title: Pathways and trajectories linking housing instability and poor health among low-income women experiencing intimate partner violence (IPV): Toward a conceptual framework.
abstract: We used grounded theory to understand pathways and trajectories to housing instability (HI) and poor health among low-income women with experiences of intimate partner violence (IPV). We conducted in-depth interviews during 2010-11 with forty-one women (ages 18-45 years) living in Ontario, Canada. All women reported depressive symptoms in combination with other health problems. In addition to the direct pathway of IPV to poor health, thematic analysis revealed an indirect multi-tiered pathway with complex trajectories among IPV, HI, and poor health. These trajectories included material HI (homelessness, high mobility, evictions, problems paying rent, hiding, and landlord discrimination), psychological HI (feeling unsafe, low self-esteem, and poor control), and social trajectories (financial problems, loss of employment, income, or social networks, and leaving school). These trajectories elevated stress and decreased self-care (unhealthy behaviors, substance abuse, and reduced medical compliance) and exacerbated poor health already compromised by IPV. Depending on her specific context, each woman experienced these pathways and trajectories differently. Moreover, the women's experiences differed across three time periods: before, immediately after, and long after leaving an abusive relationship. Finally, we found that for these women, achieving stable housing was crucial for stabilizing their health.
authors.affiliation: a Centre for Research on Inner City Health , The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada.|b Department of Public Health, Faculty of Health Sciences , Ben-Gurion University , Beer Sheva , Israel.
authors.forename: Nihaya
authors.initials: N
authors.lastname: Daoud
authors.affiliation: a Centre for Research on Inner City Health , The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada.|c Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|d Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada.
authors.forename: Flora I
authors.initials: FI
authors.lastname: Matheson
authors.affiliation: a Centre for Research on Inner City Health , The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Pedersen
authors.affiliation: a Centre for Research on Inner City Health , The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hamilton-Wright
authors.affiliation: a Centre for Research on Inner City Health , The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Minh
authors.affiliation: a Centre for Research on Inner City Health , The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada.
authors.forename: Janice
authors.initials: J
authors.lastname: Zhang
authors.affiliation: a Centre for Research on Inner City Health , The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada.|d Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D003863:Depression / Q000209:etiology / Q000523:psychology*; D005260:Female; D006304:Health Status; D006798:Housing; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D000066511:Intimate Partner Violence; D008603:Mental Health; D008875:Middle Aged; D011203:Poverty; D036301:Qualitative Research; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D012747:Sexual Partners / Q000523:psychology; D013179:Spouse Abuse / Q000523:psychology
keywords: Complex multi-layered interactions; housing instability; intimate partner violence; low-income women; pathways and trajectories; women’s mental and physical health