Community Mental Health Journal

, Volume 50, Issue 5, pp 553–559 | Cite as

Factors Associated with Poor Mental Health Status Among Homeless Women With and Without Dependent Children

  • Catharine Chambers
  • Shirley Chiu
  • Allison N. Scott
  • George Tolomiczenko
  • Donald A. Redelmeier
  • Wendy Levinson
  • Stephen W. Hwang
Brief Report


The purpose of this study was to estimate the prevalence of mental health problems among a representative sample of homeless women with and without dependent children and determine if the effects of risk factors for mental health are modified by the presence of dependent children. Homeless women (n = 522) were recruited in 2004–2005 from shelters and meal programs in Toronto, Canada. Linear and logistic regression was performed to identify factors associated with mental health status. Poor mental health was associated with low perceived access to social support, physical/sexual assault in the past 12 months, presence of a chronic health condition, and presence of a drug use problem in the past month. Efforts to improve mental health in this population will need to address the associated problems of victimization, substance abuse, and lack of social supports.


Mental health Women Homeless persons SF-12 Addiction Severity Index 


  1. Bassuk, E. L., Buckner, J. C., Perloff, J. N., & Bassuk, S. S. (1998). Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. American Journal of Psychiatry, 155, 1561–1564.PubMedGoogle Scholar
  2. Bassuk, E. L., Mickelson, K. D., Bissell, H. D., & Perloff, J. N. (2002). The role of kin and nonkin support in the mental health of low income women. American Journal of Orthopsychiatry, 72, 39–49.PubMedCrossRefGoogle Scholar
  3. Bassuk, E. L., Weinreb, L. F., Buckner, J. C., Browne, A., Salomon, A., & Bassuk, S. S. (1996). The characteristics and needs of sheltered homeless and low-income housed mothers. Journal of the American Medical Association, 276, 640.PubMedCrossRefGoogle Scholar
  4. Buckner, J. C., Bassuk, E. L., & Zima, B. T. (1993). Mental health issues affecting homeless women: Implications for intervention. American Journal of Orthopsychiatry, 63, 385–399.PubMedCrossRefGoogle Scholar
  5. Burt, M. R., Aron, L. Y., & Douglas, T. (1999). Homelessness: programs and the people they serve. Findings of the National Survey of Homeless Assistance Providers and Clients (Rep. No. 6-2-6-3). Washington, DC: Interagency Council on the Homeless.Google Scholar
  6. Burt, M., Aron, L. Y., & Lee, E. (2001). Helping America’s homeless. Washington, DC: The Urban Institute Press.Google Scholar
  7. Chiu, S., Redelmeier, D. A., Tolomiczenko, G., Kiss, A., & Hwang, S. W. (2009). The health of homeless immigrants. Journal of Epidemiology and Community Health, 63, 943–948.PubMedCentralPubMedCrossRefGoogle Scholar
  8. City of Toronto. (2009a). Street needs assessment results 2009. Toronto: Shelter, Support and Housing Administration.Google Scholar
  9. City of Toronto. (2009b). Staff report: 2010 per diem rates for the purchase of service shelter system and results of the review of the per diem funding model. Appendix C. 2008 vs. 2009 occupancy information. Retrieved from
  10. Drake, R. E., McHugo, G. J., & Biesanz, J. C. (1995). The test-retest reliability of standardized instruments among homeless persons with substance use disorders. Journal of Studies on Alcohol, 56, 161–167.PubMedGoogle Scholar
  11. Farrell, S. J., Huff, J., MacDonald, S. A., Middlebro, A., & Walsh, S. (2005). Taking it to the street: A psychiatric outreach service in Canada. Community Mental Health Journal, 41, 737–746.PubMedCrossRefGoogle Scholar
  12. Forchuk, C., Jensen, E., Csiernik, R., Gorlick, C., Ray, S. L., Berman, H., et al. (2007). Diversity and homelessness: Minorities and psychiatric survivors. Canadian Journal of Nursing Research, 39, 191–193.PubMedGoogle Scholar
  13. Gelberg, L., Browner, C. H., Lejano, E., & Arangua, L. (2004). Access to women’s health care: A qualitative study of barriers perceived by homeless women. Women and Health, 40, 87–100.PubMedCrossRefGoogle Scholar
  14. Goodman, L. A., Smyth, K. F., & Banyard, V. (2010). Beyond the 50-minute hour: Increasing control, choice, and connections in the lives of low-income women. American Journal of Orthopsychiatry, 80, 3–11.PubMedCrossRefGoogle Scholar
  15. Goodman, L. A., Smyth, K. F., Borges, A. M., & Singer, R. (2009). When crisis collide: How intimate partner violence and poverty intersect to shape women’s mental health and coping? Trauma, Violence, & Abuse, 10, 306–329.CrossRefGoogle Scholar
  16. Greenland, S. (2008). Invited commentary: Variable selection versus shrinkage in the control of multiple confounders. American Journal of Epidemiology, 167, 523.PubMedCrossRefGoogle Scholar
  17. Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression (2nd ed.). New York: Wiley.CrossRefGoogle Scholar
  18. Human Resources and Skills Development Canada. (2010). The homelessness partnering strategy. Retrieved from
  19. Hwang, S. W. (2001). Homelessness and health. Canadian Medical Association Journal, 164, 229–233.PubMedCentralPubMedGoogle Scholar
  20. Hwang, S. W., Chiu, S., Kiss, A., Katic, M., Tolomiczenko, G., Levinson, W., et al. (2005). Use of meal programs and shelters by homeless people in Toronto. Journal of Urban Health, 82, ii46.Google Scholar
  21. Hwang, S. W., Colantonio, A., Chiu, S., Tolomiczenko, G., Kiss, A., Cowan, L., et al. (2008). The effect of traumatic brain injury on the health of homeless people. Canadian Medical Association Journal, 179, 779–784.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Hwang, S. W., Kirst, M. J., Chiu, S., Tolomiczenko, G., Kiss, A., Cowan, L., et al. (2009). Multidimensional social support and the health of homeless individuals. Journal of Urban Health, 86, 791–803.PubMedCentralPubMedCrossRefGoogle Scholar
  23. Hwang, S. W., Ueng, J. J., Chiu, S., Kiss, A., Tolomiczenko, G., Cowan, L., et al. (2010). Universal health insurance and health care access for homeless persons. American Journal of Public Health, 100, 1454–1461.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Joyner, L. M., Wright, J. D., & Devine, J. A. (1996). Reliability and validity of the Addiction Severity Index among homeless substance misusers. Substance Use and Misuse, 31, 729–751.PubMedCrossRefGoogle Scholar
  25. Khandor, E., & Mason, K. (2007). The street health report 2007. Toronto, ON: Street Health.Google Scholar
  26. Lam, W. K., Wechsberg, W., & Zule, W. (2004). African-American women who use crack cocaine: A comparison of mothers who live with and have been separated from their children. Child Abuse Neglect, 28, 1229–1247.PubMedCrossRefGoogle Scholar
  27. Larson, C. O. (2002). Use of the SF 12 instrument for measuring the health of homeless persons. Health Services Research, 37, 733–750.PubMedCentralPubMedCrossRefGoogle Scholar
  28. Lewis, J. H., Andersen, R. M., & Gelberg, L. (2003). Health care for homeless women. Journal of General Internal Medicine, 18, 921–928.PubMedCentralPubMedCrossRefGoogle Scholar
  29. Lim, Y. W., Andersen, R., Leake, B., Cunningham, W., & Gelberg, L. (2002). How accessible is medical care for homeless women? Medical Care, 40, 510–520.PubMedCrossRefGoogle Scholar
  30. McGahan, P. L., Griffith, J. A., Parente, R., & McLellan, A. T. (1986). Addiction Severity Index: Composite scores manual. Philadelphia: The University of Pennsylvania/Veterans Administration Centre for Studies of Addiction.Google Scholar
  31. McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., et al. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, 199–213.PubMedCrossRefGoogle Scholar
  32. Metraux, S., & Culhane, D. P. (1999). Family dynamics, housing, and recurring homelessness among women in New York City homeless shelters. Journal of Family Issues, 20, 371–398.CrossRefGoogle Scholar
  33. Montgomery, P., Brown, S., & Forchuk, C. (2011). A comparison of individual and social vulnerabilities, health, and quality of life among Canadian women with mental diagnoses and young children. Women’s Health Issues, 21, 48–56.PubMedCrossRefGoogle Scholar
  34. National Center on Family Homelessness. (2008). The characteristics and needs of families experiencing homelessness. Newton Centre, MA: Author.Google Scholar
  35. National Coalition for the Homeless. (2008). Homeless families with children. NCH Fact Sheet #12. Washington, DC: Author.Google Scholar
  36. North, C. S., & Smith, E. M. (1993). A comparison of homeless men and women: Different populations, different needs. Community Mental Health Journal, 29, 423–431.PubMedCrossRefGoogle Scholar
  37. Paquette, K., & Bassuk, E. L. (2009). Parenting and homelessness: An overview and introduction to the special section. American Journal of Orthopsychiatry, 79, 292–298.PubMedCrossRefGoogle Scholar
  38. Power, A. (2008). Mental health. Homelessness Hub. Retrived from
  39. Robertson, M. J., & Winkleby, M. A. (1996). Mental health problems of homeless women and differences across subgroups. Annual Review of Public Health, 17, 311–336.PubMedCrossRefGoogle Scholar
  40. Statistics Canada. (2002). Ethnic diversity questionnnaire. Retrieved from
  41. Statistics Canada. (2003). The Daily, Wednesday, September 3, 2003. Canadian Community Health Survey: Mental health and well-being. Retrieved from
  42. Tam, T. W., Zlotnick, C., & Bradley, K. (2008). The link between homeless women’s mental health and service system use. Psychiatric Services, 59, 1004–1010.PubMedCrossRefGoogle Scholar
  43. Ware, J. E., Kosinski, M., & Keller, D. (1995). SF-12: How to score the SF-12 physical and mental health summary scales (2nd ed.). Boston, MA: The Health Institute, New England Medical Center.Google Scholar
  44. Weinreb, L., Goldberg, R., & Perloff, J. (1998). Health characteristics and medical service use patterns of sheltered homeless and low income housed mothers. Journal of General Internal Medicine, 13, 389–397.PubMedCentralPubMedCrossRefGoogle Scholar
  45. Weinreb, L., Nicholson, J., Williams, V., & Anthes, F. (2007). Integrating behavioral health services for homeless mothers and children in primary care. American Journal of Orthopsychiatry, 77, 142–152.PubMedCrossRefGoogle Scholar
  46. Weinreb, L., Perloff, J., Goldberg, R., Lessard, D., & Hosmer, D. W. (2006). Factors associated with health service utilization patterns in low-income women. Journal of Health Care for the Poor and Underserved, 17, 180.PubMedCrossRefGoogle Scholar
  47. Zanis, D. A., McLellan, A. T., Cnaan, R. A., & Randall, M. (1994). Reliability and validity of the Addiction Severity Index with a homeless sample. Journal of Substance Abuse Treatment, 11, 541–548.PubMedCrossRefGoogle Scholar
  48. Zlotnick, C., Robertson, M. J., & Tam, T. (2003). Substance use and separation of homeless mothers from their children. Addictive Behaviors, 28, 1373–1383.PubMedCrossRefGoogle Scholar
  49. Zugazaga, C. (2004). Stressful life event experiences of homeless adults: A comparison of single men, single women, and women with children. Journal of Community Psychology, 32, 643–654.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Catharine Chambers
    • 1
  • Shirley Chiu
    • 1
  • Allison N. Scott
    • 1
  • George Tolomiczenko
    • 2
  • Donald A. Redelmeier
    • 3
    • 4
  • Wendy Levinson
    • 3
  • Stephen W. Hwang
    • 1
    • 3
  1. 1.Centre for Research on Inner City Health, Keenan Research Centre, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  2. 2.Division of Health, Technology & EngineeringUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of MedicineUniversity of TorontoTorontoCanada
  4. 4.Sunnybrook Health Sciences CentreInstitute for Clinical Evaluative SciencesTorontoCanada

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