Depressive Symptoms and Their Association with Adverse Environmental Factors and Substance Use in Runaway and Homeless Youths

Purpose

Previous studies have suggested that depression is more prevalent among runaway and homeless youths (RHY) relative to housed youths. Understanding the factors correlated with depression in RHY is necessary to facilitating the development of preventive programs for this vulnerable population. The preponderance of depression in RHY might be attributable to exposure to adverse environments. We tested the following hypotheses: (1) family maltreatment, traumatic stressors associated with street life, stressful life events, and substance use would be independently associated with more severe depressive symptoms; (2) the effect of street-related traumatic experiences and stressful life events on severity of depressive symptoms would be greater for RHY with a history of family maltreatment; and (3) a dose–response relationship would exist between exposure to the investigated risk factors and severity of depressive symptoms.

Methods

Data for this cross-sectional study came from a convenience sample of 377 RHY who participated in a parent study designed to examine the impact of network ties on HIV risk-taking behaviors in RHY. History of family maltreatment was assessed with self-reported items that asked participants whether they had ever experienced physical or sexual abuse in their family of origin. Traumatic stressors associated with street life were assessed using the University of California, Los Angeles Posttraumatic Stress Disorder Reaction Index. Stressful life events were measured as a count of 12 dichotomous items related to the experience of major nontraumatic events that are prominent in the lives of RHY. Alcohol and substance use was assessed by asking participants how many times during the previous 30 days they used alcohol, marijuana, and other street drugs. Severity of depressive symptoms was measured using the shortened Center for Epidemiological Studies Depression Scale. Multivariable ordinary least squares linear regression analyses were conducted to identify the correlates of depressive symptoms. Age and gender were included as covariates. Multivariable regression analysis was repeated with the separate addition of two interaction terms—between family maltreatment and stressful life events and between family maltreatment and count of traumatic stressors.

Results

The sample’s mean age was 22.01 years (SD = 2.12). It was multi-ethnic and predominately males (71.35%). Greater severity of depressive symptoms was significantly related to family maltreatment (b = .26, t[314] = 2.42, p < .05), being exposed to more traumatic stressors during homelessness (b = .08, t[314] = 2.57, p < .05), and current substance use compared to no substance use (b = .32, t[314] = 2.54, p < .05 and b = .44, t[314] = 3.00, p < .01, respectively). Family maltreatment was also found to moderate the relationship between traumatic stressors and depressive symptoms (b = .15, t[314] = 2.29, p < .05). Cumulative exposure to the investigated risk factors at varying levels was associated with more severe depressive symptoms.

Implications

Environmental adversities and substance use, and their cumulative effects, are important determinants of depression in this sample of RHY. These empirically verified risk factors could inform the use of a trauma-informed approach to identify RHY at elevated risk of depression for preventive interventions.