Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2021

Open Access 01-12-2021 | Research

Associations of resilience with quality of life levels in adults experiencing homelessness and mental illness: a longitudinal study

Authors: Cilia Mejia-Lancheros, Julia Woodhall-Melnik, Ri Wang, Stephen W. Hwang, Vicky Stergiopoulos, Anna Durbin

Published in: Health and Quality of Life Outcomes | Issue 1/2021

Login to get access

Abstract

Background

Homelessness constitutes a traumatic period that adversely impacts health and quality of life outcomes. The potential mitigating effects of resilience on quality of life levels in people experiencing homelessness are underresearched. This study assesses the longitudinal associations between resilience and quality of life scores among adults experiencing homelessness and mental illness.

Methods

This study is a secondary analysis of longitudinal data collected over 6 years from participants (N = 575) of the At Home/Chez Soi study on Housing First, Toronto site. Repeatedly measured resilience scores are the primary exposure and repeatedly measured global quality of life scores and mental health-specific quality of life scores are the primary outcomes. Mixed effect models were used to assess the association between the exposures and the outcomes.

Results

The majority of the participants were men (69.2%) and were on average 40.4 (± 11.8) years old at baseline. The average resilience score ranged between 5.00 to 5.62 over 8 data collection points across the 6-year follow-up period. After adjusting for gender, age, ethno-racial background, Housing First intervention, physical and mental comorbidities, and lifetime homelessness, higher resilience scores were positively associated with higher Global quality of life (Adjusted-coefficient: 0.23, 95% CI 0.19–0.27) and mental health-related quality of life values (Adjusted-coefficient: 4.15, 95% CI 3.35–4.95).

Conclusion

In homeless adults with mental illness, higher resilience levels were positively associated with higher global and mental health related quality of life values. Further interventions and services aimed to enhance resilience mechanisms and strategies are warranted to enhance better mental health and quality of life outcomes of this population group.

Trial registration

At Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374. Registered 18 September 2009, http://​www.​isrctn.​com/​ISRCTN42520374.​
Literature
1.
2.
Goodman L, Saxe L, Harvey M. Homelessness as psychological trauma: Broadening perspectives. Am Psychol. 1991;46:1219–25.PubMedCrossRef
3.
Whitbeck LB, Armenta BE, Gentzler KC. Homelessness-related traumatic events and PTSD among women experiencing episodes of homelessness in three U.S. Cities. J Trauma Stress. 2015;28:355–60.PubMedCrossRef
4.
Deck SM, Platt PA. Homelessness is traumatic: abuse, victimization, and trauma histories of homeless men. J Aggress Maltreatment Trauma. 2015;24:1022–43.CrossRef
5.
Coates J, McKenzie-Mohr S. Out of the frying pan, into the fire: trauma in the lives of homeless youth prior to and during homelessness. J Sociol Soc Welf. 2011;37:65–96.
6.
Duncan S, Oby S, Larkin H. Trauma and adversity in the lives of people experiencing homelessness. In: Larkin H, Aykanian ASC, editors. Homelessness Prev Interv Soc Work. Springer; 2019. p. 41–56.CrossRef
7.
Ellsworth JT. Street crime victimization among homeless adults: a review of the literature. Vict Offenders. 2019;14:96–118.CrossRef
8.
Mejia-Lancheros C, Lachaud J, Campo PO, Wiens K, Nisenbaum R, Wang R, et al. Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PLoS ONE. 2020;15:e0229385.PubMedPubMedCentralCrossRef
9.
Roos LE, Mota N, Afifi TO, Katz LY, Distasio J, Sareen J. Relationship between adverse childhood experiences and homelessness and the impact of Axis I and II disorders. Am J Public Health. 2013;103:275–81.CrossRef
10.
Woodhall-Melnik J, Dunn JR, Svenson S, Patterson C, Matheson FI. Men’s experiences of early life trauma and pathways into long-term homelessness. Child Abus Negl Elsevier. 2018;80:216–25.CrossRef
11.
Padgett DK, Hawkins RL, Abrams C, Davis A. In their own words: Trauma and substance abuse in the lives of formerly homeless women with serious mental illness. Am J Orthopsychiatry. 2006;76:461–7.PubMedCrossRef
12.
Montgomery AE, Cutuli JJ, Evans-Chase M, Treglia D, Culhane DP. Relationship among adverse childhood experiences, history of active military service, and adult outcomes: Homelessness, mental health, and physical health. Am J Public Health. 2013;103:262–8.CrossRef
13.
Taylor KM, Sharpe L. homeless adults in Sydney. Arch Intern Med. 2008;42:206–13.
14.
Aburn G, Gott M, Hoare K. What is resilience? An Integrative Review of the empirical literature. J Adv Nurs. 2016;72:980–1000.PubMedCrossRef
15.
Averill LA, Averill CL, Kelmendi B, Abdallah CG, Southwick SM. Stress response modulation underlying the psychobiology of resilience. Curr Psychiatry Rep. Current Psychiatry Reports; 2018;20.
16.
Bennett JM, Rohleder N, Sturmberg JP. Biopsychosocial approach to understanding resilience: stress habituation and where to intervene. J Eval Clin Pract. 2018;24:1339–46.PubMedCrossRef
17.
Stainton A, Chisholm K, Kaiser N, Rosen M, Upthegrove R, Ruhrmann S, et al. Resilience as a multimodal dynamic process. Early Interv Psychiatry. 2019;13:725–32.PubMedCrossRef
18.
Ayed N, Toner S, Priebe S. Conceptualizing resilience in adult mental health literature: a systematic review and narrative synthesis. Psychol Psychother Theory, Res Pract. 2019;92:299–341.CrossRef
19.
Horn SR, Charney DS, Feder A. Understanding resilience: new approaches for preventing and treating PTSD. Exp Neurol. 2016;284:119–32.PubMedCrossRef
20.
Cadet JL. Epigenetics of stress, addiction, and resilience: therapeutic implications. Mol Neurobiol. 2016;53:545–60.PubMedCrossRef
21.
Färber F, Rosendahl J. The association between resilience and mental health in the somatically Il. A systematic review and meta-analysis. Dtsch Arztebl Int. 2018;115:621–7.PubMedPubMedCentral
22.
Ungar M, Theron L. Resilience and mental health: how multisystemic processes contribute to positive outcomes. Lancet Psychiatry. 2019;0366:1–8.
23.
Greenberg JM, Wynn JK, Lee J, Hellemann G, Gabrielian S, Green MF. Resilience in homeless veterans: clinical and cognitive correlates. Psychiatr Rehabil J. 2019;42:314–22.PubMedCrossRef
24.
Durbin A, Nisenbaum R, Kopp B, O’Campo P, Hwang SW, Stergiopoulos V. Are resilience and perceived stress related to social support and housing stability among homeless adults with mental illness? Heal Soc Care Community. 2019;27:1053–62.CrossRef
25.
Cleverley K, Kidd SA. Resilience and suicidality among homeless youth. J Adolesc. 2011;34:1049–54.PubMedCrossRef
26.
Shankar S, Gogosis E, Palepu A, Gadermann AM, Hwang SW. “I Haven’t Given Up and I’m Not Gonna”: a phenomenographic exploration of resilience among individuals experiencing homelessness. Qual Health Res. 2019;29:1850–61.PubMedCrossRef
27.
Paul S, Corneau S, Boozary T, Stergiopoulos V. Coping and resilience among ethnoracial individuals experiencing homelessness and mental illness. Int J Soc Psychiatry. 2018;64:189–97.PubMedCrossRef
28.
Perron JL, Cleverley K, Kidd SA. Resilience, loneliness, and psychological distress among homeless youth. Arch Psychiatr Nurs. 2014;28:226–9.PubMedCrossRef
29.
Altena AM, Beijersbergen MD, Vermunt JK, Wolf JRLM. Subgroups of Dutch homeless young adults based on risk- and protective factors for quality of life: results of a latent class analysis. Heal Soc Care Community. 2018;26:e587–97.CrossRef
30.
Goering PNPN, Streiner DLDL, Adair C, Aubry T, Barker J, Distasio J, et al. The at Home/Chez Soi trial protocol: A pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open. 2011;1:e000323.PubMedPubMedCentralCrossRef
31.
Hwang SW, Stergiopoulos V, O’Campo P, Gozdzik A. Ending homelessness among people with mental illness: the at Home/Chez Soi randomized trial of a Housing First intervention in Toronto. BMC Public Health. 2012;12:787.PubMedPubMedCentralCrossRef
32.
Stergiopoulos V, Mejia-lancheros C, Nisenbaum R, Wang R, Lachaud J, Campo PO, et al. Long-term effects of rent supplements and mental health support services on housing and health outcomes of homeless adults with mental illness: extension study of the At Home/Chez Soi randomised controlled trial. Lancet Psychiatry. 2019;6:915–25.PubMedCrossRef
33.
Connor KM, Davidson JRT. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18:76–82.PubMedCrossRef
34.
Vaishnavi S, Connor K, Davidson JRT. An abbreviated version of the Connor-Davidson Resilience Scale (CD-RISC), the CD-RISC2: psychometric properties and applications in psychopharmacological trials. Psychiatry Res. 2007;152:293–7.PubMedPubMedCentralCrossRef
35.
Lehman A. Measures of quality of life among persons with severe and persistent mental disorders. Soc Psychiatry Psychiatr Epidemiol. 1996;31:78–88.PubMedCrossRef
36.
Uttaro T, Lehman A. Graded response modeling of the Quality of Life Interview. Eval Program Plann. 1999;22:41–52.CrossRef
37.
Lam JA, Rosenheck RA. Correlates of improvement in quality of life among homeless persons with serious mental illness. Psychiatr Serv. 2000;51:116–8.PubMedCrossRef
38.
The Euroqol Group. EuroQol - a new facility for the measurement of health-related quality of life. Health Policy (New York). 1990;16:199–208.CrossRef
39.
De Boer AGEM, Van Lanschot JJB, Stalmeier PFM, Van Sandick JW, Hulscher JBF, De Haes JCJM, et al. Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Qual Life Res. 2004;13:311–20.PubMedCrossRef
40.
Stergiopoulos V, Gozdzik A, Misir V, Skosireva A, Sarang A, Connelly J, et al. The effectiveness of a Housing First adaptation for ethnic minority groups: Findings of a pragmatic randomized controlled trial. BMC Public Health. 2016;16:1–11.CrossRef
41.
Stergiopoulos V, Gozdzik A, Misir V, Skosireva A, Connelly J, Sarang A, et al. Effectiveness of housing first with intensive case management in an ethnically diverse sample of homeless adults with mental illness: a randomized controlled trial. PLoS ONE. 2015;10:1–21.CrossRef
42.
O’Campo P, Stergiopoulos V, Nir P, Levy M, Misir V, Chum A, et al. How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial. BMJ Open. 2016;6:e010581.PubMedPubMedCentralCrossRef
43.
Narayan AJ. Personal, dyadic, and contextual resilience in parents experiencing homelessness. Clin Psychol Rev Elsevier Ltd. 2015;36:56–69.CrossRef
44.
Ni MY, Li TK, Yu NX, Pang H, Chan BHY, Leung GM, et al. Normative data and psychometric properties of the Connor-Davidson Resilience Scale (CD-RISC) and the abbreviated version (CD-RISC2) among the general population in Hong Kong. Qual Life Res. 2016;25:111–6.PubMedCrossRef
45.
Rapacciuolo A, Perrone Filardi P, Cuomo R, Mauriello V, Quarto M, Kisslinger A, et al. The impact of social and cultural engagement and dieting on well-being and resilience in a group of residents in the metropolitan area of Naples. J Aging Res. 2016;2016:1–11.CrossRef
46.
Tozer K, Tzemis D, Amlani A, Coser L, Taylor D, Van Borek N, et al. Reorienting risk to resilience: Street-involved youth perspectives on preventing the transition to injection drug use. BMC Public Health. 2015;15:1–11.CrossRef
47.
Rudzinski K, McDonough P, Gartner R, Strike C. Is there room for resilience? A scoping review and critique of substance use literature and its utilization of the concept of resilience. Subst Abus Treat Prev Policy. 2017;12:1–35.
48.
Ferguson KM, Bender K, Thompson SJ. Gender, coping strategies, homelessness stressors, and income generation among homeless young adults in three cities. Soc Sci Med. 2015;135:47–55.PubMedCrossRef
49.
Potter J, Cantarero R, Wood H. The multi-dimensional nature of predicting Quality of Life. Procedia - Soc Behav Sci. 2012;50:781–90.CrossRef
50.
Gentil L, Grenier G, Bamvita JM, Dorvil H, Fleury MJ. Profiles of quality of life in a homeless population. Front Psychiatry. 2019;10:1–10.CrossRef
51.
Garey L, Reitzel LR, Neisler J, Kendzor DE, Zvolensky MJ, Neighbors C, et al. Health-related Quality of Life among homeless smokers: risk and protective factors of latent class membership. Behav Med. 2019;45:40–51.PubMedCrossRef
52.
Pauly BB, Gray E, Perkin K, Chow C, Vallance K, Krysowaty B, et al. Finding safety: a pilot study of managed alcohol program participants’ perceptions of housing and quality of life. Harm Reduct J. 2016;13:1–11.CrossRef
53.
O’Brien KK, Schuttke A, Alhakeem A, Donnelly-Swift E, Keogh C, O’Carroll A, et al. Health, perceived quality of life and health services use among homeless illicit drug users. Drug Alcohol Depend. 2015;154:139–45.PubMedCrossRef
54.
Palepu A, Hubley AM, Russell LB, Gadermann AM, Chinni M. Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study. Health Qual Life Outcomes. 2012;10:1–11.CrossRef
55.
van der Laan J, Boersma SN, van Straaten B, Rodenburg G, van de Mheen D, Wolf JRLM. Personal goals and factors related to QoL in Dutch homeless people: what is the role of goal-related self-efficacy? Heal Soc Care Community. 2017;25:1265–75.CrossRef
56.
EuroQol Research Foundation. EQ-5D-5L User Guide, 2019. The Netherlands; 2019.
Metadata
Title
Associations of resilience with quality of life levels in adults experiencing homelessness and mental illness: a longitudinal study
Authors
Cilia Mejia-Lancheros
Julia Woodhall-Melnik
Ri Wang
Stephen W. Hwang
Vicky Stergiopoulos
Anna Durbin
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2021
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-021-01713-z

Other articles of this Issue 1/2021

Health and Quality of Life Outcomes 1/2021 Go to the issue

Research

Oral health-related quality of life outcomes in a randomized clinical trial to assess a community-based oral hygiene intervention among adults living in low-income senior housing

Research

Determining the psychometric properties of a novel questionnaire to measure “preparedness for the future” (Prep FQ)

Research

EQ-5D-3L health state utility values in transfusion-dependent thalassemia patients in Malaysia: a cross-sectional assessment

Research

The path linking disease severity and cognitive function with quality of life in Parkinson’s disease: the mediating effect of activities of daily living and depression

Research

Impact of subthreshold depression on health-related quality of life in patients with Parkinson’s disease based on cognitive status

Research

Importance of personality and coping expectancy on patient-reported hearing disability, quality of life and distress level: a study of patients referred to an audiology service