财务压力、精神疾病与无家可归：一项全国性纵向研究的结果。

Financial Strain, Mental Illness, and Homelessness: Results From a National Longitudinal Study.

机构信息

National Center on Homelessness Among Veterans, Washington, DC.

VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC), Durham VA Medical Center.

出版信息

Med Care. 2021 Apr 1;59(Suppl 2):S132-S138. doi: 10.1097/MLR.0000000000001453.

DOI:10.1097/MLR.0000000000001453

PMID:33710085

Abstract

BACKGROUND

Research indicates that adults with severe mental illness have lower income and employment than adults without severe mental illness. Further, mental illness has been identified as a risk factor for homelessness. However, little research has investigated the interrelationships between financial strain, mental illness, and homelessness. It is unknown whether or to what extent financial strain mediates the association between mental illness and subsequent homelessness.

METHODS

This study examined financial strain and severe mental illness (psychotic, bipolar, and depressive disorders in the past 12 months) as predictors of subsequent homelessness and financial strain as a mediator of the link between severe mental illness and homelessness by analyzing data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (n=34,653).

RESULTS

χ2 and multivariable analyses revealed that financial crises and debt, lower income, unemployment, and past homelessness at wave 1 each significantly predicted subsequent homelessness between waves 1 and 2. For participants with and without severe mental illness, risk of homelessness between waves 1 and 2 increased as a function of the number of financial strain variables at wave 1. Mediation analyses showed a direct effect of severe mental illness on future homelessness as well as an indirect effect via greater financial strain, which accounted for 39% of the link between mental illness and homelessness.

CONCLUSIONS

The findings showing that financial strain mediated the association between severe mental illness and homelessness support assessment of financial well-being in the context of treatment of mental illness and homeless service programs. The results suggest that individuals experiencing homelessness who have severe mental illness may benefit from assistance increasing financial literacy, improving money management, and achieving financial well-being.

摘要

背景

研究表明，患有严重精神疾病的成年人的收入和就业率低于没有严重精神疾病的成年人。此外，精神疾病已被确定为无家可归的一个风险因素。然而，很少有研究调查财务压力、精神疾病和无家可归之间的相互关系。目前还不清楚财务压力是否以及在何种程度上调解精神疾病与随后无家可归之间的关联。

方法

本研究通过分析全国酒精相关情况流行病学调查（National Epidemiologic Survey on Alcohol and Related Conditions，NESARC）第 1 波和第 2 波的数据（n=34653），考察了财务压力和严重精神疾病（过去 12 个月中的精神分裂症、双相情感障碍和抑郁症）作为随后无家可归的预测因素，以及财务压力作为严重精神疾病与无家可归之间联系的中介，来分析财务压力和严重精神疾病与随后无家可归之间的关系。

结果

χ2 和多变量分析表明，第 1 波的财务危机和债务、收入较低、失业以及过去的无家可归情况，均显著预测了第 1 波和第 2 波之间的后续无家可归。对于患有和不患有严重精神疾病的参与者来说，第 1 波和第 2 波之间无家可归的风险随着第 1 波财务压力变量数量的增加而增加。中介分析显示，严重精神疾病对未来无家可归既有直接影响，也通过更大的财务压力产生间接影响，后者占精神疾病和无家可归之间关联的 39%。