Factors Associated with Homeless Young Adults' Comorbidity Between Substance Abuse/Dependence and Depression

Background and Purpose:

Mental health problems usually co-occur with substance abuse/dependence. Prevalence of comorbid mental health problems is six times higher (67.3%) among homeless young adults than their housed counterparts (10.3%). In addition, one third of depressed homeless young adults also abuse substances. Although comorbid mental health problems increase the rates of disruptive behaviors, criminal behaviors, and diminished functional status, very little is known concerning comorbid mental health problems among homeless young adults. This study thus explored factors influencing comorbid substance abuse/dependence and depression among homeless young adults.

Methods:

Data were collected on homeless young adults aged 18-25 years in Denver, Los Angeles, and Austin. Researchers administered a quantitative interview to assess such as demographic information, child abuse (Childhood Trauma Questionnaire), victimization once homeless (Traumatic Events Questionnaire), and social disconnectedness (Social Connectedness Scale). The interview also assessed substance abuse/dependence and depression using the Mini International Neuropsychiatry Interview.

The sets of independent variables considered were (1) child abuse (childhood physical and sexual abuse), (2) victimization once homeless (physical, sexual, and vicarious victimization once homeless), and (3) social disconnectedness. The two dependent variables were (1) alcohol abuse/dependence and depression (coded as no alcohol abuse/dependence and no depression=0; alcohol abuse/dependence and no depression=1; comorbid alcohol abuse/dependence and depression=2); and (2) drug abuse/dependence and depression (coded as no drug abuse/dependence and no depression=0; drug abuse/dependence and no depression=1; comorbid drug abuse/dependence and depression=2). Two multi-nominal logistic regression models were tested to examine relationships between the independent variables and each dependent variable.

 

Results:

The proportion of homeless young adults exhibiting comorbid alcohol abuse/dependence and depression was 9.2%, and the proportion of those exhibiting comorbid drug abuse/dependence and depression was 12.3%. The first model of alcohol abuse/dependence and depression (χ²=195.30 [df=22], p < .001) shows that compared with those with no alcohol abuse/dependence and no depression, those experiencing sexual abuse as children (OR=3.65, p < .001) and physical victimization once homeless (OR=2.97, p < .05) and socially disconnected young adults (OR=2.83, p < .001) were more likely to exhibit comorbidity of alcohol abuse/dependence and depression. Compared with those exhibiting no alcohol abuse/dependence and no depression, experiencing vicarious victimization once homeless (OR=4.39, p< .001) increased the likelihood of the incidence of alcohol abuse/dependence and no depression.

In the second model of drug abuse/dependence and depression (χ²=211.60 [df=22], p < .001), compared to those with no drug abuse/dependence and no depression, those experiencing sexual abuse as children (OR=2.67, p < .01) and social disconnection as young adults (OR=3.05, p < .001) were more likely to exhibit comorbid drug abuse/dependence and depression. Compared with those with no drug abuse/dependence and no depression, experiencing physical abuse (OR=2.24, p < .01) and vicarious victimization once homeless (OR=3.97, p< .001) increased the likelihood of drug abuse/dependence and no depression.

 

Conclusion/implications:

For homeless young adults, examining both childhood sexual abuse and victimization once homeless could be important intervention targets in addressing comorbid substance abuse/dependence and depression. Findings also suggest that improving social connectedness could help reduce comorbid substance abuse/dependence and depression.