Self-Identification of Mental Health Problems Among Young Adults Experiencing Homelessness: Relations to Coping and Mental Health Service Use

Background: Homelessness is inherently linked to racial and economic inequality. Young adults experiencing homelessness (YAEH) are disproportionately African American and typically have networks with limited financial resources. Compounding these experiences of marginalization, many meet criteria for mental disorders but have high rates of unmet need for treatment. Both access and attitudinal barriers (i.e., perceptions, stigma) are established contributors to low service use rates and these are particularly significant for YAEH. Due to the dual stigma of homelessness and mental illness, many YAEH may not self-identify as having a psychological problem. Drawing from a large multi-city sample of YAEH who screened positive for mental health symptoms, this study answered two research questions: 1) What are the rates and correlates of self-identified mental health problems? and 2) What associations exist between self-identification, coping strategies, and mental health service use?

 Methods: Data for this study come from the Homeless Youth Risk and Resilience Survey, a self-report survey administered in service settings in seven U.S. cities (N=1426) from 2015-2017. The current study was limited to youth screening positive on one of three mental health screening measures (PHQ-9; Kessler-6 or PC-PTSD; n=892). Self-identification was assessed by asking “Are you currently experiencing problems with your mental health?” Bivariate analyses examined variables associated with self-identification. Relations with coping strategies were assessed with t-tests.  Logistic regression models examined whether self-identification was associated with past year medication use, use of therapy, and unmet need for services, controlling for demographic and coping variables.

 Results: Overall, 35% self-identified as having a mental health problem, with the remaining 65% stating they either did not have a problem (42%) or were not sure (23%).  Bivariate analyses found that the following variables were significantly associated with self-identification: being lesbian, gay, bisexual, or queer/questioning (LGBQ) (45%; χ²=20.1, p<.01), female (42%; χ²=10.6, p<.01), white (44%; χ²=18.0, p<.01) and having been in foster care (41%; χ²=6.7.1, p<.01). Mean positive coping scores were significantly higher in those not self-identifying (t=2.31, p=.02) while negative coping behaviors were higher in those who did self-identify (t=-3.28, p<.01). Controlling for demographic and coping variables, those with self-identified problems had greater odds of prior-year medication use (OR=3.8; CI=2.7-5.2; p<.01),use of therapy (OR=3.1; CI=2.2-4.3; p<.01), and unmet need (OR=2.7; CI=2.0-3.7; p<.01).

 Conclusions and Implications: Only a third of YAEH screening positive for mental health problems identified as experiencing one, suggesting that increasing awareness about mental health symptoms is an important target to increase connections to treatment. Further, efforts to reduce stigma and promote treatment-seeking behavior as a sign of strength might increase willingness to identify as having a mental health problem, particularly among men and youth of color. Alternatively, providers should think about ways to provide mental health supports that do not explicitly require self-identification to increase access for these groups. Youth who did not self-identify endorsed a range of positive coping strategies. Efforts to increase connections to treatment should build on this strength and position formal service use as complementary to many of the positive strategies they are already using.