عوامل استرس زا، منابع و پریشانی در میان افراد بی خانمان :: تجزیه و تحلیل طولی

Relations among stressors, resources, and psychological distress were examined using two waves of data obtained from a probability sample of homeless persons (N=430) residing in a large, demographically diverse county in North California. The focus of research was to examine whether and how social resources and housing resources directly affect distress and mediate the impact of stress factors on depressive symptoms. Path analysis results revealed that levels of psychological distress were responsive to change in objective housing circumstances, with the attainment of domicile status being associated with fewer distress symptoms. Our findings, however, indicated only modest effects of social resources on psychological distress through direct effects and mediating effects of life stressors on distress. Overall, the study suggests that the relationships among stressors, resources, and distress for homeless persons may be understood within the same analytical framework for the general population.

Numerous studies have documented the not surprising finding that, overall, homeless people evidence greater psychological distress than do members of the general population. Research on mental health and homelessness has indicated that the prevalence of possible clinical depression among homeless adults is between 46 and 80%, which is about two to four times the rate of the US general population (Ritchey, La Gory, Fitzpatrick & Mullis, 1990, Robertson, 1992; Robertson & Winkleby, 1996). Nevertheless, a number of studies have also revealed substantial variation in the degree to which homeless people experience distress (Gelberg & Linn, 1989; Schutt, Meschede & Rierdan, 1994). In fact, some members of the homeless population appear to be no more distressed about their state than are people in more comfortable circumstances. Moreover, several studies have noted that correlates of distress among homeless adults do not consistently replicate those found among members of the domiciled population (Gelberg & Linn, 1989; Robertson, 1992; Schutt, Meschede, & Rierdan, 1994). While psychological distress is disproportionately distributed among women, minorities, younger adults, and persons with fewer years of schooling in the general population, few of these demographic characteristics have been shown to be predictive of distress in the homeless population. These findings raise important questions regarding the causal nexus between homelessness and psychological distress, and the circumstances upon which this bond may vary. Yet, in striking contrast to the theoretical and empirical work that has examined the relations of stressors, resources and psychological distress in the general population, these issues, as they pertain to the homeless, have seldom been investigated. Only a few multivariate studies have examined the relations of stressors and resources to distress for the homeless population; their findings remain inconclusive (Bogard, McConnell, Gerstel & Schwartz, 1999; La Gory, Ritchey & Mullis, 1990; Simons, Whitbeck & Bales, 1989; Schutt et al., 1994). Moreover, a number of methodological limitations have compromised the potential for generalizing these findings for further understanding the correlates of distress in the homeless population. These include use of cross-section design (La Gory et al., 1990; Schutt et al., 1994; Simons et al., 1989), limited and nonprobability samples (Bogard et al., 1999; Simons et al., 1989), and questionable measurement of the dependent variable (Simons et al., 1989). The research to be reported here builds upon these earlier investigations in several respects. First, the study used a longitudinal panel design, thus providing an opportunity to explore the temporal sequencing of various phenomena influencing distress. Second, it used a structural equation model as an analytic strategy for specifying the direct and indirect effects of potential causal factors. Third, the study explicitly examined housing resources and social resources as potential ameliorating influences on psychological distress among homeless persons. Research on psychological distress in the homeless population Several meta-analytic studies have reported the prevalence of psychological distress among members of the homeless population and have compared the rates to those reported in community-wide and distressed populations. Based on results from six research projects using a standardized screening instrument Center for Epidemiological Studies-Depression Scale (CES-D), Robertson (1992) reported the rate of possible clinical depression in the homeless population to be between 47 and 75%. These estimates are significantly elevated compared to the prevalence estimate of below 20% in the general population. A similar analysis conducted by Robertson and Winkleby (1996) based on four quantitative studies of mental health problems of homeless women reported equivalent rates of depression — between 46 and 80% of the female homeless population. In a study of shelter and street dwellers in Birmingham, Alabama, Ritchey and his colleagues (Ritchey et al., 1990) found the rate of possible clinical depression in their sample (73%) to be significantly higher than that reported by persons who had experienced death of spouse or marital separation in the past year or those with physical impairment. Only acutely depressed patients and mental health clinic patients reported comparable or higher rates than members of the homeless sample. A number of empirical studies have examined the relation of various demographic characteristics, stress factors, and social resources to psychological distress in the homeless population. Using data from a community-based survey of 529 homeless adults in Los Angeles County, Gelberg and Linn (1989) found that distress was not associated with most demographic or homeless characteristics. Distress, however, was related to unemployment, greater cigarette and alcohol use, poor physical health, fewer social supports, and perceived barriers to receiving medical care. In a path analysis study of 79 adult homeless persons, Simons and his colleagues (Simons et al., 1989) found that being a victim of criminal attack increased psychological distress. A somewhat surprising finding in the same study is the negative association between duration of homelessness and distress. Those who were chronically homeless reported less psychological distress than those who experienced briefer periods of homelessness. Simons et al. did not consider the effect of social support on distress in their study. Three studies employed multivariate analysis to test the relationships of life stressors and social resources to psychological distress in the homeless population. Using a sample of 150 shelter- and street-based homeless persons in the Birmingham metropolitan area, La Gory et al. (1990) found that stressful life events, indicated by various life crises including job loss, crime victimization, and various forms of institutionalization, were positively related to the psychological distress experienced by study participants. Bogard et al.'s (1999) study of 225 homeless women who were accompanied by their dependent children reported that experience of a negative life event — indicated by separation from spouse or partner — was associated with increased distress. An exception to the findings of La Gory et al. and Bogard et al. was reported in a study conducted by Schutt and his colleagues (1994) using a sample of 218 sheltered homeless adults. The researchers found no evidence that stressful life events (including experience of child trauma, robbery or assault, and legal problems) had an effect on psychological distress. All three multivariate studies conducted by La Gory et al. (1990), Bogard et al. (1999), and Schutt et al. (1994) found that social supports, variously measured, have a direct and negative effect on psychological distress. Thus, individuals who either used or perceived instrumental or expressive supports from their interpersonal networks tended to report lower levels of distress. The role that social supports played in mediating distress, however, appears to be at best marginal. While Schutt et al. found little indication of a moderating effect of social support on reducing the negative consequences of stressful events on psychological distress, La Gory et al. concluded that the presence of psychological resources was a more significant factor than social resources in reducing distress (La Gory et al., 1990, p. 99). A model of the stress process: an application to the study of psychological distress in the homeless population In this investigation, we examine the relationships of life stressors and social resources to psychological distress using a conceptual model of the stress process (Pearlin, Lieberman, Menaghan & Mullan, 1981; ]Pearlin (1989) and Pearlin (1999)). The model postulates that the process of stress can be conceptualized as combining three conceptual domains: (a) the sources of stress including stressful eventful experience and chronic life strains; (b) the mediators of stress including social and psychological resources; and (c) the manifestation of stress as indicated by physical and mental health outcomes (Pearlin et al., 1981, p. 337). Over the past three decades, a voluminous body of research literature has surfaced, providing evidence in support of the utility of the stress model for understanding physical and psychological health outcomes in the general and clinical populations (Kessler, Price & Wortman, 1985; Pearlin, 1999). Within this body of literature, three distinct research strategies were employed to study the process of stress: research targeting groups of individuals exposed to a certain event or strain; research targeting groups enmeshed in the same difficult situation; and studies involving representative samples of the general population (Pearlin, 1999, p. 167). Our research falls into the second strategy by identifying influences on psychological distress that are peculiar to the life circumstances of homeless persons. We discuss the relevance of these influences to homelessness.