Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness.

Daphne C Hernandez,Michael J Zvolensky,Adam C Alexander,Sajeevika S Daundasekara,Darla E Kendzor,Michael S Businelle,Lorraine R Reitzel,Diane Santa Maria

doi:10.3390/ijerph17155301

Abstract

Traditionally, intrapersonal characteristics (distress tolerance) and interpersonal characteristics (social support) have been studied separately rather than simultaneously. In the current study, we address this gap by simultaneously examining these characteristics as potential indirect associations linking established urban stress–depression and urban stress–Post-Traumatic Stress Disorder (PTSD) relationships. Adults experiencing homelessness were recruited from six homeless shelters in Oklahoma City (n = 567). Participants self-reported urban life stress (Urban Life Stress Scale), distress tolerance (Distress Tolerance Scale), social support (Interpersonal Support Evaluation List 12), major depressive disorder (Patient Health Questionnaire-8), and PTSD symptoms (Primary Care Post-Traumatic Stress Disorder screener). Covariate-adjusted structural equation models indicated a significant indirect effect of distress tolerance on the urban stress–depression (b = 0.101, 95% CI = 0.061, 0.147) and urban stress–PTSD (b = 0.065, 95% CI = 0.023, 0.112) relationships. Additionally, a significant indirect effect of social support on the urban stress–depression (b = 0.091, 95% CI = 0.053, 0.133) and urban stress-PTSD relationships (b = 0.043, 95% CI = 0.006, 0.082) was evident. Further, both the urban stress–depression (b = 0.022, 95% CI = 0.011, 0.037) and urban stress–PTSD relationships (b = 0.014, 95% CI = 0.005, 0.026) were associated indirectly through social support to distress tolerance. Interventions that aim to increase social support may also increase distress tolerance skills and indirectly reduce depressive and PTSD symptoms in the context of urban stress among adults experiencing homelessness.

Highlights

According to the 2018 point-in-time estimates, 552,830 people experienced homelessness in the United States [1]
Urban life stress indirectly influenced Post-Traumatic Stress Disorder (PTSD) symptoms through distress tolerance controlling for perceived social support (b = 0.065, 95% Confidence Interval (CI) = 0.023, 0.112) and through perceived social support controlling for distress tolerance (b = 0.043, 95% CI = 0.006, 0.082) (Table 4)
There was a significant indirect association between urban life stress and PTSD symptoms through the concurrent association of perceived social support and distress tolerance (b = 0.014, 95% CI = 0.005, 0.026)

Summary

Introduction

According to the 2018 point-in-time estimates, 552,830 people experienced homelessness in the United States [1]. 48–65% of adults experiencing homelessness reported diagnoses of depression, and 43% reported diagnoses of Post-Traumatic Stress Disorder (PTSD) [2,3,6]. Individuals experiencing homelessness are at risk of mental distress due to challenges associated with meeting their daily needs, including food, shelter, and health care, and stressors related to living on the streets or in shelters [7]. Research evidence indicates that urbanization may lead to mental health problems, including psychotic experiences, depression, and stress-related disorders, especially among vulnerable individuals [8]. Individuals living in urban settings frequently experience environmental and social stressors that could negatively affect their mental health. Urban life-related stressors include, but are not limited to, the poor-quality built environment, pollution, violence, substance use, racism, and discrimination

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Conclusion