Clinical and functional characteristics of young adults living in single room occupancy housing: preliminary findings from a 10-year longitudinal study

Barbic, Skye; Jones, Andrea A.; Woodward, Melissa L.; Piercy, Matt; Mathias, Steve; Vila‐Rodriguez, Fidel; Leonova, Olga; Smith, G.; Buchanan, Tari; Vertinsky, Alexandra T.; Gillingham, Stephanie; Panenka, William J.; Rauscher, Alexander; Barr, Alasdair M.; Procyshyn, Ric M.; MacEwan, G. William; Lang, Donna J.; Thornton, Allen E.; Heran, Manraj K.S.; Leon, Adelena; Krausz, Michael; Honer, William G.

doi:10.17269/s41997-018-0087-9

Cited by 22 publications

(31 citation statements)

References 45 publications

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“…The Hotel Study is planned as a 20-year, naturalistic, longitudinal prospective study following an adult, community-based sample [ 23 , 34 , 39 ]. Briefly, participants were recruited from single-room occupancy (SRO) hotels (n = 372) and a sequential series from the community court (n = 65) in a circumscribed neighborhood of downtown Vancouver, Canada from November 1, 2008 to October 26, 2015.…”

Section: Methodsmentioning

confidence: 99%

Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada

et al. 2020

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Background The “trimorbidity” of substance use disorder and mental and physical illness is associated with living in precarious housing or homelessness. The extent to which substance use increases risk of psychosis and both contribute to mortality needs investigation in longitudinal studies. Methods and findings A community-based sample of 437 adults (330 men, mean [SD] age 40.6 [11.2] years) living in Vancouver, Canada, completed baseline assessments between November 2008 and October 2015. Follow-up was monthly for a median 6.3 years (interquartile range 3.1–8.6). Use of tobacco, alcohol, cannabis, cocaine, methamphetamine, and opioids was assessed by interview and urine drug screen; severity of psychosis was also assessed. Mortality (up to November 15, 2018) was assessed from coroner’s reports and hospital records. Using data from monthly visits (mean 9.8, SD 3.6) over the first year after study entry, mixed-effects logistic regression analysis examined relationships between risk factors and psychotic features. A past history of psychotic disorder was common (60.9%). Nonprescribed substance use included tobacco (89.0%), alcohol (77.5%), cocaine (73.2%), cannabis (72.8%), opioids (51.0%), and methamphetamine (46.5%). During the same year, 79.3% of participants reported psychotic features at least once. Greater risk was associated with number of days using methamphetamine (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.05–1.24, p = 0.001), alcohol (aOR 1.09, 95% CI 1.01–1.18, p = 0.04), and cannabis (aOR 1.08, 95% CI 1.02–1.14, p = 0.008), adjusted for demographic factors and history of past psychotic disorder. Greater exposure to concurrent month trauma was associated with increased odds of psychosis (adjusted model aOR 1.54, 95% CI 1.19–2.00, p = 0.001). There was no evidence for interactions or reverse associations between psychotic features and time-varying risk factors. During 2,481 total person years of observation, 79 participants died (18.1%). Causes of death were physical illness (40.5%), accidental overdose (35.4%), trauma (5.1%), suicide (1.3%), and unknown (17.7%). A multivariable Cox proportional hazard model indicated baseline alcohol dependence (adjusted hazard ratio [aHR] 1.83, 95% CI 1.09–3.07, p = 0.02), and evidence of hepatic fibrosis (aHR 1.81, 95% CI 1.08–3.03, p = 0.02) were risk factors for mortality. Among those under age 55 years, a history of a psychotic disorder was a risk factor for mortality (aHR 2.38, 95% CI 1.03–5.51, p = 0.04, adjusted for alcohol dependence at baseline, human immunodeficiency virus [HIV], and hepatic fibrosis). The primary study limitation concerns generalizability: conclusions from a community-based, diagnostically heterogeneous sample may not apply to specific diagnostic groups in a clinical setting. Because one...

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Section: Methodsmentioning

confidence: 99%

Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada

et al. 2020

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“…1 Cross-sectional studies indicate multimorbid illness is associated with functional impairment in youth and older homeless or precariously housed people, however, the long-term trajectories of functioning are not well described. 4,5 Age-related functional impairments are disproportionately higher in homeless people over 50 years old, possibly creating vulnerability to early dementia and accelerated ageing. 6,7 Cognitive functioning is of particular interest given its importance for daily living, yet it is an often overlooked health outcome.…”

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confidence: 99%

Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study

et al. 2020

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Background Homeless and precariously housed individuals experience a high burden of comorbid illnesses, and excess mortality. Cross-sectional studies report a high rate of cognitive impairment. Long-term trajectories have not been well investigated in this group. Aims To longitudinally assess risks for premature and/or accelerated cognitive ageing, and the relationship with early mortality in homeless and precariously housed people. Method This is a 9-year community-based study of 375 homeless and precariously housed individuals from Vancouver, Canada. Annual cognitive testing assessed verbal learning and memory, and inhibitory control. Linear mixed-effects models examined associations between clinical risk factors (traumatic brain injury, psychotic disorders, viral exposure, alcohol dependence) and cognitive change over 9 years. Cox regression models examined the association between cognition and mortality. Results Traumatic brain injury and alcohol dependence were associated with decline in verbal memory. Inhibitory control declined, independent of risk factors and to a greater extent in those who died during the study. Better inhibitory control was associated with a 6.6% lower risk of mortality at study entry, with a 0.3% greater effect for each year of life. For each one-point increase in the Charlson Comorbidity Index score at study entry, the risk of mortality was 9.9% higher, and was consistent across age. Adjusting for comorbidities, inhibitory control remained a significant predictor of mortality. Conclusions Findings raise the possibility of a premature onset, and accelerated trajectory, of cognitive ageing in this group of homeless and precariously housed people. Traumatic brain injury, alcohol dependence and cognition could be treatment priorities.

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“…For descriptive analyses in the present study we evaluate adults (≥ age 30 at assessment) and youth (<29.9 at assessment) separately. 4 The study was approved by the Clinical…”

Section: Study Design and Participantsmentioning

confidence: 99%

Characterizing traumatic brain injury and its association with homelessness in a community-based sample of precariously housed adults and youth

Stubbs

Thornton

Gicas

et al. 2019

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We characterized the prevalence, mechanisms, and sex difference of lifetime traumatic brain injury (TBI) in a precariously housed sample. We also examined the impact of TBI severity and timing on becoming and staying homeless. 285 precariously housed participants (adults n = 226, youths n = 59) completed the Brain Injury Screening Questionnaire (BISQ) in addition to other health assessments. A history of TBI was reported in 82.1% of the sample, with 64.6% reporting > 1 TBI, and 21.4% reporting a moderate or severe TBI (msTBI). 10.1% of adults had traumatically-induced lesions on MRI scans. Assault was the most common mechanism of injury overall, and females reported significantly more TBIs due to physical abuse than males (adjusted OR = 1.26, 95% CI = 1.14 - 1.39, p = 9.18e-6). The first msTBI was significantly closer to the first experience of homelessness (b = 2.79, p = 0.003) and precarious housing (b = 2.69, p = 7.47e-4) than was the first mild TBI. Traumatic brain injuries more proximal to the initial loss of stable housing were associated with a longer lifetime duration of homelessness (RR = 1.04, 95% CI = 1.02 - 1.06, p = 6.8e-6) and precarious housing (RR = 1.03, 95% CI = 1.01 - 1.04, p = 5.5e-10). These findings demonstrate the high prevalence of TBI in vulnerable persons and the severity- and timing-related risk that TBI may confer for the onset and prolongation of homelessness.

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Clinical and functional characteristics of young adults living in single room occupancy housing: preliminary findings from a 10-year longitudinal study

Cited by 22 publications

References 45 publications

Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada

Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada

Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study

Characterizing traumatic brain injury and its association with homelessness in a community-based sample of precariously housed adults and youth

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