Substance use and posttraumatic stress disorder: 12-month outcomes among adults experiencing chronic homelessness in Australia.

INTRODUCTION: Substance use disorder and posttraumatic stress disorder (PTSD) are highly prevalent among individuals who experience homelessness. However, evaluations of interventions that combine housing and mental health services have reported inconsistent mental health and substance use outcomes when compared to usual services. We investigated 12-month change in substance use severity and PTSD symptom severity among adults experiencing chronic homelessness and tested whether observed differences were associated with housing, support from mental health services or the Journey to Social Inclusion (J2SI) program. METHODS: A randomised controlled trial compared the J2SI program with standard service provision (N = 135). Secondary analyses compared those who obtained housing or received mental health services with those who did not. Primary outcomes were alcohol and illicit substance use severity (alcohol, smoking and substance involvement screening test) and PTSD symptom severity (six-item PTSD checklist). RESULTS: There was significant improvement at 12 months in alcohol use severity, illicit substance use severity and PTSD symptoms in the overall sample. Having seen a mental health professional in the previous 12 months was associated with a significant reduction in alcohol and illicit substance use severity but was not associated with changes in PTSD symptom severity. Being housed at 12 months was associated with significantly higher alcohol use severity. DISCUSSION AND CONCLUSIONS: Findings highlight the importance of access to mental health care for people with a history of chronic homelessness. Research is needed to develop and test therapeutic and housing approaches to reduce PTSD symptom severity among people with experience of homelessness.

Child maltreatment and post-traumatic growth: Implications for the well-being of young adults.

BACKGROUND: Little is known about the relationship between childhood maltreatment and well-being in young adults, including the role of post-traumatic growth (PTG) in promoting better outcomes for young adults who have a history of childhood maltreatment (HCM). OBJECTIVE: To examine the relationship between child maltreatment and well-being among young adults, by considering the perpetrator and the extent of the maltreatment, as well as PTG among young adults with a HCM. PARTICIPANTS AND SETTING: The sample comprised 537 young adults (aged 18-25; M = 21.09 years, SD = 2.36) from across Australia, with 182 young adults in the sample forming the cohort with a HCM. METHOD: Participants' current well-being, the extent of maltreatment by their mother, father and other adults experienced as a child (<18 years), and PTG was collected using an online survey. Tests of group differences and multiple regression were conducted to analyse the relationships between child maltreatment, PTG, and current well-being. RESULTS: Maltreatment by one's mother or father predicted poorer current well-being, but not maltreatment by another adult. Young adults who identified as having a HCM had poorer well-being than those who did not. Within the cohort of those with a HCM, greater PTG predicted greater well-being, and also mitigated the negative relationship between child maltreatment by one's father and well-being. CONCLUSION: Findings indicate that both the extent of child maltreatment and the relationship to the perpetrator have implications for well-being among young adults. PTG appeared to play a protective role, highlighting the potential therapeutic benefit of fostering PTG to improve well-being among young adults with a HCM.

Loneliness, mental health, and social health indicators in LGBTQIA+ Australians.

Loneliness is a growing public health concern that is associated with poor mental health (e.g., social anxiety, depression) and increased physical health problems (e.g., cardiovascular disease, sleep disturbances). Socially vulnerable groups such as the elderly, migrants, and asylum seekers are more susceptible to the effects of loneliness. We examined loneliness severity in lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual orientation and gender identity diverse (LGBTQIA+) communities. The relationships between loneliness, mental health, social support, belongingness, and quality of life in a sample of LGBTQIA+ (n = 238) and non-LGBTQIA+ (n = 270) adults aged 18-73 years (N = 508) were examined. Overall, LGBTQIA+ adults experienced higher levels of loneliness, depression, and social anxiety than the non-LGBTQIA+ comparison group. LGBTQIA+ adults also reported lower perceived social support and were at higher risk of social isolation than the non-LGBTQIA+ group. Thus, LGBTQIA+ adults may be at greater risk of loneliness and social isolation than has previously been recognized. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A mixed methods randomised control trial to evaluate the effectiveness of the journey to social inclusion - phase 2 intervention for chronically homeless adults: study protocol.

BACKGROUND: Chronic homelessness is a problem characterised by longstanding inability to attain or maintain secure accommodation. Longitudinal research with homeless populations is challenging, and randomised controlled trials that evaluate the effectiveness of intensive, case management interventions aimed at improving housing and health-related outcomes for chronically homelessness people are scant. More research is needed to inform programmatic design and policy frameworks in this area. This study protocol details an evaluation of the Journey to Social Inclusion - Phase 2 program, an intervention designed to reduce homelessness and improve outcomes in chronically homeless adults. METHODS/DESIGN: J2SI Phase 2 is a three-year, mixed methods, multi-site, RCT that enrolled 186 participants aged 25 to 50 years between 07 January 2016 and 30 September 2016 in Melbourne. The intervention group (n = 90 recruited) receives the J2SI Phase 2 program, a trauma-informed intervention that integrates intensive case management and service coordination; transition to housing and support to sustain tenancy; and support to build social connections, obtain employment and foster independence. The comparison group (n = 96 recruited) receives standard service provision. Prior to randomisation, participants completed a baseline survey. Follow-up surveys will be completed every six months for three years (six in total). In addition to self-report data on history of homelessness and housing, physical and mental health, substance use, quality of life, social connectedness and public service utilisation, linked administrative data on participants' public services utilisation (e.g., hospitalisation, justice system) will be obtained for the three-year period pre- and post-randomisation. Semi-structured, qualitative interviews will be conducted with a randomly selected subset of participants and service providers at three time-points to explore changes in key outcome variables and to examine individual experiences with the intervention and standard service provision. An economic evaluation of the intervention and associated costs will also be undertaken. DISCUSSION: Results of this trial will provide robust evidence on the effectiveness of J2SI Phase 2 compared to standard service provision. If the intervention demonstrates effectiveness in improving housing, health, quality-of-life, and other social outcomes, it may be considered for broader national and international dissemination to improve outcomes among chronically homeless adults. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12616000162415 (retrospectively registered 10-February-2016).