Emotional Health Among Adolescents Experiencing Family Homelessness

Abstract

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Health Promotion and Disease Prevention, Presented at NAPNAP’s 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA Nearly 2.5 million children and adolescents were homeless in the U.S. in 2013. These youth are at an increased risk of physical and mental health problems. The purpose of this study is to determine whether family homelessness is associated with suicidality during adolescence, and whether developmental assets moderate this association. Adverse childhood experiences associated with family homelessness can threaten brain development and lifelong health. Studies in the last decade have focused on mental health and suicide risk among runaway adolescents who are homeless, but not on adolescents who are homeless with their families. This unique population now comprises 37% of the total U.S. homeless population, but suicide-related outcomes among this group have not yet been reported. We also do not yet know how developmental assets – such as social connectedness, positive identity, school connectedness, empowerment, parent connectedness, and academic orientation – impact these outcomes among homeless youth. Does family homelessness within the past year predict recent self-injurious behavior, suicidal ideation, and suicide attempts among adolescents? What role do developmental assets play in protecting homeless adolescents from suicidality compared to non-homeless youth? In this observational cohort study, we utilized cross-sectional data from 113,197 students age 12 to 19 from the 2013 Minnesota Student Survey. We used logistic regression to estimate odds of self-injurious behavior, suicidal ideation, and previous suicide attempt for adolescents who experienced family homelessness in the past 12 months compared to those who did not, adjusting for age, sex, race, poverty status, and school location. We used multivariate regression to test for moderation of suicidality by developmental assets among homeless and non-homeless youth. The University of Minnesota IRB approved this study. The mean age of the respondents was 14.9 years (SD 1.34). 4.1% (N=4594) of the sample reported being homeless with their parents or adult family member within the last 12 months. Among these youth, 29.1% (N=1317; AOR 2.52, 95% CI 2.34-2.69) reported self-injurious behavior, 21% (N=940; AOR 2.30, 95% CI 2.14-2.48) reported suicidal ideation, and 9.3% (N=416; AOR 3.24, 95% CI 2.91-3.60) reported at least one suicide attempt within the last 12 months. Developmental assets decreased the odds of these outcomes for all youth, but were less protective for homeless youth than non-homeless youth. Youth who have been homeless with their families during the past year are at significantly higher risk of suicidality than their non-homeless peers. Internal and external factors that protect against suicidality are somewhat less impactful among youth who have experienced family homelessness, implicating family homelessness as a marker of extreme risk during adolescence. Future research among this group should take broader ecological factors into account, ideally in a longitudinal manner. Preventive interventions among homeless youth may need to not only promote developmental assets but also address the need for stable housing and the mitigation of extreme psychosocial risk.