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Individual-Level Predictors for Becoming Homeless and Exiting Homelessness: a Systematic Review and Meta-analysis

Journal of Urban Health volume 96, pages 741–750 (2019)Cite this article

Abstract

Homelessness remains a societal problem. Compiled evidence of predictors for becoming homeless and exiting homelessness might be used to inform policy-makers and practitioners in their work to reduce homeless-related problems. We examined individual-level predictors for becoming homeless and exiting homelessness by searching PubMed, EMBASE, PsycINFO, and Web of Science up to January 2018. Becoming homeless and exiting homelessness were the outcomes. Observational studies with comparison groups from high-income countries were included. The Newcastle Ottawa Quality Assessment Scale was used for bias assessment. Random effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). We included 116 independent studies of risk factors for becoming homeless and 18 for exiting homelessness. We found evidence of adverse life events as risk factors for homelessness, e.g., physical abuse (OR 2.9, 95% CI 1.8–4.4) and foster care experiences (3.7, 1.9–7.3). History of incarceration (3.6, 1.3–10.4), suicide attempt (3.6, 2.1–6.3), and psychiatric problems, especially drug use problems (2.9, 1.5–5.1), were associated with increased risk of homelessness. The heterogeneity was substantial in most analyses (I2 > 90%). Female sex (1.5, 1.1–1.9; I2 = 69%) and having a partner (1.7, 1.3–2.1; I2 = 40%) predicted higher chances whereas relationship problems (0.6, 0.5–0.8), psychotic disorders (0.4, 0.2–0.8; I2 = 0%), and drug use problems (0.7, 0.6–0.9; I2 = 0%) reduced the chances for exiting homelessness. In conclusion, sociodemographic factors, adverse life events, criminal behaviour, and psychiatric problems were individual-level predictors for becoming homeless and/or exiting homelessness. Focus on individual-level vulnerabilities and early intervention is needed. PROSPERO registration number: CRD42014013119.

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Acknowledgements

Thanks to Manon Chaine and Karl Ole Köhler-Forsberg for help with translation of French and German articles during this work.

Contributors

SFN and CH led the conception and design of the study. SFN did the literature search. SFN and CH selected the studies. SFN extracted the data. SFN and CH did the quality assessment. SFN performed the analyses and interpreted data with supervision from CH and MN. SFN drafted the manuscript with critical revisions for important intellectual content from CH and MN.

Funding

This study was funded by a stipend from the University of Copenhagen and by iPSYCH – The Lundbeck Foundation Initiative for Integrated Psychiatric Research.

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Authors and Affiliations

  1. Copenhagen Research Center for Mental Health – CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegaardsvej 28, Build. 15, 4th floor, DK-2900, Hellerup, Denmark

    Sandra Feodor Nilsson, Merete Nordentoft & Carsten Hjorthøj

  2. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Sandra Feodor Nilsson & Merete Nordentoft

  3. iPSYCH – The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Aarhus, Denmark

    Sandra Feodor Nilsson, Merete Nordentoft & Carsten Hjorthøj

  4. Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark

    Carsten Hjorthøj

Authors
  1. Sandra Feodor Nilsson
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  2. Merete Nordentoft
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  3. Carsten Hjorthøj
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Correspondence to Sandra Feodor Nilsson.

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Electronic Supplementary Material

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Supplementary file 8

Forest plot of meta-analyses of predictors for becoming homeless based on studies with low risk of bias with summary estimates (PNG 283 kb)

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Supplementary file 9

Forest plot of meta-analyses of predictors for exiting homelessness based on studies with low risk of bias with summary estimates (PNG 143 kb)

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Nilsson, S.F., Nordentoft, M. & Hjorthøj, C. Individual-Level Predictors for Becoming Homeless and Exiting Homelessness: a Systematic Review and Meta-analysis. J Urban Health 96, 741–750 (2019). https://doi.org/10.1007/s11524-019-00377-x

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