Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site

Cilia Mejia-Lancheros,Tim Aubry,Kathryn Wiens,Stephen W Hwang,Patricia O’Campo,Vicky Stergiopoulos,James Lachaud

doi:10.1007/s00127-021-02093-x

Abstract

PurposeTo conduct a multi-dimensional and time-patterned analysis to identify distinct well-being trajectory profiles over a 6-year follow-up period among adults experiencing homelessness and mental illness.MethodsData from 543 participants of the At Home Chez Soi study’s Toronto site were examined over a 6-year follow-up period, including measures of quality of life, community functioning, housing stability, and substance use. Well-being trajectories were identified using Group-Based Trajectory Modelling. Multinomial regression was used to identify predictor variables that were associated with each well-being trajectory profile.ResultsFour well-being profiles were identified: low well-being, moderate well-being, good well-being, and high well-being. Factors associated with a greater likelihood of following a better well-being profile included receiving Housing First, reporting female gender and non-white ethnicity, having post-secondary studies, and reporting a high resilience level. Concurrently, factors associated with a lower likelihood of better well-being profiles were having a history of chronic homelessness, experiences of discrimination in the healthcare setting, having comorbid mental disorders and a high level of symptom severity, and reporting a history of traumatic brain injury and childhood adversity.ConclusionsIndividuals experiencing homelessness follow distinct well-being profiles associated with their socio-demographic characteristics, health status, trauma history, resilience capabilities, and access to housing and support services. This work can inform integrated housing and support services to enhance the well-being trajectories of individuals experiencing homelessness.Trial registrationAt Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374, http://www.isrctn.com/ISRCTN42520374.

Highlights

Homelessness is a daunting issue affecting millions of people worldwide
Four well-being multi-trajectory profiles were identified based on housing stability, QoLi, community functioning, and substance use severity measures over 6 years (Fig. 1)
These individuals experienced a moderate improvement in their housing stability, had a moderately high QoLi, moderate community functioning, and declining substance use severity

Summary

Introduction

Homelessness is a daunting issue affecting millions of people worldwide. In North America, there are over 552,500 people experiencing homelessness in a single night in the United States [1] and 35,000 in Canada, where over 235,000 people experience homelessness in a given year. The ability to improve the living conditions, health, and overall well-being of individuals experiencing homelessness remains a crucial social and public health challenge. An individual’s well-being status is influenced by multiple objective and subjective aspects of their life; there is not a universal definition or a single set of indicators to fully capture well-being [3,4,5]. Psychological, self-perceived health, quality of life, spirituality, social relations, and life satisfaction are subjective aspects of well-being [3, 4]. Subjective and objective well-being related factors are frequently interweaved over an individual’s life course [6]. Well-being is seldom studied as a long-term outcome in the general population or groups of people experiencing homelessness, severe mental illness and poverty

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