: To determine MetS prevalence and most prevalent criteria in a sample of first-year college students. Participants: First-year college students between 18 and 24 years of age (n = 189). Methods: Metabolic syndrome was defined using the updated 2001 National Cholesterol Education Programs Adult Treatment Panel III. Anthropometrics and blood pressure were obtained. Lipid and glucose concentrations were determined. Results: Overall prevalence of MetS was 3.7%. Prevalence of 1 or 2 MetS criteria was 28.0% and 7.4%, respectively. Low high-density lipoprotein cholesterol (20.1%) and elevated triacylglycerol (17.5%) concentrations were the most prevalent criteria. Conclusions: Young adults have and are at risk of developing MetS. Identification of MetS early in life is critical and screening young adults will aid in targeted intervention development to decrease CHD risk.     

Evaluation of a Resilience Intervention to Enhance Coping Strategies and Protective Factors and Decrease Symptomatology

Objective: In this pilot study, the authors examined the effectiveness of a 4-week resilience intervention to enhance resilience, coping strategies, and protective factors, as well as decrease symptomatology during a period of increased academic stress. Participants and Methods: College students were randomly assigned to experimental (n = 30) and wait-list control (n = 27) groups. The experimental group received a psychoeducational intervention in 4 two-hour weekly sessions. Measures of resilience, coping strategies, protective factors, and symptomatology were administered pre- and postintervention to both groups. Results: Analyses indicated that the experimental group had significantly higher resilience scores, more effective coping strategies (ie, higher problem solving, lower avoidant), higher scores on protective factors (ie, positive affect, self-esteem, self-leadership), and lower scores on symptomatology (ie, depressive symptoms, negative affect, perceived stress) postintervention than did the wait-list control group. Conclusions: These findings indicate that this resilience program may be useful as a stress-management and stress-prevention intervention for college students.     

Predicting illegal income generation among homeless male and female young adults: Understanding strains and responses to strains

This study examined gender differences among homeless young adults' engagement in illegal economic activity (i.e., panhandling, selling drugs, survival sex, gambling, theft). A purposive sample of 601 homeless young adults (ages 18–24) was recruited from three U.S. cities (Los Angeles, CA [n = 200], Austin, TX [n = 200], and Denver, CO [n = 201]) to participate in semi-structured interviews. General strain theory was used to identify predictors of illegal economic activity, including strains (childhood abuse, street victimization, length of homelessness, transience) and responses to strain (deviant peer associations, substance use, post-traumatic stress disorder, arrest history). The full hypothesized path models for males and females separately were tested using observed-variable path analysis. Among females, a greater variety of illegal income sources was reported by those who had experienced greater street victimization and who had used a greater number of substances in the past year. Among males, a greater variety of illegal income sources was reported by those who had more deviant peer associations, experienced greater street victimization, and used a greater number of substances in the past year. Findings have implications for research and preventive interventions to address engagement in illegal economic activity among male and female homeless young adults.     

Longitudinal predictors of cigarette use among students from 24 Texas colleges

ABSTRACT

Objective: The purpose of this study is to examine differences between current and non-current cigarette users, focusing on sociodemographic factors, non-cigarette tobacco product use, parental and friend use, and alcohol and marijuana use; and to identify predictors of cigarette use sixmonths later. Participants: Participants included young adults (n = 4,296) from 24 Texas colleges, participating in a young adult cohort study, beginning in fall 2014. Methods: Mixed effects logistic regressions were conducted accounting for school-level variability. Results: Cigarette users were older, more likely to report use of non-cigarette tobacco products and peer use of cigarettes than non-current users. Wave 1 cigarette and non-cigarette tobacco product use, marijuana use and binge drinking, and peer use all uniquely predicted cigarette use at wave 2. Conclusions: Colleges need prevention programs targeting multiple tobacco products, because non-cigarette tobacco use and other risky behaviors appear to be independent risk factors for cigarette use in young adults.     

Exploring community stress and empowerment among stakeholders and youth in an urban community

ABSTRACT

Community-level stress, such as pervasive substance abuse and violence, can yield negative health and mental heath outcomes for youth from disadvantaged communities. Community empowerment is a process whereby community members work together to increase control in their community. This qualitative inquiry analyzed in-depth interviews with adult stakeholders (n = 17) as well as focus group interviews with token youth (n = 85) to explore perceptions of community stress and empowerment in one disadvantaged locale. Each of the 102 total participants helped interrogate the research questions: What does it mean to live in a stressed community? How might youth and adults perceive themselves capable of impacting a stressed community’s quality of life? Emergent themes, which include a nod to the utility of coalition building, are explored. Implications for policy, practice, and future research are also discussed.     

Risk and Protective Factors Associated with Personal Mastery Among Sexual Minority African-American Female Sex Workers

Research among sexual minorities has traditionally examined problems such as substance use, HIV risk, mental health problems, and victimization. Among sexual minority street-based female sex workers, these vulnerabilities can be magnified. Grounded in theories of resilience, this study examines risk and protective factors associated with a high level of personal mastery among a vulnerable population of women. Data are drawn from baseline interviews from street-based African-American female sex workers enrolled in a randomized intervention trial in Miami, Florida. We compare sexual minority (N = 197) and heterosexual (N = 365) women on measures of risk and protective factors; among sexual minority women we present logistic regression analyses which reveal that severe mental distress and HIV transmission risk are associated with low levels of personal mastery, while protective factors of transportation access and social support are associated with high levels of personal mastery. These findings suggest that these protective factors may potentially facilitate the development of personal mastery and represent beneficial avenues for intervention efforts.     

Variability in measures of health and health behavior among emerging adults 1 year after high school according to college status

Objective: To examine changes in health behaviors among US emerging adults 1 year after high school. Participants: The national sample of participants (N = 1,927), including those attending 4-year college/university (n = 884), 2-year colleges/technical schools (n = 588), and no college (n = 455), participated in annual spring surveys 2013–2014. Methods: Health behaviors were assessed the last year of high school and first year of college; differences by college status controlling for previous-year values were estimated using regression analyses. Results: Relative to 4-year college attendees, those attending technical school/community college were less likely to binge drink (odds ratio [OR] = 0.57, confidence interval [CI] = 0.38–0.86) but more likely to speed (OR = 1.26, CI = 1.0–2.84), consume sodas (OR = 1.57, CI = 1.0–2.47), and report lower family satisfaction (p < .01), with marginally more physical and depressive symptoms. College nonattendees reported more DWI (driving while intoxicated; OR = 1.60, CI = 1.05–2.47), soda drinking (OR = 2.51, CI = 1.76–3.59), oversleeping (OR = 4.78, CI = 3.65–8.63), and less family satisfaction (p < .04). Conclusions: Health risk behaviors among emerging adults varied by college status.     

Life Experiences and Vulnerabilities of Homeless Women: A Comparison of Women Unaccompanied Versus Accompanied by Minor Children, and Correlates with Children's Emotional Distress

The histories and service needs of 2 groups of homeless women, those unaccompanied by minor children (n = 46) and those accompanied by minor children (n = 22), were compared, on the basis of their responses to a biennial survey of homeless people in a midsize city in the southeast United States. Mothers of children aged 2–10 also completed a measure of stress symptoms for their children (n = 20). Irrespective of family status group, problems such as substance abuse, history of mental illness, health problems, chronicity of homelessness, and crime victimization tended to cluster together. The findings also suggest that declining and/or inadequate levels of public benefits, Temporary Assistance to Needy Families, and Medicaid-funded health care in particular, have adversely affected the 2 groups, particularly families with children. The young children in this sample experienced elevated levels of stress, and significant associations were found between children's stress levels and certain risk factors of their mothers. Implications for service delivery are discussed.     

“To be HIV positive is not the end of the world”: Resilience among perinatally infected HIV positive adolescents in Johannesburg

BackgroundResilience, or positive adaptation to challenging situations, has potential to improve health outcomes for high risk populations. Resilience may be particularly important for perinatally infected HIV positive adolescents, who are exposed to significant stigma, risks and stressors. Despite recognition that HIV positive adolescents show remarkable resilience in the face of adversity, little is known about how resilience occurs within this population.MethodsThe aim of this study was to identify elements of resilience in a group of perinatally infected HIV positive adolescents attending HIV clinics. In-depth interviews were conducted with 25 purposively selected HIV positive adolescents (15 female, 10 male) between the ages of 13–19 years in Johannesburg. Data were analysed in NVIVO 10 using a thematic approach to coding.ResultsDespite marked stressors in the lives of these adolescents, a high degree of resilience was described. Characteristics of resilience in this group included a pertinent set of beliefs, including a belief in fate and recognition of personal strength as a consequence of managing adversity. Character traits such as a pragmatic acceptance about one's life, actively taking responsibility, and a robust self-esteem were evident. Social behaviours included the ability to pursue and access adults and healthcare to meet developmental needs, having a desire to support and help others and challenging HIV related stigma. These characteristics were underscored by the capacity for self-reflection.ConclusionPerinatally infected adolescents, who face high levels of hardship and change, nevertheless exhibit strong resiliency beliefs, traits, and behaviours. Healthcare environments have the potential to be utilized as powerful resources in fostering resilience in HIV positive adolescents, if characteristics of adolescent resilience were integrated into current prevention and intervention programming. Resilience promotion could lead to improved health outcomes for HIV positive adolescents.     

Influence of Expectations for Parental Support on Intergenerational Coresidence Behavior

Abstract

Using the 1988 and 1992 waves of the National Survey of Families and Households (NSFH), this study examines whether the expectation of support by young adults is widely held and if such a belief predicts if young adults will at some point live with their parents before their final launch. At issue is whether or not the increase in young adults in the parental home represents a normative shift in the expectations that children have of their parents or perhaps is indicative of some other process. The findings suggest that expectation of support does in fact predict living at home but only 31% of the respondents felt that parents were obligated to let their adult children live with them. Findings are placed within a broader context of how shifts in age at first marriage and educational attainment influence young adults' transitions out of the home.     

Young Adult Suicide and Sexual Orientation

ABSTRACT

The current project focused on the suicidal ideation and risk potential of young adults (N = 312) and explored scores on self-report measures of suicidal ideation inclusive of various sexual orientations. Results suggest that the Lesbian, Gay, and Bisexual (LGB) youth surveyed (N = 73) differ in their display of suicide risk with significantly higher Beck Hopelessness Scale (BHS) and Suicide Probability Scale (SPS) scores. Social support served as a mitigating factor relating significantly to lower levels of hopelessness and suicidal ideation, especially among those LGB participants. The SPS held a significant relationship to suicide attempt in the past year, while the BHS held a significant relationship to suicide attempt in the past six months. Implications for counselors serving young adults are addressed, including specific suggestions to enhance counselor education and supervision related to suicide assessment and LGB counselor competency.     

The Effects of Childhood Sexual Abuse and Other Trauma on Drug Court Participants

Within the context of a larger study of drug court participants, this study examined the impact of traumatic experiences on psychiatric distress and on court outcomes. In the analyses, the participants (n = 229) were separated into 3 groups: childhood sexual abuse (CSA; n = 18), other trauma (n = 134), and no trauma (n = 77). The CSA group had higher mean scores on depression, anxiety, panic disorder, social phobia, somatization, and posttraumatic stress disorder than the other trauma group. Path analyses suggest that a history of trauma is a positive predictor of psychiatric distress and negative court events (positive urine screens, sanctions, etc.), with indirect effects on substance abuse severity, and failure in the drug court. These results suggest a need for the initial assessment procedure in drug courts to include a screening for trauma history, including CSA. They also suggest a need for trauma-informed care within drug courts.