Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

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.

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.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014;384(9953):1529–40. https://doi.org/10.1016/S0140-6736(14)61132-6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fransham M, Dorling D. Homelessness and public health. BMJ. 2018;360:k214. https://doi.org/10.1136/bmj.k214.

    Article  PubMed  Google Scholar 

  3. Nielsen SF, Hjorthøj CR, Erlangsen A, Nordentoft M. Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study. Lancet (London, England). 2011;377(9784):2205–14. https://doi.org/10.1016/S0140-6736(11)60747-2.

    Article  Google Scholar 

  4. Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. McGrath J, ed. PLoS Med. 2008;5(12):e225. https://doi.org/10.1371/journal.pmed.0050225.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Baggett TP, Hwang SW, O’Connell JJ, Porneala BC, Stringfellow EJ, Orav EJ, et al. Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA Intern Med. 2013;173(3):189–95. https://doi.org/10.1001/jamainternmed.2013.1604.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet (London, England). 2018;391(10117):241–50. https://doi.org/10.1016/S0140-6736(17)31869-X.

    Article  Google Scholar 

  7. Feodor Nilsson S, Laursen TM, Hjorthøj C, Nordentoft M. Homelessness as a predictor of mortality: an 11-year register-based cohort study. Soc Psychiatry Psychiatr Epidemiol. 2018;53(1):63–75. https://doi.org/10.1007/s00127-017-1456-z.

    Article  PubMed  Google Scholar 

  8. Nilsson SF, Laursen TM, Hjorthøj C, Thorup A, Nordentoft M. Risk of psychiatric disorders in offspring of parents with a history of homelessness during childhood and adolescence in Denmark: a nationwide, register-based, cohort study. Lancet Public Health. 2017;2(12):e541–50. https://doi.org/10.1016/S2468-2667(17)30210-4.

    Article  PubMed  Google Scholar 

  9. Tsai J, Rosenheck RA. Risk factors for homelessness among US veterans. Epidemiol Rev. 2015;37(1):177–95. https://doi.org/10.1093/epirev/mxu004.

    Article  PubMed  Google Scholar 

  10. Byrne T, Montgomery AE, Dichter ME. Homelessness among female veterans: a systematic review of the literature. Women Health. 2013;53(6):572–96. https://doi.org/10.1080/03630242.2013.817504.

    Article  PubMed  Google Scholar 

  11. Embleton L, Lee H, Gunn J, Ayuku D, Braitstein P. Causes of child and youth homelessness in developed and developing countries: a systematic review and meta-analysis. JAMA Pediatr. 2016;170(5):435–44. https://doi.org/10.1001/jamapediatrics.2016.0156.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Susser E, Moore R, Link B. Risk factors for homelessness. Epidemiol Rev. 1993;15(2):546–56. http://www.ncbi.nlm.nih.gov/pubmed/8174670. Accessed February 11, 2019

    Article  CAS  PubMed  Google Scholar 

  13. Hwang SW, Burns T. Health interventions for people who are homeless. Lancet (London, England). 2014;384(9953):1541–7. https://doi.org/10.1016/S0140-6736(14)61133-8.

    Article  Google Scholar 

  14. Stergiopoulos V, Hwang SW, Gozdzik A, Nisenbaum R, Latimer E, Rabouin D, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial. JAMA. 2015;313(9):905–15. https://doi.org/10.1001/jama.2015.1163.

    Article  CAS  PubMed  Google Scholar 

  15. O’Campo P, Stergiopoulos V, Nir P, et al. How did a Housing First intervention improve health and social outcomes among homeless adults with mental illness in Toronto? Two-year outcomes from a randomised trial. BMJ Open. 2016;6(9):e010581. https://doi.org/10.1136/bmjopen-2015-010581.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12. http://www.ncbi.nlm.nih.gov/pubmed/10789670. Accessed February 11, 2019.

    Article  CAS  PubMed  Google Scholar 

  17. The World Bank. High Income. https://data.worldbank.org/income-level/high-income. Published 2016. Accessed February 11, 2019.

  18. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Published 2014. Accessed February 11, 2019.

  19. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Converting Among Effect Sizes. Introduction to Meta-analysis. Chichester: Wiley; 2009. http://doi.wiley.com/10.1002/9780470743386

    Book  Google Scholar 

  20. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60. https://doi.org/10.1136/bmj.327.7414.557.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Biostat Inc. Comprehensive Meta-Analysis Software (CMA). https://www.meta-analysis.com/index.php?cart=BP2W1080211. Published 2019. Accessed February 11, 2019.

  22. Bassuk EL, Weinreb LF, Buckner JC, Browne A, Salomon A, Bassuk SS. The characteristics and needs of sheltered homeless and low-income housed mothers. JAMA. 1996;276(8):640–6. http://www.ncbi.nlm.nih.gov/pubmed/8773638. Accessed February 11, 2019

    Article  CAS  PubMed  Google Scholar 

  23. Caton CL, Shrout PE, Dominguez B, Eagle PF, Opler LA, Cournos F. Risk factors for homelessness among women with schizophrenia. Am J Public Health 1995;85(8 Pt 1):1153–1156. http://www.ncbi.nlm.nih.gov/pubmed/7625518. Accessed February 11, 2019.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Rocha C, Johnson AK, McChesney KY, Butterfield WH. Predictors of permanent housing for sheltered homeless families. Fam Soc J Contemp Soc Serv. 1996;77(1):50–7. https://doi.org/10.1606/1044-3894.838.

    Article  Google Scholar 

  25. Greenberg GA, Hoblyn J, Seibyl C, Rosenheck RA. Housing outcomes for hospitalized homeless veterans. J Health Care Poor Underserved. 2006;17(2):425–40. https://doi.org/10.1353/hpu.2006.0061.

    Article  PubMed  Google Scholar 

  26. Spicer B, Smith DI, Conroy E, Flatau PR, Burns L. Mental illness and housing outcomes among a sample of homeless men in an Australian urban centre. Aust N Z J Psychiatry. 2015;49(5):471–80. https://doi.org/10.1177/0004867414563187.

    Article  PubMed  Google Scholar 

  27. Van Straaten B, Van der Laan J, Rodenburg G, Boersma SN, Wolf JRLM, Van de Mheen D. Dutch homeless people 2.5 years after shelter admission: what are predictors of housing stability and housing satisfaction? Health Soc Care Community. 2017;25(2):710–22. https://doi.org/10.1111/hsc.12361.

    Article  PubMed  Google Scholar 

  28. Shaheen G, Rio J. Recognizing work as a priority in preventing or ending homelessness. J Prim Prev. 2007;28(3–4):341–58. https://doi.org/10.1007/s10935-007-0097-5.

    Article  PubMed  Google Scholar 

  29. Poremski D, Rabouin D, Latimer E. A randomised controlled trial of evidence based supported employment for people who have recently been homeless and have a mental illness. Adm Policy Ment Health Ment Health Serv Res. 2017;44(2):217–24. https://doi.org/10.1007/s10488-015-0713-2.

    Article  Google Scholar 

  30. Poremski D, Stergiopoulos V, Braithwaite E, Distasio J, Nisenbaum R, Latimer E. Effects of housing first on employment and income of homeless individuals: results of a randomized trial. Psychiatr Serv. 2016;67(6):603–9. https://doi.org/10.1176/appi.ps.201500002.

    Article  PubMed  Google Scholar 

Download references

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.

Author information

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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Merete Nordentoft
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carsten Hjorthøj
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sandra Feodor Nilsson.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Supplementary file 1

(PDF 55 kb)

Supplementary file 2

(PDF 386 kb)

Supplementary file 3

(PDF 77 kb)

Supplementary file 4

(PDF 2223 kb)

Supplementary file 5

(PDF 569 kb)

Supplementary file 6

(PDF 779 kb)

Supplementary file 7

(PDF 180 kb)

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)

High resolution image

(EPS 51 kb)

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)

High resolution image

(EPS 33 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-019-00377-x

Keywords

Search

Navigation