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Cho, Lianne Lok-Ian

University of British Columbia

Depression, suicidal ideation (SI), and anxiety are common in people who are homeless or precariously housed. However, predictors of these conditions over time in these individuals remain understudied, and this information is crucial for the design of effective support services. The objective of this thesis was to determine longitudinal predictors of depressive symptom severity, SI, and anxiety symptom severity among adults who are homeless or precariously housed in a community-based setting. Data were collected as part of the “Hotel Study”, an observational study of people living in an impoverished neighbourhood in Vancouver, Canada. Participants (N=475) completed assessments of health and social factors monthly over a period of three years. SI and anxiety symptoms were assessed by the Maudsley Addiction Profile, which has demonstrated reliability in people who are homeless. The Beck Depression Inventory (BDI) assessed depressive symptoms, but its suitability for the present context was unknown because it was developed in a clinical setting. Thus, we first determined the psychometric properties of the BDI. Using the measurement approaches of Classical Test Theory and Rasch analysis, we found the BDI to be valid and reliable for assessing depressive symptom severity in the group. Next, we identified longitudinal predictors of depressive symptom severity, SI, and anxiety symptom severity using mixed effects regression models. We found that having a history of clinical depression, more trauma, more anxiety and psychotic symptoms, and frequent non-prescribed opioid use were associated with more depressive symptoms. Predictors of SI included having a history of psychotic disorder, more trauma, more anxiety symptoms, and concurrent clinical depression. Regarding anxiety, we found that having a history of anxiety disorder, history of alcohol dependence, more depressive and psychotic symptoms, daily tobacco use, frequent anxiolytic use, and recent negative social interactions were associated with increased symptoms. The results suggest that managing psychotic symptoms, substance use, and the lasting effects of trauma may help alleviate depressive and anxiety symptoms in adults who are homeless or precariously housed. Given the variety of predictors identified, decreasing the burden of these conditions on those affected likely requires multidisciplinary interventions at the community, clinical and policy levels.

Text

2024-05-03

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/88172

Neuroscience

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/