A Response to the Comments of Walter R. Gove on Gender Differences in Health Risks and Physical Symptoms Among the Homeless

Abstract

In a recent paper (Ritchey, La Gory, and Mullis 1991), we outlined research that utilized 100 homeless subjects (72 men and 28 nonpregnant women) and addressed four questions: (1) Are there in the types of health risks encountered by homeless men and women?; (2) does the typical gender pattern, that of women reporting more physical symptoms, hold for the homeless?; (3) what are the relationships among risks, number of symptoms reported, and gender?; and (4) how do our findings contribute to an understanding of gender variation in survey reports of physical symptoms generally? For the first question, we examined gender among four categories of health risks: situational risks (e.g., exposure), the absence of social and psychological resources (e.g., presence of social supports, social contacts, psychological mastery), predisposing risks (demographics and causes of homelessness), and physical and psychological health risks (e.g., serious illness since homeless, previous mental/ physical hospitalization or substance abuse detoxification). Men exhibited greater prevalence for 29 of 35 risk items; this was true for 13 of 15 risk factors for which there were statistically significant differences. Scrutiny of service delivery structure also revealed larger, more crowded shelters for men, and no male day shelters at the time of the study. Thus, the cumulative evidence on risk differentials suggested that physical illness should be as, or more, prevalent among men than women, a conclusion consistent with Wright and Weber's (1987, pp. 111-17) diagnostic data, which showed that homeless men and women have roughly equivalent disease prevalence. They concluded that many of the gender routinely reported in studies of domiciled men and women apparently disappear among the homeless ... The condition simply overpowers most gender factors in determining health differences (Wright and Weber 1987, p. 111). Given the apparently high risks of illness for homeless men and diagnostic studies which show the equal prevalence of disease for homeless men and women, our second question addressed whether these risk would be reflected in survey reports of physical symptoms. We hypothesized that homelessness was such an extreme state of environmental press (Lawton 1980), especially for males, that the typical pattern of women reporting more symptoms might not hold for the homeless. To control for type of symptom, we compared our list of 24 physical symptoms (reported as experienced in the past month) with roughly comparable general population data from Verbrugge (1985) and Marcus and Seeman (1981). Our analysis focused on the direction of the relationship between gender and symptoms. To our surprise, women reported higher rates for 18 of the 24 symptoms. Of the 19 symptoms for which general population data led us to expect a gender differential, the predicted direction was accurate for 13. Male rates were higher for only two of these exceptions (sinus trouble/hay fever and painful or swollen joints), and these could be explained by exposure. Our third question addressed the relationship among risk factors, number of symptoms reported, and gender. An examination of total symptoms by gender produced results consistent with general population findings. Homeless women reported a significantly higher rate of symptoms, and the distribution was skewed for men, with a much higher