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Multilayer depressive symptom networks in adults with bodily pain living in precarious housing or homelessness

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Abstract

Housing insecurity is associated with co-occurring depression and pain interfering with daily activities. Network analysis of depressive symptoms along with associated risk or protective exposures may identify potential targets for intervention in patients with co-occurring bodily pain. In a community-based sample of adults (n = 408) living in precarious housing or homelessness in Vancouver, Canada, depressive symptoms were measured by the Beck Depression Inventory; bodily pain and impact were assessed with the 36-item Short Form Health Survey. Network and bootstrap permutation analyses were used to compare depressive symptoms endorsed by Low versus Moderate-to-Severe (Mod + Pain) groups. Multilayer networks estimated the effects of risk and protective factors. The overall sample was comprised of 78% men, mean age 40.7 years, with 53% opioid use disorder and 14% major depressive disorder. The Mod + Pain group was characterized by multiple types of pain, more persistent pain, more severe depressive symptoms and a higher rate of suicidal ideation. Global network connectivity did not differ between the two pain groups. Suicidal ideation was a network hub only in the Mod + Pain group, with high centrality and a direct association with exposure to lifetime trauma. Antidepressant medications had limited impact on suicidal ideation. Guilt and increased feelings of failure represented symptoms from two other communities of network nodes, and completed the shortest pathway from trauma exposure through suicidal ideation, to the non-prescribed opioid exposure node. Interventions targeting these risk factors and symptoms could affect the progression of depression among precariously housed patients.

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Acknowledgements

We thank the Hotel Study research assistants and volunteers. We are grateful for the individuals that participate in this study.

Funding

This work was supported by the Canadian Institutes of Health Research (MOP-137103).

Author information

Author notes

  1. Andrea A. Jones and Lianne L. Cho shared co-first authorship.

Authors and Affiliations

  1. Division of Neurology, Department of Medicine, University of British Columbia, 8219-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada

    Andrea A. Jones & Thalia S. Field

  2. Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

    Andrea A. Jones, Lianne L. Cho, Ric M. Procyshyn, Fidel Vila-Rodriguez, Jacob L. Stubbs, Olga Leonova, Tari Buchanan, G. William MacEwan, William J. Panenka & William G. Honer

  3. Department of Psychology, York University, Toronto, ON, Canada

    Kristina M. Gicas

  4. Department of Psychology, Simon Fraser University, Burnaby, BC, Canada

    Allen E. Thornton

  5. Department of Radiology, University of British Columbia, Vancouver, BC, Canada

    Donna J. Lang

  6. Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada

    Alasdair M. Barr

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  1. Andrea A. Jones
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Corresponding author

Correspondence to Andrea A. Jones.

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Conflict of interest

AAJ, LLC, KMG, OL, JLS, TB, AET, DJL, GWM, WJP, AMB, and TSF report no conflicts of interest. RMP has received consulting fees or sat on paid advisory boards for Janssen, Lundbeck, and Otsuka; and is on the speaker’s bureau for Janssen, Lundbeck, and Otsuka. FVR receives research support from CIHR, Brain Canada, Michael Smith Foundation for Health Research, Vancouver Coastal Health Research Institute, and Weston Brain Institute for investigator-initiated research. Philanthropic support from Seedlings Foundation. FVR has also received in-kind equipment support for this investigator-initiated trial from MagVenture and honoraria for participation in advisory board for Janssen. WGH has received consulting fees or sat on paid advisory boards for: In Silico (unpaid), Translational Life Sciences (TLS), Newron and AbbVie.

Ethical approval

The authors assert that all procedures contributing to this work comply with the ethical standards of the University of British Columbia Clinical Research Ethics Boards and the Helsinki Declaration of 1975 as revised in 2008. Ethics approval certificate H08-00521. Written informed consent was obtained from participants to participate in the study.

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Jones, A.A., Cho, L.L., Gicas, K.M. et al. Multilayer depressive symptom networks in adults with bodily pain living in precarious housing or homelessness. Eur Arch Psychiatry Clin Neurosci 274, 643–653 (2024). https://doi.org/10.1007/s00406-023-01664-0

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