Examination of bidirectional associations between neurocognitive functioning and housing stability in homeless adults: A longitudinal subgroup analysis of the at Home/Chez Soi study.

Abstract

Homeless adults represent a marginalized group with numerous psychiatric and physical illness risk factors for poor functional outcomes. This study investigated bidirectional associations between housing stability and neurocognitive functioning in homeless adults using a longitudinal study design. Participants were homeless adults with serious mental illness from the At Home/Chez Soi study Toronto site who participated in a randomized control trial of Housing First. Participants underwent a comprehensive structured baseline interview and clinical evaluation. Up to four brief cognitive evaluations were completed over a period of up to 6 years. Housing status was ascertained every 3 months during the study period. The analysis included 283 participants with at least one follow-up evaluation (Mage = 41 years, 70% men). In an adjusted time-lagged mixed-effects logistic regression model, higher verbal learning and memory performance (OR = 1.71, 95% CI [1.16, 2.52], p = .007), but not cognitive flexibility and processing speed, was associated with an increased likelihood of being stably housed in the subsequent 3 months. In a test of reverse associations, mixed-effects linear models did not reveal associations between housing stability in the preceding 3 months and neurocognitive functioning in either domain. These results suggest verbal learning and memory functioning is a key contributor to housing stability among homeless adults with serious mental illness. This work has important implications for health services that support individuals transitioning into stable housing and for the attainment of long-term functional independence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).