Background and Purpose
Homelessness is a complex public health problem in the United States, contributing to adverse mental and physical health outcomes. Individuals experiencing homelessness are more prone to suffer from physical and mental trauma compared to non-homeless counterparts. Due to the pronounced disparities, trauma, and toxic stress faced by homeless individuals, they tend to adapt to destructive coping behaviors such as self-harm leading to severe psychological and substance abuse disorders. Individuals experiencing homelessness are also four times more likely to use emergency department services (ED) than the general population.
Despite the abundance of research on homelessness and ED service utilization, there are gaps in the literature examining the relationship between trauma and self-harm among individuals who have used ED services. Our study aims to assess the moderating effect of self-harm behavior on the association between ED utilization and homelessness due to trauma among adults in Texas.
Methods
Sample: A sample of 282 adults, aged 21 to 75 years who completed their baseline Vulnerability Index Service Prioritization Decision Assistance Prescreen Tool (VI-SPDAT) assessment between February 2021 to February 2022 were selected from a Local Mental Authority (LMHA) organization in Texas. The LMHA is a part of a state-funded program called Healthy Community Collaborate (HCC).
Measures: The primary outcome variable was current period of homelessness due to trauma (Y/N). The main predictor was ED service utilization (0-10+). The moderating variable was self-harm or inflicting harm on others in the past year (Y/N). Other covariates such as age, gender, race, ethnicity, and marital status were also included.
Analysis: A multivariate logistic regression with a moderation analysis was conducted.
Results
84% of the sample reported homelessness due to trauma. 65% were males, and 58% were white, with a mean age of 50 years. Individuals used ED service an average of three times, with almost 55% of the sample engaging in risky behaviors and self-harm. Females were more likely to be homeless due to trauma compared to males. Individuals who engaged in risky behaviors and self-harm had a higher rate of experiencing homelessness due to trauma. Individuals who used ED services were 1.26 times more likely to be homeless due to trauma. Individuals who performed in risky behaviors were 3.57 times more likely to face homelessness due to trauma. Individuals who engaged in self-harm were more likely to suffer from homelessness due to trauma.
Engaging in self-harm behavior was found to be an overall significant moderator. Individuals who used ED services 10+ times and engaged in self-harm had the highest likelihood to experience current period of homelessness due to trauma compared to those who used ED services only three times.
Conclusions and Implications
Findings from this study demonstrated that individuals who used ED services had higher odds of experiencing homelessness due to emotional, physical, psychological, sexual, or other types of abuse or trauma. Furthermore, self-harm behavior was a significant moderator of the relationship between ED use and experiencing homelessness due to trauma or abuse. Coping with complex trauma can be highly challenging, especially among homeless populations. This study may help inform efforts to develop targeted strategic early interventions and promote resilience-based approaches among homeless and clinical service providers to help reduce ED use and improve mental health outcomes and quality of life among individuals experiencing homelessness due to trauma or abuse.
