Social Indicators Research

, Volume 116, Issue 2, pp 341–352 | Cite as

Subjective Health-Related Quality of Life in Homeless and Vulnerably Housed Individuals and Its Relationship with Self-Reported Physical and Mental Health Status

  • Anne M. GadermannEmail author
  • Anita M. Hubley
  • Lara B. Russell
  • Anita Palepu


Although the association between homelessness and objective indicators of poor health is well-established, little research has focused on the subjective health-related quality of life of homeless and vulnerably housed (HVH) individuals. This study examined the subjective health-related quality of life of HVH individuals, using the Multiple Discrepancies Theory (MDT) Scale for Health of the Quality of Life for Homeless and Hard-to-House Individuals (QoLHHI) Inventory, and its association with self-reported functional health status, as measured by the SF-12, and self-reported physical and mental health conditions in a sample of 100 HVH individuals recruited in Vancouver, Toronto and Ottawa. Our findings indicate that physical and mental health conditions are highly prevalent among HVH individuals and that the SF-12 Physical and Mental Component Summary scores are substantially lower compared to US population norms. The MDT Health items were not statistically significantly associated with physical or mental health conditions and only showed correlations of small to moderate magnitude with the SF-12 Component Summary Scales. These findings suggest that the QoLHHI MDT Scale for Health can provide information about HVH individuals’ subjective health experiences that is different from, and can serve as a valuable complement to, health status information for use in research and evaluation studies, as well as for policy purposes to make informed decisions based on subjective health-related quality of life data from HVH individuals.


Health-related quality of life Homeless Vulnerably housed Quality of Life for Homeless and Hard-to-House Individuals Inventory SF-12 Multiple Discrepancies Theory 



This project was supported by an operating grant from the Canadian Institutes of Health Research to Dr. Anita Hubley and Dr. Anita Palepu. Dr. Anne Gadermann also gratefully acknowledges support from the Michael Smith Foundation for Health Research.


  1. Anderson, K. L., & Burkhardt, C. S. (1999). Conceptualization and measurement of quality of life as an outcome variable for health care intervention and research. Journal of Advanced Nursing, 29, 298–306.CrossRefGoogle Scholar
  2. Binik, Y. M., & Devins, G. M. (1986–1987). Transplant failure does not compromise quality of life in end-stage renal disease. International Journal of Psychiatry in Medicine, 16, 281–292.Google Scholar
  3. Breakey, W. R., Fischer, P. J., Kramer, M., Nestadt, G., Romanoski, A. J., Ross, A., et al. (1989). Health and mental health problems of homeless men and women in Baltimore. Journal of the American Medical Association, 262, 1352–1357.CrossRefGoogle Scholar
  4. Canadian Institute for Health Information. (2007). Improving the health of Canadians: Mental health and homelessness. Ottawa, ON: Canadian Institute for Health Information.Google Scholar
  5. Cheung, A. M., & Hwang, S. W. (2004). Risk of death among homeless women: A cohort study and review of the literature. Canadian Medical Association Journal, 170, 1243–1247.CrossRefGoogle Scholar
  6. de Haes, J. C. J. M., & Van Knippenberg, F. C. E. (1985). The quality of life of cancer patients: A review of the literature. Social Science and Medicine, 20, 809–817.CrossRefGoogle Scholar
  7. Fischer, P. J., & Breakey, W. R. (1991). The epidemiology of alcohol, drug, and mental disorders among homeless persons. American Psychologist, 46, 1115–1128.CrossRefGoogle Scholar
  8. Frankish, C. J., Hwang, S. W., & Quantz, D. (2005). Homelessness and health in Canada: Research lessons and priorities. Canadian Journal of Public Health, 96(Suppl2), S23–S29.Google Scholar
  9. Gill, T. M., & Feinstein, A. R. (1994). A critical appraisal of the quality of quality-of-life measurements. Journal of the American Medical Association, 272, 619–626.CrossRefGoogle Scholar
  10. Hubley, A. M., Rusell, L. B., Palepu, A., & Hwang, S. W. (2012). Subjective quality of life among individuals who are homeless: A review of current knowledge. Social Indicators Research,. doi: 10.1007/s11205-012-9998-7.Google Scholar
  11. Hubley, A. M., Russell, L. B., Gadermann, A. M., & Palepu, A. (2009). Quality of Life for Homeless and Hard-to-House Individuals (QOLHHI) Inventory: Administration and scoring manual. Vancouver, BC: Authors.Google Scholar
  12. Hwang, S. W. (2000). Mortality among men using homeless shelters in Toronto, Ontario. Journal of the American Medical Association, 283, 2152–2157.CrossRefGoogle Scholar
  13. Hwang, S. W. (2001). Homelessness and health. Canadian Medical Association Journal, 164, 229–233.Google Scholar
  14. Hwang, S. W., Wilkins, R., Tjepkema, M., O’Campo, P. J., & Dunn, J. R. (2009). Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. British Medical Journal, 339, b4036.CrossRefGoogle Scholar
  15. Johnson, J. P., McCauley, C. R., & Copley, J. B. (1982). The quality of life of hemodialysis and transplant patients. Kidney International, 22, 286–291.CrossRefGoogle Scholar
  16. Kertesz, S. G., Larson, M. J., Horton, N. J., Winter, M., Saitz, R., & Samet, J. H. (2005). Homeless chronicity and health-related quality of life trajectories among adults with addictions. Medical Care, 43(6), 574–585.CrossRefGoogle Scholar
  17. Kushel, M. B., Vittinghoff, E., & Haas, J. S. (2001). Factors associated with the health care utilization of homeless persons. Journal of the American Medical Association, 285, 200–206.CrossRefGoogle Scholar
  18. Laird, G. (2007). Shelter. Homelessness in a growth economy: Canada’s 21st century paradox. Sheldon Chumir Foundation for Ethics in Leadership, Calgary.Google Scholar
  19. Larson, C. O. (2002). Use of the SF-12 instrument for measuring the health of homeless persons. Health Services Research, 37, 733–750.CrossRefGoogle Scholar
  20. Lehman, A. F. (1983). The well-being of chronic mental patients. Archives of General Psychiatry, 40, 369–373.CrossRefGoogle Scholar
  21. Lehman, A. F., Ward, N. C., & Linn, L. S. (1982). Chronic mental patients: The quality of life issue. American Journal of Psychiatry, 139, 1271–1276.Google Scholar
  22. Luo, X., Lynn George, M., Kakouras, I., Edwards, C. L., Pietrobon, R., Richardson, W., et al. (2003). Reliability, validity and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine, 28, 1739–1745.Google Scholar
  23. Mayer, T., & Andrews, H. B. (1981). Changes in self-concept following a spinal cord injury. Journal of Applied Rehabilitation Counseling, 12, 135–137.Google Scholar
  24. Michalos, A. C. (1985). Multiple discrepancies theory (MDT). Social Indicators Research, 16, 37–413.CrossRefGoogle Scholar
  25. Michalos, A. C. (2004). Social indicators research and health-related quality of life research. Social Indicators Research, 65, 27–72.CrossRefGoogle Scholar
  26. Michalos, A. C. (in press). Multiple discrepancies theory. In A. C. Michalos (Ed.), Encyclopedia of quality of life research. New York: Springer.Google Scholar
  27. Moons, P., Budts, W., & De Geest, S. (2006). Critique on the conceptualisation of quality of life: A review and evaluation of different conceptual approaches. International Journal of Nursing Studies, 43, 891–901.CrossRefGoogle Scholar
  28. Muldoon, M. F., Barger, S. D., Flory, J. D., & Manuk, S. B. (1998). What are quality of life measurements measuring? British Medical Journal, 316, 542–545.CrossRefGoogle Scholar
  29. Palepu, A., Hubley, A. M., Russell, L. B., Gadermann, A. M., & Chinni, M. (2012). Quality of life themes in Canadian adults and street youth who are homeless or hard-to-house: A multi-site focus group study. Health and Quality of Life Outcomes, 10, 1–11.CrossRefGoogle Scholar
  30. Research Alliance for Canadian Homelessness, Housing, and Health (REACH3). (2010). Housing vulnerability and health: Canada’s hidden emergency. Toronto: Research Alliance for Canadian Homelessness, Housing, and Health (REACH3).Google Scholar
  31. Salyers, M. P., Bosworth, H. B., Swanson, J. W., Lamb-Pagone, J., & Osher, F. C. (2000). Reliability and validity of the SF-12 health survey among people with severe mental illness. Medical Care, 2000(38), 1141–1150.CrossRefGoogle Scholar
  32. Smith, K. W., Avis, N. E., & Assmann, S. F. (1999). Distinguishing between quality of life and health status in quality of life research: A meta-analysis. Quality of Life Research, 8, 447–459.CrossRefGoogle Scholar
  33. Sun, S., Irestig, R., Burström, B., Beijer, U., & Burström, K. (2012). Health-related quality of life (EQ-5D) among homeless persons compared to a general population sample in Stockholm County, 2006. Scandinavian Journal of Public Health, 40(2), 115–125.CrossRefGoogle Scholar
  34. Tsui, J. I., Bangsberg, D. R., Ragland, K., Hall, C. S., & Riley, E. D. (2007). The impact of chronic Hepatitis C on health-related quality of life in homeless and marginally housed individuals with HIV. AIDS and Behavior, 11(4), 603–610.CrossRefGoogle Scholar
  35. Ware, J. E. J., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.CrossRefGoogle Scholar
  36. Weissman, J. S., Cleary, P. D., Seage, G. R., I. I. I., Gatsonis, C., Haas, J. S., Chasan-Taber, S., et al. (1996). The influence of health-related quality of life and social characteristics on hospital use by patients with AIDS in the Boston Health Study. Medical Care, 34(10), 1037–1056.CrossRefGoogle Scholar
  37. Wen, C., Hudak, P., & Hwang, S. (2007). Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters. Journal of General Internal Medicine, 22, 1011–1017.CrossRefGoogle Scholar
  38. WHOQOL Group. (1995). The World Health Organization Quality of Life Assessment (WHOQOL): Position paper from the World Health Organization. Social Science and Medicine, 41, 1403–1409.CrossRefGoogle Scholar
  39. Wright, S. J. (1985). Health satisfaction: A detailed test of the multiple discrepancies theory Model. Social Indicators Research, 17, 299–313.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Anne M. Gadermann
    • 1
    Email author
  • Anita M. Hubley
    • 2
  • Lara B. Russell
    • 2
  • Anita Palepu
    • 1
  1. 1.Centre for Health Evaluation and Outcome Sciences, St. Paul’s HospitalUniversity of British ColumbiaVancouverCanada
  2. 2.Department of ECPSUniversity of British ColumbiaVancouverCanada

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