(see Poster Gallery) Interrelationships between Personality Functioning and Psychopathology in Adults Experiencing Homelessness

Background and Purpose: Personality functioning and psychopathology have been found, in clinical and community settings, to covary substantially. Difficulties in personality functioning can interact with psychopathology to contribute to poorer psychosocial functioning. Homeless adults are at increased risk of behavioral health concerns that can negatively impact psychosocial functioning, yet few studies have investigated the unique contribution of personality functioning and psychopathology to difficulties in psychosocial functioning in this population. This study investigates the relationships of personality functioning and psychopathology with psychosocial functioning in a sample of adults experiencing homelessness.

Methods: Between March and December 2019, data was collected by a master’s-level evaluator at a mental health center where participants (N = 76) were receiving outreach services. The sample was comprised of adults experiencing homelessness who were mostly male (64.47%) and African American (50.72%). Mean age was 45 years (SD = 11). Diagnosed behavioral health conditions included: substance use (55.26%), psychotic (23.68%), mood (50.00%), and anxiety and trauma-related (40.79%) disorders. Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0; α = 0.85) assessed intrapersonal functioning (α = 0.77) and interpersonal functioning (α= 0.76; Weekers et al., 2019). Brief Psychiatric Rating Scale-Expanded (Lukoff et al., 1986) assessed overall psychopathology. Eight items from the National Outcome Measures from Substance Abuse and Mental Health Services Administration (α = 0.75) measured self-reported psychosocial functioning. Bivariate correlations and multiple linear regression tested the association of personality functioning and psychopathology with psychosocial functioning.

Results: Difficulties in intrapersonal functioning (M = 17.04, SD = 5.58) was moderately positively correlated with impairment in interpersonal functioning (M = 14.28, SD = 5.26; r = 0.67, p < .001). Psychopathology (M = 47.64, SD = 12.05) was positively associated with difficulties in both intrapersonal (r = 0.26, p = .02) and interpersonal (r = 0.33, p = .003) functioning. Psychosocial functioning (M = 20.74, SD = 5.25) was inversely related to impairments in intrapersonal functioning (r = -0.46, p < .001), interpersonal functioning (r = -0.30, p = .009), and psychopathology (r = -0.32, p = .005). In the multivariate model (F(3, 72) = 8.26, p < .001), impairments in personality functioning and psychopathology accounted for 25.59% of the variance in psychosocial functioning scores. Difficulties in intrapersonal functioning shared a stronger inverse relationship with psychosocial functioning (B = -0.46, p = .001) compared to psychopathology (B = -0.23, p = .038). Impairments in interpersonal functioning were uncorrelated with psychosocial functioning (B = 0.09, p = .525).

Conclusions and Implications: Impairment in psychosocial functioning in homeless adults is associated with both intrapersonal difficulties and overall psychopathology, although difficulties in self-functioning were most strongly correlated with poorer psychosocial functioning. Findings complement existing research from clinical and community samples showing significant covariation between psychopathology and personality functioning. Clinicians serving homeless adults should consider assessing for difficulties in self- and other-functioning to guide treatment planning. Future studies may benefit from incorporating additional measures of self- and other-functioning based on clinician observation. This is especially important given the inconsistencies in self-report often seen in the literature.