School of Nursing, University of California, San Francisco.
Center for Vulnerable Populations, University of California, San Francisco.
JAMA Netw Open. 2024 Aug 1;7(8):e2427956. doi: 10.1001/jamanetworkopen.2024.27956.
Depression is common in adults experiencing homelessness. It is unclear whether continued homelessness is associated with more depressive symptoms.
To examine the association between residential status and depressive symptoms in adults aged 50 years or older experiencing homelessness at study entry.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age (HOPE HOME) project, which in 2013 began enrolling adults aged 50 years or older experiencing homelessness in Oakland, California, and conducted structured interviews every 6 months for a mean duration of 5.5 years through 2023 (for this cohort study). Eligible participants included those aged 50 years or older, able to speak English, and experiencing homelessness at enrollment. We analyzed data collected from 2013 to 2023.
The exposure of interest was residential status. At follow-up visits, residential status was categorized as (1) homelessness (meeting the HEARTH [Homeless Emergency Assistance and Rapid Transition to Housing] Act definition) or (2) housed (living in a noninstitutional environment and not meeting the HEARTH Act definition).
The primary outcome was moderate to severe depressive symptoms (with Center for Epidemiologic Studies-Depression [CES-D] scale score ≥22). The augmented inverse probability of treatment weighting (AIPTW) approach was used to examine the association between continued homelessness and depressive symptoms. The AIPTW adjusted for the following variables: number of chronic health conditions, age, sex, visiting a health care practitioner, receiving outpatient mental health treatment, receiving mental health medication, exposure to abuse, substance use disorder, and binge drinking.
The cohort was composed of 450 participants, of whom 343 (76.2%) were males, and the mean (SD) age was 58.5 (5.2) years. Participants completed a median (IQR) of 8.9 (8-11) follow-up visits. With 1640 person-years of observation time, participants continued homelessness for 880 person-years (57.1%) and experienced being housed for 715 person-years (44.3%). Many participants (304 [78.0%]) were housed during at least 1 follow-up visit. The odds of a CES-D scale score of 22 or higher was significantly higher among participants who continued experiencing homelessness than among housed participants (marginal causal odds ratio, 1.08; 95% CI, 1.04-1.11; P < .001).
This cohort study found that continued homelessness was associated independently with increased odds of depressive symptoms. Obtaining housing may have a favorable role in depression and overall well-being of older adults experiencing homelessness and may be considered as a mental health intervention.
在经历无家可归的成年人中，抑郁症很常见。目前尚不清楚持续无家可归是否与更多的抑郁症状有关。
在研究开始时，检查年龄在 50 岁或以上经历无家可归的成年人的居住状况与抑郁症状之间的关系。
设计、地点和参与者：这项队列研究分析了“中老年经历无家可归者健康结果（HOPE HOME）”项目的结果，该项目于 2013 年开始在加利福尼亚州奥克兰招募年龄在 50 岁或以上经历无家可归的成年人，并在 5.5 年的平均时间内（对于本队列研究）每 6 个月进行一次结构访谈，直至 2023 年。符合条件的参与者包括年龄在 50 岁或以上、能够讲英语和在入组时经历无家可归的人。我们分析了 2013 年至 2023 年收集的数据。
感兴趣的暴露因素是居住状况。在随访期间，居住状况分为（1）无家可归（符合 HEARTH [无家可归紧急援助和快速过渡到住房]法案的定义）或（2）有房（居住在非机构环境中且不符合 HEARTH 法案的定义）。
主要结果是中度至重度抑郁症状（采用中心流行病学研究-抑郁量表[CES-D]评分≥22）。采用增强逆概率治疗加权（AIPTW）方法来检查持续无家可归与抑郁症状之间的关联。AIPTW 调整了以下变量：慢性健康状况的数量、年龄、性别、就诊医疗保健从业者、接受门诊心理健康治疗、接受心理健康药物治疗、暴露于虐待、物质使用障碍和狂饮。
该队列由 450 名参与者组成，其中 343 名（76.2%）为男性，平均（SD）年龄为 58.5（5.2）岁。参与者完成了中位数（IQR）为 8.9（8-11）次随访。在 1640 人年的观察时间内，参与者无家可归的时间为 880 人年（57.1%），有房的时间为 715 人年（44.3%）。许多参与者（304[78.0%]）在至少一次随访中都有房。与有房的参与者相比，持续无家可归的参与者 CES-D 量表评分为 22 或更高的可能性显著更高（边缘因果比值比，1.08；95%置信区间，1.04-1.11；P<0.001）。
这项队列研究发现，持续无家可归与抑郁症状的几率增加独立相关。获得住房可能对经历无家可归的老年人的抑郁和整体健康状况有积极作用，可被视为一种心理健康干预措施。
