title: Relationship between adverse childhood experiences and homelessness and the impact of axis I and II disorders.
abstract: OBJECTIVE
  We investigated the links between homelessness associated with serious mental and physical healthy disparities and adverse childhood experiences (ACEs) in nationally representative data, with Axis I and II disorders as potential mediators.
  
  
  METHODS
  We examined data from the National Epidemiologic Survey of Alcohol and Related Conditions in 2001-2002 and 2004-2005, and included 34,653 participants representative of the noninstitutionalized US population who were 20 years old or older. We studied the variables related to 4 classes of Axis I disorders, all 10 Axis II personality disorders, a wide range of ACEs, and a lifetime history of homelessness.
  
  
  RESULTS
  Analyses revealed high prevalences of each ACE in individuals experiencing lifetime homelessness (17%-60%). A mediation model with Axis I and II disorders determined that childhood adversities were significantly related to homelessness through direct effects (adjusted odd ratios = 2.04, 4.24) and indirect effects, indicating partial mediation. Population attributable fractions were also reported.
  
  
  CONCLUSIONS
  Although Axis I and II disorders partially mediated the relationship between ACEs and homelessness, a strong direct association remained. This novel finding has implications for interventions and policy. Additional research is needed to understand relevant causal pathways.
authors.affiliation: Leslie E. Roos is with the Department of Psychology, University of Oregon, Eugene. Natalie Mota is with the Department of Psychology, University of Manitoba, Winnipeg. Tracie O. Afifi is with the Departments of Psychiatry, Community Health Sciences, and Family Social Science, University of Manitoba. Laurence Y. Katz is with the Department of Psychiatry, University of Manitoba. Jino Distasio is with the Department of Geography, Institute of Urban Studies, University of Winnipeg, and the Department of Psychiatry, University of Manitoba. Jitender Sareen is with the Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba.
authors.forename: Leslie E
authors.initials: LE
authors.lastname: Roos
authors.forename: Natalie
authors.initials: N
authors.lastname: Mota
authors.forename: Tracie O
authors.initials: TO
authors.lastname: Afifi
authors.forename: Laurence Y
authors.initials: LY
authors.lastname: Katz
authors.forename: Jino
authors.initials: J
authors.lastname: Distasio
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005195:Family Relations; D005260:Female; D006304:Health Status; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010554:Personality Disorders / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D014754:Violence