Lachaud James, Mejia-Lancheros Cilia, Liu Michael, Wang Ri, Nisenbaum Rosane, Stergiopoulos Vicky, Hwang Stephen W, O'Campo Patricia
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Harvard Medical School, Boston, MA, United States.
Front Nutr. 2021 May 12;8:608811. doi: 10.3389/fnut.2021.608811. eCollection 2021.
We examined the housing trajectories of homeless people with mental illness over a follow-up period of 6 years and the association of these trajectories with food security. We then examined the modifying role of psychopathology and alcohol and substance use disorders in this association. We followed 487 homeless adults with mental illness at the Toronto site of the At Home/Chez-Soi project-a randomized trial of Housing First. Food security data were collected seven times during the follow-up period. Psychopathology (Colorado Symptom Index score) and alcohol and substance use disorders were assessed at baseline. Housing trajectories were identified using group-based trajectory modeling. Logistic regression was used to estimate the association between housing trajectory groups and food security. Three housing trajectory groups were identified: rapid move to consistent stable housing (34.7%), slow and inconsistent housing (52.1%), and never moved to stable housing (13.2%). Individuals included in the rapid move to consistent housing trajectory group had higher odds of remaining food secure compared with those in the never moved to stable housing trajectory group over the follow-up period [AOR 2.9, 95% CI: 1.3-6.6, -value: 0.009]. However, when interactions were considered, this association was significant among those with moderate psychopathology but not severe psychopathology. Individuals with substance use disorder and in the never moved to stable housing group had the lowest food security status. Severe psychopathology and substance use disorders modified the association between housing trajectories and food security. International Standard Randomized Control Trial Number Register (ISRCTN42520374).
我们研究了患有精神疾病的无家可归者在6年随访期内的住房轨迹，以及这些轨迹与粮食安全之间的关联。然后，我们研究了精神病理学以及酒精和物质使用障碍在这种关联中的调节作用。我们跟踪了“在家/ chez - Soi项目”多伦多站点的487名患有精神疾病的无家可归成年人，该项目是一项“住房优先”的随机试验。在随访期间收集了7次粮食安全数据。在基线时评估精神病理学（科罗拉多症状指数评分）以及酒精和物质使用障碍。使用基于群体的轨迹模型确定住房轨迹。采用逻辑回归来估计住房轨迹组与粮食安全之间的关联。确定了三个住房轨迹组：迅速搬至持续稳定住房（34.7%）、缓慢且不稳定住房（52.1%）以及从未搬至稳定住房（13.2%）。在随访期间，与从未搬至稳定住房轨迹组的个体相比，迅速搬至持续稳定住房轨迹组的个体保持粮食安全的几率更高【调整后比值比（AOR）为2.9，95%置信区间（CI）：1.3 - 6.6，P值：0.009】。然而，在考虑交互作用时，这种关联在患有中度精神病理学而非重度精神病理学的个体中显著。患有物质使用障碍且属于从未搬至稳定住房组的个体粮食安全状况最差。重度精神病理学和物质使用障碍改变了住房轨迹与粮食安全之间的关联。国际标准随机对照试验编号注册（ISRCTN42520374）。
