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. 2013 Dec;103 Suppl 2(Suppl 2):S275-81.
doi: 10.2105/AJPH.2013.301323. Epub 2013 Oct 22.

Relationship between adverse childhood experiences and homelessness and the impact of axis I and II disorders

Leslie E Roos  1 , Natalie Mota, Tracie O Afifi, Laurence Y Katz, Jino Distasio, Jitender Sareen
Affiliations

Relationship between adverse childhood experiences and homelessness and the impact of axis I and II disorders

Leslie E Roos et al. Am J Public Health. 2013 Dec.

Abstract

Objectives: We investigated the links between homelessness associated with serious mental and physical healthy disparities and adverse childhood experiences (ACEs) in nationally representative data, with Axis I and II disorders as potential mediators.

Methods: We examined data from the National Epidemiologic Survey of Alcohol and Related Conditions in 2001-2002 and 2004-2005, and included 34,653 participants representative of the noninstitutionalized US population who were 20 years old or older. We studied the variables related to 4 classes of Axis I disorders, all 10 Axis II personality disorders, a wide range of ACEs, and a lifetime history of homelessness.

Results: Analyses revealed high prevalences of each ACE in individuals experiencing lifetime homelessness (17%-60%). A mediation model with Axis I and II disorders determined that childhood adversities were significantly related to homelessness through direct effects (adjusted odd ratios = 2.04, 4.24) and indirect effects, indicating partial mediation. Population attributable fractions were also reported.

Conclusions: Although Axis I and II disorders partially mediated the relationship between ACEs and homelessness, a strong direct association remained. This novel finding has implications for interventions and policy. Additional research is needed to understand relevant causal pathways.

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Figures

FIGURE 1—
FIGURE 1—
Structural equation model adjusted for age, education, household income, marital status, and race/ethnicity on mediator (any Axis I or II) and on dependent (lifetime homeless) variables: National Epidemiologic Survey of Alcohol and Related Conditions, United States, 2001–2002 and 2004–2005.
See this image and copyright information in PMC

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