Public Assistance Use and Depression Symptoms Among Young Adults Experiencing Homelessness

Background: Young adults experiencing homelessness (YAEH) typically sustain themselves through various formal (e.g., employment, public assistance) and informal sources (e.g., panhandling, survival sex). This study used the Social Determinants of Health (SDOH) framework to examine the extent to which income, in the form of public assistance, constitutes adequate social protection for YAEH. Limited research exists on public assistance use by YAEH or homeless adults in general and the research that does exist demonstrates mixed results regarding usage rates, characteristics of users, and health outcomes. This study examined associations between public assistance use and depression symptoms among YAEH through two research questions: 1) What are the characteristics of YAEH who are and are not public assistance users, and 2) Does public assistance use predict depression in a large U.S. sample of YAEH?

Methods: This study used a purposive sample of 1,342 YAEH (ages 18-26) residing in seven U.S. cities. Participants indicated whether they received any form of public assistance (e.g., food stamps) over the past year, of which 46% did, and completed the Patient Health Questionnaire-9 which measured depression symptoms. Propensity score matching balanced the two groups (i.e., public assistance recipients and non-recipients) and accounted for selection bias. Then multivariate ordinary least squares (OLS) regression analysis was conducted to examine the relationship between public assistance and depression, controlling for individual demographics, personal characteristics, and city-level clustering effects.

Results: In comparison to non-recipients, recipients of public assistance had a significantly higher depression score by 1.13 (p = .004). Additionally, several covariates were significantly associated with lower depression symptoms. YAEH who identified as a female; black, Latinx, or other races; or were currently in school had lower depression scores than their male, White, and out-of-school counterparts, respectively. However, YAEH who identified as LGBQ had significantly higher depression scores than their heterosexual peers.

Conclusions: Findings suggest that public assistance does not appear to improve mental health for a population facing multiple hardships. Three plausible explanations exist for the association between benefit use and depression symptoms among YAEH: 1) YAEH may experience stigma and feel shame associated with benefit use; 2) YAEH may feel distressed by interfacing with complicated, demanding bureaucracies (i.e., work requirements); and 3) benefit recipients may experience a higher degree of poverty, recognized as is a risk factor for depression, than their peers who do not receive benefits. The latter explanation may suggest that the dosage effect (i.e., benefit payment amounts) of most public assistance is too low to offset the effects poverty has on mental health. Economic-strengthening interventions, integrated with mental health services, are warranted for populations such as YAEH, who face numerous barriers. To advocate for these interventions, results will be disseminated to service providers online via infographics and through a presentation to the Maricopa County Continuum of Care Homeless Youth Workgroup. Furthermore, these data have provided the researchers herein a natural segue for discussion with local partners from Opportunities for Youth and Arizona State University’s Homeless Nexus regarding opportunities for alternatives to public assistance (i.e., basic income) for YAEH.