Department of Psychology, Wilfrid Laurier University, Waterloo, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Canada.
Department of Psychology, Wilfrid Laurier University, Waterloo, Canada.
Soc Sci Med. 2020 Nov;265:113481. doi: 10.1016/j.socscimed.2020.113481. Epub 2020 Oct 31.
Recent research has shown that social integration, involving community integration and social support, can be protective resources for the health of homeless individuals. However, it is not clear how social integration affects health in the transition from homelessness into housing, and subsequent housing retention. This paper examines, through mixed quantitative and qualitative methods, how social integration changes over time, and how these changes relate to housing stability, substance use and mental health outcomes among a sample of homeless individuals experiencing mental illness participating in the At Home/Chez Soi Housing First randomized controlled trial in Canada.
Longitudinal quantitative data (baseline, 6, 12, 24 month) and qualitative data ( 18 month) from the five trial sites (Moncton, Montreal, Toronto, Winnipeg and Vancouver) were examined using mixed models, mediation analyses, and thematic analysis.
Social integration (i.e., social network size, social interest, psychological integration) increased over time among study participants, with social network size increasing significantly more among Housing First participants than Treatment as Usual participants. Social network size mediated the effect of the intervention on the percentage of days in stable housing, indicating that the Housing First intervention may have increased participants' social network size, which in turn increased the percentage of days stably housed. No significant mediation of social integration on the effects of the intervention on mental health and substance use outcomes was found. Findings from the qualitative interviews support and expand upon these quantitative findings.
最近的研究表明，社会融合（包括社区融合和社会支持）可以成为无家可归者健康的保护资源。然而，目前尚不清楚社会融合如何在从无家可归到住房再到随后的住房保留的过渡过程中影响健康。本文通过混合定量和定性方法，研究了社会融合如何随时间变化，以及这些变化如何与住房稳定性、物质使用和心理健康结果相关，研究对象是参与加拿大安身立命住房第一随机对照试验的经历精神疾病的无家可归者样本。
从五个试验点（蒙克顿、蒙特利尔、多伦多、温尼伯和温哥华）的纵向定量数据（基线、6、12、24 个月）和定性数据（18 个月），采用混合模型、中介分析和主题分析进行了检验。
研究参与者的社会融合（即社交网络规模、社交兴趣、心理融合）随时间推移而增加，住房第一组参与者的社交网络规模增长显著大于常规治疗组。社交网络规模中介了干预对稳定住房天数百分比的影响，表明住房第一干预可能增加了参与者的社交网络规模，从而增加了稳定住房的天数百分比。没有发现社会融合对干预对心理健康和物质使用结果的影响有显著的中介作用。定性访谈的结果支持并扩展了这些定量发现。
