Journal
AMERICAN JOURNAL OF PUBLIC HEALTH
Volume 103, Issue -, Pages S275-S281Publisher
AMER PUBLIC HEALTH ASSOC INC
DOI: 10.2105/AJPH.2013.301323
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Funding
- Canadian Institutes of Health Research (CIHR) [152348]
- Manitoba Health Research Council Chair award
- The Mental Health Commission of Canada At Home/Chez Soi Project
- Manitoba Health Research Council Establishment Award
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Objectives. We investigated the links between homelessness associated with serious mental and physical healthy disparities and adverse childhood experiences (ACEs) in nationally representative data, with Axis I and II disorders as potential mediators. Methods. We examined data from the National Epidemiologic Survey of Alcohol and Related Conditions in 2001-2002 and 2004-2005, and included 34 653 participants representative of the noninstitutionalized US population who were 20 years old or older. We studied the variables related to 4 classes of Axis I disorders, all 10 Axis II personality disorders, a wide range of ACEs, and a lifetime history of homelessness. Results. Analyses revealed high prevalences of each ACE in individuals experiencing lifetime homelessness (17%-60%). A mediation model with Axis I and II disorders determined that childhood adversities were significantly related to homelessness through direct effects (adjusted odd ratios = 2.04, 4.24) and indirect effects, indicating partial mediation. Population attributable fractions were also reported. Conclusions. Although Axis I and II disorders partially mediated the relationship between ACEs and homelessness, a strong direct association remained. This novel finding has implications for interventions and policy. Additional research is needed to understand relevant causal pathways.
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