Homeless chronicity and health-related quality of life trajectories among adults with addictions.
BACKGROUND
New federal initiatives target funds toward chronically homeless as distinct from other homeless persons. Few data exist, however, to substantiate the implications of chronic homelessness for major health outcomes.


OBJECTIVE
Using data from a 2-year cohort of addicted persons, we tested whether changes in mental and physical health-related quality of life (HRQOL) differed according to homeless chronicity.


METHODS
Using self-reported homelessness, we classified subjects as chronically homeless (CH; n = 60), transitionally homeless (TRANS; n = 108), or as housed comparison subjects (HSD; n = 106). The Short Form-36 Health Survey, administered at baseline and 2 follow-ups over a period of 2 years, provided a Mental Component Summary (MCS) and a Physical Component Summary (PCS) for HRQOL. Mixed model linear regression was used to test the association between housing status, MCS, and PCS. Additional models assessed whether medical, psychiatric, addiction, and social support measures could account for HRQOL differences.


RESULTS
All subjects had low MCS scores at study entry (mean, 31.2; SD, 12.6). However, there was a significant housing status-by-time interaction (P = 0.01). At final follow-up, CH and TRANS subjects had lower adjusted MCS scores than HSD subjects (33.4, 38.8, and 43.7 for the 3 groups, respectively; all P < or = 0.01). By contrast, housing status and PCS were not significantly associated (P = 0.19). Medical, psychiatric, addiction, and social support variables had significant associations with MCS, and their inclusion in the regression reduced the apparent effect of housing status on MCS.


CONCLUSIONS
Chronic homelessness was associated with especially poor mental but not physical HRQOL over time. These findings reinforce a new typology of homelessness.
Kertesz
Stefan G
SG
Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA. skertesz@uab.edu
Larson
Mary Jo
MJ
Horton
Nicholas J
NJ
Winter
Michael
M
Saitz
Richard
R
Samet
Jeffrey H
JH
D000328:Adult; D001900:Boston / Q000453:epidemiology; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006703:Ill-Housed Persons / Q000145:classification / Q000523:psychology*; D006798:Housing / Q000145:classification; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000503:physiopathology / Q000534:rehabilitation; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology*; D012008:Recurrence; D018434:Sickness Impact Profile; D012944:Social Support; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000503:physiopathology / Q000534:rehabilitation; D014504:Urban Health / Q000706:statistics & numerical data