Experiences of Discrimination Among Homeless Young Adults: Relationship to Mental Health Outcomes

Background: Homeless youth (HY) experience discrimination in their day to day lives for multiple reasons.  Not only is homelessness itself a stigmatized status, but HY also disproportionally come from marginalized groups, including overrepresentation of LGBT youth and youth of color. Minority stress theory posits that marginalized status and experiences of discrimination adversely impact mental health outcomes.  This study sought to 1) document experiences of discrimination among homeless youth and 2) understand the mental health outcomes associated with perceived discrimination using a large, multi-city sample.

Methods: This study used data from the Homeless Youth Risk and Resilience Survey (HYRRS), a self-report survey administered in 4 cities (Houston, LA, Denver, and Phoenix; N=834). Data were collected via tablet-administered surveys using standardized instruments. Discrimination was measured with the short version of the Everyday Discrimination Scale (Williams et al, 1997) which assessed how often youth experienced five forms of discrimination (e.g., being treated with less courtesy than other people, people acting as if you are not as smart as others, and being threatened or harassed). A follow-up question asked those with reported discrimination to report the perceived reason(s) for those experiences from a list of 12 potential reasons (e.g., homelessness status, race).  Mental health measures included depression (PHQ-9; Kroenke et al, 2001), psychological distress (K-6; WHO, 2003), PTSD (PC-PTSD; Prins et al, 2003), and suicidal thoughts/attempts (NSDUH, 2015).  Analyses examined frequencies of discrimination experiences and perceived causes, then used ANOVA tests to assess whether overall discrimination varied by race, gender, LGBT, or housing status.  Multivariable models were then analyzed to assess associations between discrimination and each mental health variable, controlling for demographic variables. 

Results: Three quarters of participants (76%) reported having at least one of the five experiences of discrimination several times a year or more.  Most common perceived reasons for discrimination were homelessness (51%), physical appearance (43%), race (41%), and age (35%). HY who had spent the previous night on the streets (F=4.83, p<.01) and those who identified as LGBT (F=8.58, p<.001) were more likely to report discrimination than their temporarily housed and straight/cisgender counterparts. Discrimination was a significant predictor of each of the mental health outcomes after controlling for demographic variables (PHQ-9, B=.57, SE=.04; K-6, B=.49, SE=.04; PTSD, B=.10, SE=.01; Suicide Attempt, B=.05, SE=.02).

Conclusions: Findings underscore that most HY experience discrimination for multiple reasons.  And, these experiences contribute to increased mental health symptoms.  Providers working with HY should validate these experiences, acknowledging that homelessness itself is a prevalent reason for experiences of discrimination. Mental health service providers working with HY may need to explicitly assess and process experiences of discrimination. In addition, the pervasiveness of these experiences across multiple cities underscores the need for community-wide interventions to increase education, promote tolerance, and reduce the stigma that may be fueling these experiences of discrimination. Finally, critical consciousness-raising projects, such as youth participatory action research, may help HY make sense of experienced discrimination and resist it as a group rather than internalizing these oppressive messages.