title: Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study.
abstract: OBJECTIVE
  To examine whether childhood adversity is associated with depressive symptoms, suicide attempts, or psychiatric hospitalization.
  
  
  METHODS
  History of seven childhood adversities (physical neglect, verbal abuse, physical abuse, sexual abuse, parental death, parental incarceration, and child welfare system placement) was gathered through in-person interviews. Multivariate models examined associations between history of childhood adversities and moderate to severe depressive symptoms, lifetime history of suicide attempt, or lifetime history of psychiatric hospitalization. The study enrolled 350 homeless adults, aged 50 and older, in Oakland, California, using population-based sampling methods. Moderate to severe depressive symptoms were measured on a Center for Epidemiologic Studies-Depression Scale (≥22), self-reported lifetime history of suicide attempt, and self-reported lifetime history of psychiatric hospitalization.
  
  
  RESULTS
  Participants with exposure to one childhood adversity had elevated odds of reporting moderate to severe depressive symptoms (adjusted odds ratio [AOR]: 2.0; 95% confidence interval [CI]: 1.1-3.7) and lifetime history of suicide attempt (AOR: 4.6; 95% CI: 1.0-21.6) when compared with those who had none; the odds of these two outcomes increased with exposure to additional childhood adversities. Participants with four or more childhood adversities had higher odds of having a lifetime history of psychiatric hospitalization (AOR: 7.1; 95% CI: 2.8-18.0); no increase with fewer adversities was found.
  
  
  CONCLUSIONS
  Childhood adversities are associated with poor mental health outcomes among older homeless adults. Clinicians should collect information about childhood adversities among this high-risk population to inform risk assessment and treatment recommendations.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA. Electronic address: ChuanMei.Lee@ucsf.edu.
authors.forename: Chuan Mei
authors.initials: CM
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA; Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA.
authors.forename: Christina
authors.initials: C
authors.lastname: Mangurian
authors.affiliation: Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA; Division of General Internal Medicine, University of California, San Francisco General Hospital and Trauma Center, San Francisco, CA.
authors.forename: Lina
authors.initials: L
authors.lastname: Tieu
authors.affiliation: Division of General Internal Medicine, University of California, San Francisco General Hospital and Trauma Center, San Francisco, CA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ponath
authors.affiliation: Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA; Division of General Internal Medicine, University of California, San Francisco General Hospital and Trauma Center, San Francisco, CA.
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.affiliation: Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA; Division of General Internal Medicine, University of California, San Francisco General Hospital and Trauma Center, San Francisco, CA.
authors.forename: Margot
authors.initials: M
authors.lastname: Kushel
mesh_terms: D054523:Adult Survivors of Child Abuse / Q000523:psychology*; D000368:Aged; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006304:Health Status; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D057566:Self Report; D013406:Suicide, Attempted / Q000706:statistics & numerical data*
keywords: depression; epidemiology; geriatrics; homeless persons; mental health services; suicide