Skip to main content

Advertisement

SpringerLink
Log in

Conduct disorder behaviors, childhood family instability, and childhood abuse as predictors of severity of adult homelessness among American veterans

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Despite US federal efforts to end and prevent homelessness among veterans, there has been limited examination of pre-military factors like childhood problems, associated with adult homelessness. This study examined childhood problems among homeless veterans and its relation to severity of homelessness and outcomes in supported housing.

Methods

Using data from 1,161 homeless veterans at 19 sites enrolled in the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program, three types of childhood problems were examined: conduct disorder behaviors, family instability, and childhood abuse. Multiple regressions were conducted to examine the association between childhood problems and severity of homelessness before supported housing, and childhood problems and outcomes after supported housing.

Results

About one-third reported conduct disorder behaviors, over half reported family instability, and 40 % reported childhood abuse. Greater childhood problems were found in this sample compared to published samples of non-homeless veterans. Conduct disorder behaviors, family instability, and childhood abuse were each weakly associated with lifetime homeless episodes. One year after enrollment in the HUD-VASH program, past conduct disorder behaviors and family instability were not predictive of outcomes, except childhood abuse was related to less social support and lower quality of life.

Conclusions

These findings demonstrate not only the potential impact of childhood abuse on social relationships and quality of life in adulthood, but also the resilience of homeless veterans from adverse childhoods to be successfully housed in a supported housing program.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. United States Department of Veterans Affairs (2011) Homeless veterans: prevention services. United States Department of Veterans Affairs. http://www.va.gov/HOMELESS/prevention.asp. Accessed 2 July 2011

  2. US Department of Housing and Urban Development, US Department of Veterans Affairs (2009) Veteran homelessness: a supplemental report to the 2009 annual homeless assessment report to Congress. US Department of Housing and Urban Development, office of community planning and development; US Department of Veterans Affairs, National Center on Homelessness among Veterans, Washington, DC

  3. Edens EL, Kasprow W, Tsai J, Rosenheck RA (2011) Association of substance use and VA service-connected disability benefits with risk of homelessness among veterans. Am J Addictions 20(5):412–419

    Article  Google Scholar 

  4. Gamache G, Rosenheck RA, Tessler R (2001) The proportion of veterans among homeless men: a decade later. Soc Psychiatry Psychiatr Epidemiol 36:481–485

    Article  PubMed  CAS  Google Scholar 

  5. Rosenheck RA, Frisman L, Chung A (1994) The proportion of veterans among homeless men. Am J Public Health 84:466–469

    Article  PubMed  CAS  Google Scholar 

  6. Rosenheck RA, Fontana A (1994) A model of homelessness among male veterans of the Vietnam War generation. Am J Psychiatry 151:421–427

    PubMed  CAS  Google Scholar 

  7. Garcia-Rea EA, LePage JP (2010) Effects of childhood abuse on relapse in a recently homeless substance-dependent veteran population. Psychological Trauma Theory Res Pract Policy 2(3):201–205

    Article  Google Scholar 

  8. Fontana A, Rosenheck R (1993) A casual model of the etiology of war-related PTSD. J Trauma Stress 6(4):475–499

    Article  Google Scholar 

  9. Fontana A, Schwartz LS, Rosenheck R (1997) Posttraumatic stress disorder among female Vietnam veterans: a causal model of etiology. Am J Public Health 87(2):169–175

    Article  PubMed  CAS  Google Scholar 

  10. Fontana A, Rosenheck RA (2005) The role of war-zone trauma and PTSD in the etiology of antisocial behavior. J Nerv Ment Dis 193(3):203–209

    Article  PubMed  Google Scholar 

  11. McGuire J (2007) Closing a front door to homelessness among veterans. J Prim Prevention 28:389–400

    Article  Google Scholar 

  12. McGuire J, Rosenheck RA (2004) Criminal history as a prognostic indicator in the treatment of homeless people with severe mental illness. Psychiatr Serv 55:42–48

    Article  PubMed  Google Scholar 

  13. Bifulco A, Moran PM, Baines R, Bunn A, Stanford K (2002) Exploring psychological abuse in childhood: II. Association with other abuse and adult clinical depression. Bull Menninger Clin 66(3):241–258

    Article  PubMed  Google Scholar 

  14. McCauley J, Kern DE, Kolodner K, Dill L, Schroeder AF, DeChant HK, Ryden J, Derogatis LR, Bass EB (1997) Clinical characteristics of women with a history of childhood abuse: unhealed wounds. J Am Med Assoc 277(17):1362–1368

    Article  CAS  Google Scholar 

  15. Tessler R, Rosenheck RA, Gamache G (2002) Comparison of homeless veterans with other homeless men in a large clinical outreach program. Psychiatr Q 73(2):109–119

    Article  PubMed  Google Scholar 

  16. Susser ES, Conover SA, Struening EL (1991) Childhood antecedents of homelessness in psychiatric patients. Am J Psychiatry 148:1026–1030

    PubMed  CAS  Google Scholar 

  17. Koegel P, Melamid E, Burnam A (1995) Childhood risk factors for homelessness among homeless adults. Am J Public Health 85:1642–1649

    Article  PubMed  CAS  Google Scholar 

  18. Herman DB, Susser ES, Struening EL, Link BL (1997) Adverse childhood experiences: are they risk factors for adult homelessness? Am J Public Health 87:249–255

    Article  PubMed  CAS  Google Scholar 

  19. Stein JA, Leslie MB, Nyamathi A (2002) Relative contributions of parent substance use and childhood maltreatment to chronic homelessness, depression, and substance abuse problems among homeless women: mediating roles of self-esteem and abuse in adulthood. Child Abuse Negl 26:1011–1027

    Article  PubMed  Google Scholar 

  20. Booth RE, Zhang Y (1996) Severe aggression and related conduct problems among runaway and homeless adolescents. Psychiatr Serv 47:75–80

    PubMed  CAS  Google Scholar 

  21. Whitbeck LB, Hoyt DR, Bao WN (2000) Depressive symptoms and co-occurring depression, substance abuse, and conduct problems among runaway and homeless adolescents. CD 71(3):721–732

    CAS  Google Scholar 

  22. Sullivan G, Burnam A, Koegel P (2000) Pathways to homelessness among the mentally ill. Soc Psychiatry Psychiatr Epidemiol 35:444–450

    Article  PubMed  CAS  Google Scholar 

  23. National Alliance to End Homelessness (2007) Homelessness. Homelessness counts. http://www.endhomelessness.org/content/article/detail/1440. Accessed 28 July 2011

  24. Tsai J, Edens EL, Rosenheck RA (2011) A Typology of childhood problems among chronically homeless adults and its association with housing and clinical outcomes. J Health Care Poor Underserved 22(3):853–870

    Article  PubMed  Google Scholar 

  25. Helzer JE (1980) Methodological issues in the interpretation of the consequences of extreme situations. In: Dohrenwend BS, Dohrenwend BP (eds) Stressful life events and their contexts. Prodist, New York, pp 108–129

    Google Scholar 

  26. Helzer JE, Robins LN, McEvoy L (1987) Posttraumatic stress disorder in general population. N Engl J Med 317:1630–1634

    Article  PubMed  CAS  Google Scholar 

  27. Laufer RS, Yager T, Frey-Wouters E, Donnellan J (1981) Legacies of Vietnam, vol. 3. House Commitee Print 14, US Government Printing Office, Washington, DC

  28. Kadushin C, Boulanger G, Martin J (1981) Legacies of Vietnam, vol. 4. Long term stress reactions: some causes, consequences, and naturally occurring support systems. Housing Committee Print No.14, US Government Printing Office, Washington, DC

  29. DeVellis RF (1991) Scale development. Sage publications, Newbury Park

    Google Scholar 

  30. Vaux A, Athanassopulou M (1987) Social support appraisals and network resources. J Community Psychol 15:537–556

    Article  Google Scholar 

  31. Lehman AF (1988) A quality of life interview for the chronically mentally ill. Eval Program Plann 11(1):51–62

    Article  Google Scholar 

  32. Shevlin M, Murphy J, Read J, Mallett J, Adamson G, Houston JE (2011) Childhood adversity and hallucinations: a community-based study using the National Comorbidity Survey Replication. Soc Psychiatry Psychiatr Epidemiol 46(12):1203–1210

    Article  PubMed  Google Scholar 

  33. Storr CL, Schaeffer CM, Petras H, Ialongo NS, Breslau N (2009) Early childhood behavior trajectories and the likelihood of experiencing a traumatic event and PTSD by young adulthood. Soc Psychiatry Psychiatr Epidemiol 44(5):398–406

    Article  PubMed  Google Scholar 

  34. Polusny MA, Follette VM (1995) Long-term correlates of child sexual abuse: theory and review of the empirical literature. Appl Preventive Psychol 4(3):143–166

    Article  Google Scholar 

  35. Glaser D (2000) Child abuse and neglect and the brain—a review. J Child Psychol Psychiatry 41(1):97–116

    Article  PubMed  CAS  Google Scholar 

  36. Wind TW, Silvern LE (1992) Type and extent of child abuse as predictors of adult functioning. J Fam Violence 7:261–281

    Article  Google Scholar 

  37. Sourander A et al (2011) What is the long-term outcome of boys who steal at age eight? Findings from the Finnish nationwide “From a Boy to a Man” birth cohort study. Soc Psychiatry Psychiatr Epidemiol (in press)

  38. Tsai J, Desai RA, Rosenheck RA (2012) Social integration of people with severe mental illness: relationships between symptom severity, professional assistance, and natural support. J Behav Health Serv Res 39(2):144–157

    Article  PubMed  Google Scholar 

  39. Lam JA, Rosenheck RA (1999) Social support and service use among homeless persons with serious mental illness. Int J Soc Psychiatry 45(1):13–28

    Article  PubMed  CAS  Google Scholar 

  40. Rosenheck RA, Morrissey JP, Lam J, Calloway M, Stolar M, Johnsen M, Randolph FL, Blaskinsky M, Goldman HH (2001) Service delivery and community: social capital, service systems integration, and outcomes among homeless persons with severe mental illness. Health Serv Res 36(4):691–710

    PubMed  CAS  Google Scholar 

  41. Tsai J, Rosenheck RA (2012) Does housing chronically homeless adults lead to social integration? Psychiatr Serv 63(5):427–434

    Article  PubMed  Google Scholar 

  42. Rosenheck RA, Kasprow W, Frisman L, Liu-Mares W (2003) Cost-effectiveness of supported housing for homeless persons with mental illness. Arch Gen Psychiatry 60:940–951

    Article  PubMed  Google Scholar 

  43. American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders, 3rd edn. Author, Washington

    Google Scholar 

  44. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4 (text rev) edn. Author, Washington

    Google Scholar 

Download references

Acknowledgments

There was no specific funding for this study. This material was based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development. The views presented here are those of the authors alone, and do not represent the position of any federal agency or of the United States Government.

Author information

Authors and Affiliations

  1. VA New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA

    Jack Tsai & Robert A. Rosenheck

  2. Department of Psychiatry, Yale University, New Haven, CT, USA

    Jack Tsai & Robert A. Rosenheck

  3. School of Epidemiology and Public Health, Yale University, New Haven, CT, USA

    Robert A. Rosenheck

Authors
  1. Jack Tsai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert A. Rosenheck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jack Tsai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tsai, J., Rosenheck, R.A. Conduct disorder behaviors, childhood family instability, and childhood abuse as predictors of severity of adult homelessness among American veterans. Soc Psychiatry Psychiatr Epidemiol 48, 477–486 (2013). https://doi.org/10.1007/s00127-012-0551-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-012-0551-4

Keywords

Search

Navigation