title: Setting the stage for chronic health problems: cumulative childhood adversity among homeless adults with mental illness in Vancouver, British Columbia.
abstract: BACKGROUND
  It is well documented that childhood abuse, neglect and household dysfunction are disproportionately present in the backgrounds of homeless adults, and that these experiences adversely impact child development and a wide range of adult outcomes. However, few studies have examined the cumulative impact of adverse childhood experiences on homeless adults with mental illness. This study examines adverse events in childhood as predictors of duration of homelessness, psychiatric and substance use disorders, and physical health in a sample of homeless adults with mental illness.
  
  
  METHODS
  This study was conducted using baseline data from a randomized controlled trial in Vancouver, British Columbia for participants who completed the Adverse Childhood Experiences (ACE) scale at 18 months follow-up (n=364). Primary outcomes included current mental disorders; substance use including type, frequency and severity; physical health; duration of homelessness; and vocational functioning.
  
  
  RESULTS
  In multivariable regression models, ACE total score independently predicted a range of mental health, physical health, and substance use problems, and marginally predicted duration of homelessness.
  
  
  CONCLUSIONS
  Adverse childhood experiences are overrepresented among homeless adults with complex comorbidities and chronic homelessness. Our findings are consistent with a growing body of literature indicating that childhood traumas are potent risk factors for a number of adult health and psychiatric problems, particularly substance use problems. Results are discussed in the context of cumulative adversity and self-trauma theory.
  
  
  BACKGROUND
  This trial has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374.
authors.affiliation: Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, Canada. michelle_patterson@sfu.ca.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Patterson
authors.forename: Akm
authors.initials: A
authors.lastname: Moniruzzaman
authors.forename: Julian M
authors.initials: JM
authors.lastname: Somers
mesh_terms: D000328:Adult; D001955:British Columbia; D002648:Child; D002649:Child Abuse; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology*
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