Harvard Medical School, Boston, Massachusetts; MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.
MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.
Am J Prev Med. 2020 Jun;58(6):807-816. doi: 10.1016/j.amepre.2019.12.017. Epub 2020 Mar 5.
Adverse childhood experiences are known risk factors for a range of social, economic, and health-related outcomes over the life course. Resilience is a known protective factor. This study examines the associations of adverse childhood experiences and resilience with poor mental health outcomes among homeless adults with mental illness.
This study utilized data from 565 homeless adults with mental illness participating in a Housing First intervention in Toronto (2009-2013) to evaluate their sociodemographic characteristics, adverse childhood experience exposure, resilience, and mental health outcomes. Descriptive statistics were generated, and logistic regression models were used to examine the association of total adverse childhood experience score and resilience with poor mental health outcomes. Analyses were conducted in 2019.
The average total adverse childhood experience score was 4.1 (SD=2.8) among all study participants. Individuals with a lifetime duration of homelessness exceeding 36 months (p=0.011) had higher mean scores. Total score was positively associated with several mental illness diagnoses and psychopathology severity, indicated by co-occurring mental illness diagnoses (AOR=1.23, 95% CI=1.13, 1.33) and high Colorado Symptom Index scores (AOR=1.26, 95% CI=1.14, 1.38). Resilience served as a protective factor against several individual mental illness diagnoses, co-occurring mental illness diagnoses (AOR=0.85, 95% CI=0.76, 0.95), and high Colorado Symptom Index scores (AOR=0.69, 95% CI=0.61, 0.79).
Findings highlight the high prevalence of adverse childhood experiences and their negative impact on homeless adults with mental illness. Resilience protects against adverse childhood experience-associated poor mental health outcomes, thereby serving as a potential interventional target in homeless populations.
不良的童年经历是一系列社会、经济和健康相关结果的已知风险因素，贯穿人的一生。韧性是已知的保护因素。本研究调查了不良童年经历和韧性与无家可归的精神病患者不良心理健康结果之间的关系。
本研究利用了 565 名参加多伦多住房优先干预的无家可归精神病患者的数据（2009-2013 年），评估了他们的社会人口统计学特征、不良童年经历暴露、韧性和心理健康结果。生成了描述性统计数据，并使用逻辑回归模型来检验总不良童年经历得分和韧性与不良心理健康结果的关联。分析于 2019 年进行。
所有研究参与者的平均总不良童年经历得分为 4.1（标准差=2.8）。有终生无家可归时间超过 36 个月的个体（p=0.011）的平均得分更高。总得分与多种精神疾病诊断和精神病理学严重程度呈正相关，表现为同时存在的精神疾病诊断（优势比[OR]=1.23，95%置信区间[CI]=1.13，1.33）和高科罗拉多症状指数得分（OR=1.26，95%CI=1.14，1.38）。韧性是多种个体精神疾病诊断、同时存在的精神疾病诊断（OR=0.85，95%CI=0.76，0.95）和高科罗拉多症状指数得分（OR=0.69，95%CI=0.61，0.79）的保护性因素。
研究结果强调了不良童年经历的高发生率及其对无家可归的精神病患者的负面影响。韧性可预防不良童年经历相关的不良心理健康结果，因此可作为无家可归人群的潜在干预目标。
