Advertisement

Canadian Journal of Public Health

, Volume 109, Issue 2, pp 204–214 | Cite as

Clinical and functional characteristics of young adults living in single room occupancy housing: preliminary findings from a 10-year longitudinal study

  • Skye P. Barbic
  • Andrea A. Jones
  • Melissa Woodward
  • Matt Piercy
  • Steve Mathias
  • Fidel Vila-Rodriguez
  • Olga Leonova
  • Geoffrey N. Smith
  • Tari Buchanan
  • Alexandra T. Vertinsky
  • Stephanie Gillingham
  • William J. Panenka
  • Alexander Rauscher
  • Alasdair M. Barr
  • Ric M. Procyshyn
  • G. William MacEwan
  • Donna J. Lang
  • Allen E. Thornton
  • Manraj K. Heran
  • Adelena M. Leon
  • Michael Krausz
  • William G. Honer
Special Section on Substance Use: Quantitative Research

Abstract

Objective

Young adults living in single room occupancy (SRO) hotels, a form of low-income housing, are known to have complex health and substance problems compared to their peers in the general population. The objective of this study is to comprehensively describe the mental, physical, and social health profile of young adults living in SROs.

Methods

This study reports baseline data from young adults aged 18–29 years, as part of a prospective cohort study of adults living in SROs in Vancouver, British Columbia, Canada. Baseline and follow-up data were collected from 101 young adults (median follow-up period 1.9 years [IQR 1.0–3.1]). The comprehensive assessment included laboratory tests, neuroimaging, and clinician- and patient-reported measures of mental, physical, and social health and functioning.

Results

Three youth died during the preliminary follow-up period, translating into a higher than average mortality rate (18.6, 95% CI 6.0, 57.2) compared to age- and sex-matched Canadians. High prevalence of interactions with the health, social, and justice systems was reported. Participants were living with median two co-occurring illnesses, including mental, neurological, and infectious diseases. Greater number of multimorbid illnesses was associated with poorer real-world functioning (ρ = − 0.373, p < 0.001). All participants reported lifetime alcohol and cannabis use, with pervasive use of stimulants and opioids.

Conclusion

This study reports high mortality rates, multimorbid illnesses, poor functioning, poverty, and ongoing unmet mental health needs among young adults living in SROs. Frequent interactions with the health, social, and justice systems suggest important points of intervention to improve health and functional trajectories of this vulnerable population.

Keywords

Young adult Mental health Social marginalization Housing 

Résumé

Objectif

Les jeunes adultes qui vivent dans des maisons de chambres (une forme d’habitation à loyer modique) sont connus pour avoir des problèmes de santé et de consommation complexes comparativement à leurs pairs dans la population générale. Nous avons cherché à décrire de façon exhaustive leur profil de santé mentale, physique et sociale.

Méthode

Nos données de référence sur les jeunes adultes de 18 à 29 ans proviennent d’une étude prospective de cohortes d’adultes vivant dans des maisons de chambres à Vancouver (Colombie-Britannique), au Canada. Les données de référence et de suivi ont été recueillies auprès de 101 jeunes adultes (période de suivi médiane de 1,9 an [écart interquartile 1,0–3,1]). L’évaluation exhaustive a reposé sur des tests de laboratoire, sur la neuroimagerie et sur des indicateurs de santé et de fonctionnement sur le plan mental, physique et social fournis par les cliniciens et les patients.

Résultats

Trois jeunes sont décédés durant la période de suivi préliminaire, ce qui représente un taux de mortalité supérieur à la moyenne (18,6, IC de 95 % : 6,0, 57,2) comparativement aux Canadiens de mêmes groupes d’âge et de sexe. Une forte prévalence d’interactions avec les systèmes sociosanitaire et judiciaire a été déclarée. Les participants vivaient avec un nombre médian de deux maladies concomitantes, notamment des maladies mentales, neurologiques et infectieuses. Le nombre élevé de multimorbidités était associé à des problèmes de fonctionnement dans le monde réel (ρ = −0,373, p < 0,001). Tous les participants ont indiqué avoir consommé de l’alcool et du cannabis au cours de leur vie, et la consommation de stimulants et d’opioïdes était omniprésente chez eux.

Conclusion

L’étude fait état de taux de mortalité élevés, de multimorbidités, de problèmes de fonctionnement, de pauvreté et de besoins de santé mentale non comblés chez les jeunes adultes vivant dans des maisons de chambres. Leurs interactions fréquentes avec les systèmes sociosanitaire et judiciaire pourraient être d’importants points d’intervention pour améliorer la santé et les trajectoires fonctionnelles de cette population vulnérable.

Mots-clés

Jeune adulte Santé mentale Marginalisation sociale Logement 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Vila-Rodriguez has received Advisory Board fees from Janssen. Dr. Panenka is on the board of directors (Abbatis Bioceuticals) or scientific advisory boards (Medipure Pharmaceuticals and Vinergy Inc) of three local emerging biotechnology companies. Dr. Rauscher has received advisory board fees from Hofmann-La Roche. Dr. Barr has received consulting fees or sat on Advisory Boards for Bristol-Myers Squibb, Eli Lilly, and Roche. Dr. Procyshyn has received speaking and Advisory Board fees from Janssen, Lundbeck, and Otsuka. He has also received Royalties as the Principal Editor of The Clinical Handbook of Psychotropic Drugs. Dr. MacEwan has received speaking or consulting fees or sat on advisory boards for Apotex, AstraZeneca, Bristol-Myers Squibb, Janssen, Lundbeck, Otsuka, Pfizer, and Sunovion and has received research grant support from Janssen. Dr. Honer has received consulting fees or sat on Advisory Boards for In Silico, Lundbeck, Otsuka, and Alphasights. The remaining authors declare no conflict of interest.

Supplementary material

41997_2018_87_MOESM1_ESM.docx (15 kb)
Supplementary Table 1 (DOCX 15 kb)

References

  1. Alldredge, B. K., Lowenstein, D. H., & Simon, R. P. (1989). Seizures associated with recreational drug abuse. Neurology, 39(8), 1037–1039.CrossRefPubMedGoogle Scholar
  2. Aubry, T., Nelson, G., & Tsemberis, S. (2015). Housing First for people with severe mental illness who are homeless: a review of the research and findings from the At Home—Chez soi demonstration project. Canadian Journal of Psychiatry, 60(11), 467–474.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Barbic, S., Kidd, S. A., Durisko, Z. T., Yachouch, S., Rathithran, G., McKenzie, K. (2018). What are the personal recovery needs of community-dwelling Canadians with mental illness? Preliminary findings from the Canadian Personal Recovery Outcome Measurement (C-PROM) study. Canadian Journal of Community Mental Health. (in press).Google Scholar
  4. BC Non-Profit Housing Association and M. Thomson Consulting. (2017). Homeless Count in Metro Vancouver Final Report. 2017; http://www.metrovancouver.org/services/regional-planning/homelessness/HomelessnessPublications/2017MetroVancouverHomelessCount.pdf. Accessed October 31st, 2017.
  5. Brown, J. W., Dunne, J. W., Fatovich, D. M., Lee, J., & Lawn, N. D. (2011). Amphetamine-associated seizures: clinical features and prognosis. Epilepsia, 52(2), 401–404.PubMedGoogle Scholar
  6. Canadian Institutes of Health Research (2015). Canada’s strategy for patient-oriented research—patient engagement. Framework. http://www.cihr-irsc.gc.ca/e/48413.html. Accessed 28 Sept 2017.
  7. Chamberlain, C., & Mackenzie, D. (1992). Understanding contemporary homelessness: issues of definition and meaning. The Australian Journal of Social Issues, 27, 274–297.CrossRefGoogle Scholar
  8. Cheng, T., Johnston, C., Kerr, T., Nguyen, P., Wood, E., & DeBeck, K. (2016a). Substance use patterns and unprotected sex among street-involved youth in a Canadian setting: a prospective cohort study. BMC Public Health, 16, 4.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Cheng, T., Kerr, T., Small, W., Nguyen, P., Wood, E., & DeBeck, K. (2016b). High prevalence of risky income generation among street-involved youth in a Canadian setting. The International Journal on Drug Policy, 28, 91–97.CrossRefPubMedGoogle Scholar
  10. Cochran, B. N., Stewart, A. J., Ginzler, J. A., & Cauce, A. M. (2002). Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts. American Journal of Public Health, 92(5), 773–777.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Corbiere, M., Lanctot, N., Lecomte, T., et al. (2010). A pan-Canadian evaluation of supported employment programs dedicated to people with severe mental disorders. Community Mental Health Journal, 46(1), 44–55.CrossRefPubMedGoogle Scholar
  12. Corring, D. J., Whittall, S., MustinPowell, J., Jarmain, S., Chapman, P., & Sussman, S. (2016). Mental health system transformation: drivers for change, organizational preparation, engaging partners and outcomes. Healthcare Quarterly, 18(Suppl), 6–11.CrossRefPubMedGoogle Scholar
  13. DeBeck, K., Kerr, T., Nolan, S., Dong, H., Montaner, J., & Wood, E. (2016). Inability to access addiction treatment predicts injection initiation among street-involved youth in a Canadian setting. Substance Abuse Treatment, Prevention, and Policy, 11(1).  https://doi.org/10.1186/s13011-015-0046-x.
  14. Forchuk, C., Dickins, K., & Corring, D. J. (2016). Social determinants of health: housing and income. Healthcare Quarterly, 18(Suppl), 27–31.CrossRefPubMedGoogle Scholar
  15. Gaetz, S., Donaldson, J., Richter, T., Gulliver, T. (2013) The State of Homelessness in Canada. Toronto. https://www.canada.ca/en/health-canada/services/health-concerns/drug-prevention-treatment/canadian-alcohol-drug-use-monitoring-survey.html. Accessed 18 July 2017.
  16. Goodman, S. H., Sewell, D. R., Cooley, E. L., & Leavitt, N. (1993). Assessing levels of adaptive functioning: the Role Functioning Scale. Community Mental Health Journal, 29(2), 119–131.CrossRefPubMedGoogle Scholar
  17. Grebely, J., Lima, V. D., Marshall, B. D., et al. (2014). Declining incidence of hepatitis C virus infection among people who inject drugs in a Canadian setting, 1996-2012. PLoS One, 9(6), e97726.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Hetrick, S. E., Bailey, A. P., Smith, K. E., et al. (2017). Integrated (one-stop shop) youth health care: best available evidence and future directions. The Medical Journal of Australia, 207(10), S5–s18.CrossRefPubMedGoogle Scholar
  19. Honer, W. G., Cervantes-Larios, A., Jones, A. A., et al. (2017). The Hotel Study—clinical and health service effectiveness in a cohort of homeless or marginally housed persons. Canadian Journal of Psychiatry.  https://doi.org/10.1177/0706743717693781.
  20. Jones, A. A., Vila-Rodriguez, F., Leonova, O., et al. (2015). Mortality from treatable illnesses in marginally housed adults: a prospective cohort study. BMJ Open, 5(8), e008876.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Kidd, S. A., Karabanow, J., Hughes, J., & Frederick, T. (2013). Brief report: youth pathways out of homelessness—preliminary findings. Journal of Adolescence, 36(6), 1035–1037.CrossRefPubMedGoogle Scholar
  22. Kidd, S. A., Gaetz, S., & O’Grady, B. (2017). The 2015 National Canadian Homeless Youth Survey: mental health and addiction findings. Canadian Journal of Psychiatry.  https://doi.org/10.1177/0706743717702076.
  23. Kirst, M., Zerger, S., Wise Harris, D., Plenert, E., & Stergiopoulos, V. (2014). The promise of recovery: narratives of hope among homeless individuals with mental illness participating in a Housing First randomised controlled trial in Toronto, Canada. BMJ Open, 4(3), e004379.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Kirst, M., Zerger, S., Misir, V., Hwang, S., & Stergiopoulos, V. (2015). The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug and Alcohol Dependence, 146, 24–29.CrossRefPubMedGoogle Scholar
  25. Kozloff, N., Stergiopoulos, V., Adair, C. E., et al. (2016a). The unique needs of homeless youths with mental illness: baseline findings from a Housing First Trial. Psychiatric Services.  https://doi.org/10.1176/appi.ps.201500461.
  26. Kozloff, N., Adair, C. E., Palma Lazgare, L. I., et al. (2016b). “Housing First” for homeless youth with mental illness. Pediatrics, 138(4), e20161514.Google Scholar
  27. Kumar, M. M., Nisenbaum, R., Barozzino, T., Sgro, M., Bonifacio, H. J., & Maguire, J. L. (2015). Housing and sexual health among street-involved youth. The Journal of Primary Prevention, 36(5), 301–309.CrossRefPubMedGoogle Scholar
  28. Labonte, R. (1986). Social inequality and healthy public policy. Health Promotion (Oxford, England), 1(3), 341–351.CrossRefGoogle Scholar
  29. Lang, W. R. (1912). Housing conditions in Canada. Canadian Medical Association Journal, 2(6), 487–493.PubMedPubMedCentralGoogle Scholar
  30. Latimer, E. A., Rabouin, D., Cao, Z., et al. (2017). Costs of services for homeless people with mental illness in 5 Canadian cities: a large prospective follow-up study. CMAJ Open, 5(3), E576–e585.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Lazarus, L., Chettiar, J., Deering, K., Nabess, R., & Shannon, K. (2011). Risky health environments: women sex workers’ struggles to find safe, secure and non-exploitative housing in Canada’s poorest postal code. Social Science & Medicine (1982), 73(11), 1600–1607.CrossRefGoogle Scholar
  32. Manwell, L. A., Barbic, S. P., Roberts, K., et al. (2015). What is mental health? Evidence towards a new definition from a mixed methods multidisciplinary international survey. BMJ Open, 5(6), e007079.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Mar, M. Y., Linden, I. A., Torchalla, I., Li, K., & Krausz, M. (2014). Are childhood abuse and neglect related to age of first homelessness episode among currently homeless adults? Violence and Victims, 29(6), 999–1013.CrossRefPubMedGoogle Scholar
  34. McGorry, P., Bates, T., & Birchwood, M. (2013). Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. The British Journal of Psychiatry. Supplement, 54, s30–s35.CrossRefPubMedGoogle Scholar
  35. McKenzie, K. (2013). How do social factors cause psychotic illnesses? Canadian Journal of Psychiatry / Revue Canadienne de Psychiatrie, 58(1), 41–43.CrossRefPubMedGoogle Scholar
  36. Morosini, P. L., Magliano, L., Brambilla, L., Ugolini, S., & Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 101(4), 323–329.PubMedGoogle Scholar
  37. Piat, M., Barker, J., Goering, P., Piat, M., Barker, J., & Goering, P. (2009). A major Canadian initiative to address mental health and homelessness. The Canadian Journal of Nursing Research, 41(2), 79–82.PubMedGoogle Scholar
  38. Poremski, D., & Hwang, S. W. (2016). Willingness of Housing First participants to consider supported-employment services. Psychiatric Services.  https://doi.org/10.1176/appi.ps.201500140.
  39. Poremski, D., Rabouin, D., Latimer, E. (2015a). A randomised controlled trial of evidence based supported employment for people who have recently been homeless and have a mental illness. Administration and Policy in Mental Health, 41(2), 217–224.  https://doi.org/10.1007/s10488-015-0713-2.
  40. Poremski, D., Woodhall-Melnik, J., Lemieux, A. J., Stergiopoulos, V. (2015b). Persisting barriers to employment for recently housed adults with mental illness who were homeless. Journal of Urban Health, 93(1), 96–108.  https://doi.org/10.1007/s11524-015-0012-y.
  41. Province of British Columbia. (2017). Residential Tenancy Act [SBC 2002] CHAPTER 78. Victorial: Queen’s Press.Google Scholar
  42. Rickwood, D. J., Telford, N. R., Parker, A. G., Tanti, C. J., & McGorry, P. D. (2014). headspace—Australia’s innovation in youth mental health: who are the clients and why are they presenting? The Medical Journal of Australia, 200(2), 108–111.CrossRefPubMedGoogle Scholar
  43. R Core Team (2017). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org/. Accessed February 1st, 2017.
  44. Roy, E., Haley, N., Leclerc, P., Sochanski, B., Boudreau, J. F., & Boivin, J. F. (2004). Mortality in a cohort of street youth in Montreal. JAMA, 292(5), 569–574.CrossRefPubMedGoogle Scholar
  45. Sadowski, L. S., Kee, R. A., VanderWeele, T. J., & Buchanan, D. (2009). Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA, 301(17), 1771–1778.CrossRefPubMedGoogle Scholar
  46. Shah, J., Mizrahi, R., & McKenzie, K. (2011). The four dimensions: a model for the social aetiology of psychosis. The British Journal of Psychiatry : The Journal of Mental Science, 199(1), 11–14.CrossRefGoogle Scholar
  47. Somers, J. M., Moniruzzaman, A., & Rezansoff, S. N. (2016). Migration to the Downtown Eastside neighbourhood of Vancouver and changes in service use in a cohort of mentally ill homeless adults: a 10-year retrospective study. BMJ Open, 6(1), e009043.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Statistics Canada. (2009). Age-specific mortality rates per 1,000 population by age group and sex, Canada, provinces and territories, 2009. http://www.statcan.gc.ca/pub/91-209-x/2013001/article/11785/tbl/tbl02-eng.htm. Accessed July 18th, 2017.
  49. Statistics Canada (2011). Canadian Alcohol and Drug Use Monitoring Survey. In: Canada H, ed. Ottawa, Canada.Google Scholar
  50. Statistics Canada. (2012). The Canadian Community Health Survey: Mental Health 2012. http://www.statcan.gc.ca/daily-quotidien/130918/dq130918a-eng.htm. Accessed August 19th, 2016.
  51. Stergiopoulos, V., Gozdzik, A., O’Campo, P., Holtby, A. R., Jeyaratnam, J., & Tsemberis, S. (2014). Housing First: exploring participants’ early support needs. BMC Health Services Research, 14, 167.CrossRefPubMedPubMedCentralGoogle Scholar
  52. United Nations Educational SaCOU. (2015). What do we mean by youth? http://www.unesco.org/new/en/social-and-humansciences/.
  53. Vila-Rodriguez, F., Panenka, W. J., Lang, D. J., et al. (2013). The hotel study: multimorbidity in a community sample living in marginal housing. The American Journal of Psychiatry, 170(12), 1413–1422.CrossRefPubMedGoogle Scholar
  54. Willi, T. S., Lang, D. J., Honer, W. G., et al. (2016). Subcortical grey matter alterations in cocaine dependent individuals with substance-induced psychosis compared to non-psychotic cocaine users. Schizophrenia Research, 176(2–3), 158–163.CrossRefPubMedGoogle Scholar
  55. Wolitzky-Taylor, K., Sewart, A., Vrshek-Schallhorn, S., et al. (2017). The effects of childhood and adolescent adversity on substance use disorders and poor health in early adulthood. Journal of Youth and Adolescence, 46(1), 15–27.CrossRefPubMedGoogle Scholar

Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  • Skye P. Barbic
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
  • Andrea A. Jones
    • 1
    • 3
  • Melissa Woodward
    • 1
    • 7
  • Matt Piercy
    • 5
  • Steve Mathias
    • 1
    • 3
    • 4
    • 5
    • 8
  • Fidel Vila-Rodriguez
    • 1
    • 3
  • Olga Leonova
    • 1
    • 3
  • Geoffrey N. Smith
    • 1
    • 3
  • Tari Buchanan
    • 1
    • 3
  • Alexandra T. Vertinsky
    • 5
    • 9
  • Stephanie Gillingham
    • 5
  • William J. Panenka
    • 1
    • 3
  • Alexander Rauscher
    • 5
    • 10
  • Alasdair M. Barr
    • 11
  • Ric M. Procyshyn
    • 1
    • 3
  • G. William MacEwan
    • 1
    • 3
    • 8
  • Donna J. Lang
    • 1
    • 7
  • Allen E. Thornton
    • 12
  • Manraj K. Heran
    • 5
    • 9
  • Adelena M. Leon
    • 1
    • 2
  • Michael Krausz
    • 1
    • 3
    • 4
  • William G. Honer
    • 1
    • 3
  1. 1.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  2. 2.Department of Occupational Science and Occupational TherapyUBCVancouverCanada
  3. 3.Department of PsychiatryUBCVancouverCanada
  4. 4.Centre for Health Evaluation and Outcome SciencesVancouverCanada
  5. 5.FoundryVancouverCanada
  6. 6.Faculty of Medicine, Department of Occupational Science and Occupational TherapyThe University of British Columbia St. Paul’s HospitalVancouverCanada
  7. 7.Department of RadiologyUBCVancouverCanada
  8. 8.St. Paul’s HospitalVancouverCanada
  9. 9.Vancouver General HospitalVancouverCanada
  10. 10.Department of PediatricsUBCVancouverCanada
  11. 11.Department of Anesthesiology, Pharmacology & TherapeuticsUBCVancouverCanada
  12. 12.Department of PsychologySimon Fraser UniversityBurnabyCanada

Personalised recommendations