Predicting homelessness: Housing risk insights from latent class analysis.

Millions of families with children in the U.S. struggle to afford adequate housing. Housing cost burden places families at risk for homelessness, and prevention efforts are hindered by limited understanding of insecure housing experiences at the margins. The present study investigated variation in housing insecurity experiences in a sample of mothers, as well as which risk profiles were most strongly associated with subsequent homelessness. Latent class analysis identified four distinct subgroups of housing insecurity: "Stable," "Unstable," "Rent-Focused," and "Strategic Bill-Paying." Classes differed on whether they made rent or utility payments on time, experienced utility shutoffs, or were evicted. Mothers who missed rent payments were significantly more likely to experience subsequent homelessness, whereas those who prioritized rent were more likely to have their utilities shut off but remain housed. Policy efforts should emphasize increased wages, rent control, changes to zoning laws and tax codes to prioritize affordable housing, and benefits that help mothers maintain their incomes such as comprehensive healthcare, paid maternity leave, and subsidized childcare.

Violence and suicide risk behavior in a nationally representative sample of youth aged 12-17: What does it mean to be at-risk?

Suicide attempts and school violence, including gun violence, are now leading causes of death in youth 12-17. This study applied a latent class analytic approach to investigate how heterogenous subgroups of youth differed regarding patterns of violence engagement and suicide risk behavior and how geographic, demographic, and socioeconomic predictors related to subgroup membership. Data were drawn from the youth subsample of the 2021 National Survey on Drug Use and Health (N = 10,743). A suicide risk subgroup had low probabilities of violence engagement but high probabilities of suicide ideation and plan. A violence + suicide risk subgroup had high probabilities of violence engagement, suicide ideation, and suicide plan. A violence risk subgroup had high probabilities of violence engagement and carrying a handgun, but low probabilities of suicide ideation or plan. The largest subgroup had low probabilities across all class indicators. Demographic, geographic, and socioeconomic variables uniquely predicted subgroup membership.

Latent profile analysis of veterans' psychological risk and protective factors: Associations with nonroutine military discharge.

OBJECTIVE: Veterans with nonroutine military discharge (NRD) often have worse psychosocial outcomes than their routinely discharged peers. However, little is known about how subgroups of veterans vary regarding risk and protective factors like PTSD, depression, self-stigma of mental illness, mindfulness, and self-efficacy, and how subgroup characteristics relate to discharge status. We applied person-centered models to detect latent profiles and associations with NRD. METHOD: A total of 485 post-9/11 era veterans completed online surveys, and a sequence of latent profile (LPA) models were fitted to the data and examined for parsimony, profile separation, and substantive utility. Following LPA model selection, we applied a series of models to analyze demographic predictors of latent profile membership and associations between latent profiles and the outcome NRD. RESULTS: LPA model comparison supported a 5-profile solution for the data. We identified a Self-Stigmatized (SS) profile comprising 26% of the sample with mindfulness and self-efficacy below full sample averages and self-stigma, PTSD, and depressive symptoms above sample averages. Those in the SS profile were significantly more likely than a profile approximating full sample averages on indicators to report nonroutine discharge (OR = 2.42, 95% CI [1.15, 5.10]). CONCLUSIONS: Meaningful subgroups were present in this sample of post-9/11 service-era military veterans with respect to psychological risk and protective factors. The SS profile had over 10 times the odds of nonroutine discharge compared to the Average profile. Findings suggest that veterans most in need of mental health treatment face external barriers from nonroutine discharge and an internal stigma barrier to obtaining care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Housing insecurity and adolescent behavioral outcomes: The mediating role of aggression in parenting.

BACKGROUND: Housing insecurity impacts millions of families with children each year and is linked with a range of adverse outcomes. Greater understanding of pathways linking housing insecurity with emotional and behavioral problem is needed to prevent enduring mental health problems. The Family Stress Model and Bronfenbrenner's Ecological Model contribute understanding to the complex dynamics underlying development from childhood to adolescence in the context of economic hardship and parental strain. OBJECTIVE: The present study aimed to investigate the mediating role of harsh parenting in the relationship between childhood housing insecurity and adolescent behavior problems. PARTICIPANTS AND SETTING: Data from the Fragile Families and Child Well-being Study, and included a sample of at-risk mothers with children from 20 large U.S. cities (N = 2719). METHODS: Structural equation modeling with latent variables tested direct and indirect pathways from housing insecurity at age 5 with emotional and behavioral problems at age 15 via intermediary harsh parenting at age 9. RESULTS: Housing insecurity directly predicted adolescent anxious/depressive behaviors (ß = 0.14, p < 0.01); and indirectly predicted rule-breaking (ß = 0.04, p < 0.01), aggressive (ß = 0.05, p < 0.01), and anxious/depressive (ß = 0.03, p < 0.05) behaviors via psychological aggression in parenting. CONCLUSIONS: Failure to address housing hardship among families with young children increases maltreatment risk and subsequent enduring mental health problems. Efforts to identify and mitigate housing hardship and maltreatment among at-risk families offer promise to promote long-term mental health in the transition from childhood to adolescence.

Toward a dual process model of moral injury and traumatic illness.

Moral injury has emerged as a topic of significant research and clinical interest over the last decade. However, much work remains to be done to comprehensively define the moral injury construct, with implications for understanding the etiology and maintenance of moral injury, its symptoms, associations with and distinctions from traumatic illness, and treatment approaches. We provide a brief overview of the existing moral injury literature and introduce a novel dual process model (DPM) of moral injury and traumatic illness. The DPM posits an event exposure which may satisfy DSM-5 posttraumatic stress disorder (PTSD) criterion A, potential morally injurious event (PMIE) criteria, or both, followed by individual role appraisal as a perpetrator through action or inaction, a witness, a victim, or a combination of the these. Role appraisal influences symptoms and processes across biological, psychological, behavioral, social, spiritual/religious, as well as values, character, and identity domains to support a label of traumatic illness, moral injury, or both. The DPM provides a flexible analytical framework for evaluating symptoms associated with moral injury and traumatic stress and has important implications for treatment. The most thoroughly reviewed evidence-based interventions for traumatic stress hinge on exposure and habituation mechanisms to manage dysregulation of fear and memory systems, but these mechanisms often do not address core domains of moral injury identified in the DPM, including spiritual, religious, values, character, and identity domains as these exist largely outside of the putative fear network. We provide brief vignettes to illustrate the practical application of the DPM and argue that adjunct and stand-alone approaches which address values and character domains, leveraging principles of Stoicism, non-judgment of experience, acceptance, and values-oriented action, are more likely than traditional trauma treatment approaches to positively affect moral injury symptoms.

Direct and indirect effects of mindfulness, PTSD, and depression on self-stigma of mental illness in OEF/OIF veterans.

OBJECTIVE: Two of the most common and costly mental health diagnoses among military veterans who served in the post-9/11 conflicts in Afghanistan and Iraq are posttraumatic stress disorder (PTSD) and depression, but over half of veterans who screen positive for these problems do not seek treatment. A key barrier is self-stigma of mental illness. Mindfulness has shown promise as an explanatory variable in the context of mental health symptoms and self-stigma, but these associations are underexplored in the veterans' literature. This study examines direct and indirect effects among mindfulness, PTSD and depression, and self-stigma in post-9/11-era military veterans. METHOD: A sample of 577 veterans from 3 large American cities completed surveys capturing mindfulness, symptoms of PTSD and depression, and self-stigma. A structural equation modeling approach was used to examine direct and indirect effects among study variables. RESULTS: Mindfulness was associated with less PTSD and depression and indirectly with less self-stigma through the PTSD pathway. PTSD was associated with more depression and self-stigma, and depression was not significantly associated with self-stigma. CONCLUSION: PTSD is strongly associated with self-stigma in military veterans, many of whom do not seek mental health treatment. Findings show that mindfulness is a promising intervention target for reducing symptoms of PTSD directly and reducing associated self-stigma of mental illness indirectly. Additional investigation of links between mindfulness, PTSD and depressive symptoms, and self-stigma in military veterans is warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

MYPATH: A novel mindfulness and yoga-based peer leader intervention to prevent violence among youth experiencing homelessness.

Young adults experiencing homelessness (YAEH) are at elevated risk for violence victimization and perpetration. However, there are no evidence-based violence prevention interventions for homeless populations. This study is an evaluation of a novel mindfulness-based peer-leader intervention designed to reduce violence and improve mindfulness in YAEH. A social network of YAEH receiving services at a drop-in agency was recruited in Summer 2018 (n = 106) and peer-leaders identified at baseline (n = 12). Peer leaders were trained in mindfulness and yoga skills during a 1-day intensive workshop and seven 1-h weekly follow-up workshops and encouraged to share their knowledge with in-network peers. Postintervention data were collected 2 and 3 months after baseline. Two one-way repeated-measures analyses of variance (ANOVAs) tested differences in means for mindfulness and fighting. ANOVA models showed significant increases in group mean mindfulness F(2, 110) = 3.42, p < 0.05 and significant decreases in group mean violent behavior F(2, 112) = 5.23, p < 0.01 at the network level. Findings indicate a network-based, peer-leader model can be effective for influencing complex, socially conditioned attitudes and behaviors among YAEH. Additional advantages of the peer-leader model include relatively few direct-service person-hours required from providers and convenience to participants able practice skills in their relevant social contexts.

Can Better Emotion Regulation Protect Against Interpersonal Violence in Homeless Youth Social Networks?

Homeless youth experience all types of violence at higher rates than their housed counterparts. This is typically the result of many contributing factors including childhood experiences of trauma, subsistence survival strategies, and exposure to perpetrators while living on the streets. Reducing violence in the lives of homeless youth is imperative and can contribute to a young person's ability to safely and successfully exit the streets and lead a long and productive life in society. However, developing public health and social interventions to reduce violence in adolescent and young adult populations is difficult due to the complex interplay of extrinsic and intrinsic drivers of this phenomenon. Los Angeles area homeless youth (N = 366) were asked questions regarding recent violence experiences, emotion regulation, and their social network. Multivariable logistic regressions tested the overall effect of emotion regulation on violence, controlling for age, gender, race, sexual identity, experience of childhood abuse, and data collection site. In this sample, 56% of youth endorsed fighting in the previous year, and those who reported more difficulties with emotion regulation were significantly more likely to fight. In addition, youth who scored below the mean on difficulties with regulation and belonged to networks characterized by low-difficulty peers were 60% less likely to report fighting. Emotion regulation skills represent a malleable target for intervention that may contribute to reduced propensity for violence in this population. Implications for network-based interventions to improve individual emotion regulation and reduce overall violence among homeless youth and other at-risk populations are discussed.

Symptom Severity, Self-efficacy and Treatment-Seeking for Mental Health Among US Iraq/Afghanistan Military Veterans.

Military veterans have high rates of mental health problems, yet the majority do not seek treatment. Understanding treatment-seeking in this population is important. This study investigated if symptom severity and self-efficacy are associated with treatment-seeking among US Iraq/Afghanistan veterans. Survey data from 525 veterans meeting clinical criteria for PTSD and depression were included of which, 54.4% had sought treatment in the past 12 months. Multivariate logistic regression analysis indicated that high symptom severity was associated with treatment seeking, whereas high self-efficacy was associated with a decreased likelihood to seek treatment. Self-efficacy could be an underlying mechanism of treatment seeking decisions.

Can Mindfulness Help to Predict Veterans' Mental Health Service Utilization?

Post-9/11 era military veterans are at high risk for posttraumatic stress disorder (PTSD) and depression, but less than half of veterans who screen positive for these disorders seek mental health treatment. Self-stigma of mental illness has emerged as a core barrier to mental health service use (MHSU) in this population. Mindfulness is associated with attention control, nonjudgment, and reduced self-stigma in civilians, but associations between PTSD and depression, mindfulness, self-stigma, and MHSU have never been investigated in military veterans. The present study used a logistic regression modeling strategy to investigate main and interaction effects for PTSD, depression, mindfulness, and self-stigma on MHSU. Study findings demonstrated a positive main effect for PTSD and negative main effects for mindfulness and self-stigma on MHSU, and a positive interaction effect for mindfulness and PTSD on MHSU. Findings suggest that more mindful individuals with PTSD symptoms are more likely to seek mental health services, whereas less mindful individuals with PTSD symptoms are less likely to seek treatment. More research into the potential for mindfulness to enhance MHSU outcomes for military veterans appears warranted.

Effect of Mindfulness-Based Relapse Prevention on Impulsivity Trajectories Among Young Adults in Residential Substance Use Disorder Treatment.

OBJECTIVES: Impulsivity has been identified as an important construct in predicting the initiation and maintenance of substance use among at-risk populations. Interventions emphasizing mindfulness strategies appear particularly promising in reducing substance use and marking change in various aspects of impulsivity. METHODS: The current study used a rolling group mindfulness-based relapse prevention (MBRP) intervention for young adults in residential substance use disorder treatment. We examined change in impulsivity facets measured by the S-UPPS for youth randomly assigned to MBRP (n = 45) versus those assigned to treatment as usual plus 12 step/self-help (n = 34). We also examined how change in impulsivity mediated changes in substance use post-treatment. RESULTS: In general, results indicated that MBRP is effective at reducing facets of trait impulsivity in treatment-seeking individuals with SUDs. Only positive and negative urgency mediated the relation between treatment assignment and substance use. CONCLUSIONS: MBRP is a viable and useful intervention for young adults in residential treatment for substance use disorders and can aid in marked change in facets of impulsivity. Both positive and negative urgency were significant mechanisms of change in reducing substance use following treatment. Results are discussed focused on the utility of MRBP as a clinical intervention for at-risk, marginalized, and young adults.

PTSD in U.S. Veterans: The Role of Social Connectedness, Combat Experience and Discharge.

Service members who transition out of the military often face substantial challenges during their transition to civilian life. Leaving military service requires establishing a new community as well as sense of connectedness to that community. Little is known about how social connectedness may be related to other prominent transition outcomes, particularly symptoms of posttraumatic stress disorder (PTSD). The purpose of this study was to explore the role of social connectedness in the development of PTSD, as well as its relationship to the known risk factors of combat exposure and discharge status. Data used were drawn from a needs assessment survey of 722 veterans. A path model was specified to test direct and indirect effects of combat experiences, non-honorable discharge status, and social connectedness on PTSD symptoms. Results demonstrated positive direct effects for combat experiences and non-honorable discharge status on PTSD symptoms while social connectedness demonstrated a negative direct effect. Both combat experiences and non-honorable discharge status demonstrated negative direct effects on social connectedness and indirect on PTSD through the social connectedness pathway. Study findings indicate social connectedness may be an important factor related to PTSD in veterans as well as an intervention point for mitigating risk related to combat exposure and discharge status.

Can Better Emotion Regulation Protect against Suicidality in Traumatized Homeless Youth?

A substantial majority of homeless youth and young adults (HYA) experience abuse prior to and during homelessness. HYA also have high rates of posttraumatic stress disorder (PTSD) and suicidal behavior. This study investigated relationships between traumatic experiences, PTSD symptoms, substance use, and the protective effects of emotion regulation on outcome variables suicidal ideation and suicide attempts. Data were drawn from a sample of 398 HYA interviewed at 3 drop-in centers in Los Angeles County. A bivariate logistic regression modeling strategy was employed to examine relationships among demographic characteristics and dependent and independent variables. Trauma prior to homelessness and trauma prior to and after homelessness were positively associated with suicidal ideation, whereas emotional awareness and control demonstrated negative associations. PTSD symptoms were positively associated with suicide attempts, whereas emotional awareness and control demonstrated negative associations. Better emotion regulation is associated with reduced odds of suicidal ideation and attempts in HYA and may protect against effects of traumatic experiences. Interventions targeting emotion regulation skills in HYA to reduce suicidality associated with traumatic experiences merit additional investigation.

A systematic review of self-management health care models for individuals with serious mental illnesses.

OBJECTIVE: The general medical health of individuals with serious mental illnesses is compromised relative to those without serious mental illnesses. To address this health disparity, numerous integrated care strategies are being employed from the system level to the level of individual patients. However, self-management of health care, a strategy considered an integral aspect of typical care, has been infrequently included in interventions for this population. Despite reservations about the capacity of those with serious mental illnesses to self-manage health care, a subset of new interventions focused on general medical health in this population has tested whether models including self-management strategies have empirical support. To understand whether these models are supported, the authors reviewed the evidence for self-management models. METHODS: This systematic review examined collaborative and integrated care models that include self-management components for individuals with serious mental illnesses. RESULTS: Across the 14 studies identified in this review, promising evidence was found that individuals with serious mental health issues can collaborate with health professionals or be trained to self-manage their health and health care. The evidence supports the use of mental health peers or professional staff to implement health care interventions. However, the substantial heterogeneity in study design, types of training, and examined outcomes limited conclusions about the comparative effectiveness of existing studies. CONCLUSIONS: This review found preliminary support that self-management interventions targeting the general medical health of those with serious mental illnesses are efficacious, but future work is needed to determine what elements of training or skills lead to the most salient changes.