Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study

Abstract

Objective: To examine whether childhood adversity is associated with depressive symptoms, suicide attempts, or psychiatric hospitalization.

Methods: History of seven childhood adversities (physical neglect, verbal abuse, physical abuse, sexual abuse, parental death, parental incarceration, and child welfare system placement) was gathered through in-person interviews. Multivariate models examined associations between history of childhood adversities and moderate to severe depressive symptoms, lifetime history of suicide attempt, or lifetime history of psychiatric hospitalization. The study enrolled 350 homeless adults, aged 50 and older, in Oakland, California, using population-based sampling methods. Moderate to severe depressive symptoms were measured on a Center for Epidemiologic Studies-Depression Scale (≥22), self-reported lifetime history of suicide attempt, and self-reported lifetime history of psychiatric hospitalization.

Results: Participants with exposure to one childhood adversity had elevated odds of reporting moderate to severe depressive symptoms (adjusted odds ratio [AOR]: 2.0; 95% confidence interval [CI]: 1.1-3.7) and lifetime history of suicide attempt (AOR: 4.6; 95% CI: 1.0-21.6) when compared with those who had none; the odds of these two outcomes increased with exposure to additional childhood adversities. Participants with four or more childhood adversities had higher odds of having a lifetime history of psychiatric hospitalization (AOR: 7.1; 95% CI: 2.8-18.0); no increase with fewer adversities was found.

Conclusion: Childhood adversities are associated with poor mental health outcomes among older homeless adults. Clinicians should collect information about childhood adversities among this high-risk population to inform risk assessment and treatment recommendations.

Keywords: depression; epidemiology; geriatrics; homeless persons; mental health services; suicide.

Figure 1

Flow-chart of Recruitment of 350 Older Homeless Adults^{a a}This figure shows the number of individuals approached, assessed for eligibility, and enrolled in the study, noting specific reasons for inability to enroll. Values represent the number of individuals in each group. ^bParticipants who declined after being approached (335) were not assessed for eligibility. Therefore, the number of participants who were ineligible for the study may have been higher than the numbers presented in this figure.