The Hotel Study: Multimorbidity in a Community Sample Living in Marginal Housing

Vila‐Rodriguez, Fidel; Panenka, William J.; Lang, Donna J.; Thornton, Allen E.; Vertinsky, Talia; Wong, Hubert; Barr, Alasdair M.; Procyshyn, Ric M.; Sidhu, Jasmeet; Smith, G.; Buchanan, Tari; Krajden, Mel; Krausz, Michael; Montaner, Julio S. G.; MacEwan, G. William; Honer, William G.

doi:10.1176/appi.ajp.2013.12111439

Cited by 84 publications

(116 citation statements)

References 57 publications

(55 reference statements)

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“…Our recent investigations of a large cohort dwelling in this region found that greater drug-related harm was associated with a 1.43-fold increase in multimorbidity (Jones et al, 2013). In the same sample, greater multimorbidity (physical and psychiatric illness) was found to be associated with poorer social and role functioning (The Hotel Study;Vila-Rodriguez et al, 2013). At present, the mortality rate in this sample is 8.29 times what would be expected for an age-and sex-matched Canadian cohort (Jones et al, 2015).…”

Section: Chapter 1 General Introductionmentioning

confidence: 66%

“…Indeed, in our initial investigations, nearly half of the Hotel sample met criteria for a neurological illness, with 28% evidencing pathological MRI findings (Vila-Rodriguez et al, 2013). Therefore, this presents as a fruitful investigative angle to better understand the neurobiological vulnerabilities of this population.…”

Section: Chapter 1 General Introductionmentioning

confidence: 92%

“…Of the 299 clustered subjects, 211 had complete multivariate data and were included in our primary regression analysis. All participants provided written informed consent and received small honoraria for each assessment completed (clinical, neurocognitive, MRI (Vila-Rodriguez et al, 2013;Jones et al, 2015). A description of the full clustered sample (N = 299) is provided in Table 3.1.…”

Section: Participantsmentioning

confidence: 99%

“…Across these settings, co-occurring polysubstance use, infectious disease (e.g., HIV, Hepatitis C), and severe psychiatric illness are commonplace (Fazel et al, 2008;Robertson et al 2004;Shannon et al 2006;Vila-Rodriguez et al, 2013). Notably, the rate of reported comorbid substance use and psychiatric illness is upwards of 50% (Fazel et al, 2014;Krausz et al 2013).…”

Section: Chapter 1 General Introductionmentioning

confidence: 99%

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Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

et al. 2017

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Homeless and marginally housed individuals constitute a socially impoverished population characterized by high rates of multimorbid illness that includes polysubstance use, viral infection, and psychiatric illness. Their extensive exposure to risk factors is associated with numerous poor outcomes, yet little is known about structural brain integrity and its association with neurocognition in this population. In Study 1, we conducted a cluster analysis to re-construct three previously derived subgroups with distinct neurocognitive profiles in a large sample of socially marginalized persons (N = 299). Cluster 1 (n = 87) was characterized as highest functioning overall, whereas Cluster 3 (n = 103) was the lowest functioning neurocognitively, with a relative strength in decision-making. Cluster 2 (n = 109) fell intermediate to the other subgroups, with a relative weakness in decision-making. Next, we examined the association between complementary fronto-temporal cortical brain measures (gyrification, cortical thickness) and neurocognitive profiles using multinomial logistic regression. Chi-square tests and ANOVAs differentiated subgroups on proxy measures of neurodevelopment and acquired brain insult/risk exposure. We found that greater frontal and temporal gyrification and more proxies of aberrant neurodevelopment were associated with Cluster 3 (lowest functioning subgroup). Further, age moderated the association between orbitofrontal cortical thickness and neurocognition, with positive associations in older adults, and negative associations in younger adults. Finally, greater acquired brain insult/risk exposure was associated with the cluster characterized by selective decisionmaking impairment (Cluster 2), and the higher functioning cluster (Cluster 1). In Study 2, we examined the association between white matter integrity and neurocognitive profiles using multinomial logistic regression and Tract-based Spatial Statistics. We found significantly lower fractional anisotropy (FA), with corresponding increased axial and radial diffusivity (AD, RD) in widespread and bilateral brain regions of Cluster 3.Differences in RD were more prominent compared to AD. Altogether, our findings highlight the unique pathways to neurocognitive impairment in a heterogeneous population and help to clarify the vulnerabilities confronted by different subgroups.

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Section: Chapter 1 General Introductionmentioning

confidence: 66%

Section: Chapter 1 General Introductionmentioning

confidence: 92%

Section: Participantsmentioning

confidence: 99%

Section: Chapter 1 General Introductionmentioning

confidence: 99%

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Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

et al. 2017

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“…Mental illness rates also tend to be significantly higher in the homeless than in the general population [11][12][13][14]. Deinstitutionalization has been named as a possible cause [15], and the inverse association of mental disorders with socioeconomic status has been widely debated [16].…”

Section: Are Substance Use and Mental Illness Associated To An Earliementioning

confidence: 99%

Are Substance Use and Mental Illness Associated to an Earlier Onset of Homelessness?

Cambioli¹,

Maremmani²,

Bacciardi³

et al. 2016

Ment Health Fam Med

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Diffusion tensor imaging of neurocognitive profiles in a community cohort living in marginal housing

et al. 2019

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Objective We investigated white matter differences associated with distinct neurocognitive profiles derived from a large cohort of marginally housed persons with comorbid physical and mental illnesses. Our prior work identified three profile cluster groups: a high functioning group (Cluster 1), a low functioning group with relative strength in decision‐making (Cluster 3), and an intermediary group with a relative decision‐making weakness (Cluster 2). This study extends previous findings of cortical gray matter differences between these groups with evidence for putative neurodevelopmental abnormalities in the low cognitive functioning group (i.e., Cluster 3). We hypothesized that altered white matter diffusion would be associated with the lowest functioning neurocognitive profile and would be associated with previously observed gray matter differences. Method Participants from a socially impoverished neighborhood in Vancouver, Canada underwent neurocognitive evaluation and neuroimaging. We performed Tract‐Based Spatial Statistics using diffusion tensor imaging data from 184 participants to examine whole‐brain differences in white matter microstructure between cluster analytically derived neurocognitive profiles, as well as unitary neurocognitive measures. Correlations between frontal gray and white matter were also examined. Results Cluster 3 showed increased diffusion in predominately bilateral frontal and interhemisphere tracts (vs. Clusters 1 and 2), with relatively greater diffusion in the left hemisphere (vs. Cluster 1). Differences in radial diffusivity were more prominent compared with axial diffusivity. A weak association between regional frontal fractional anisotropy and previously defined abnormalities in gyrification was observed. Conclusions In a socially marginalized sample, we established several patterns in the covariation of white matter diffusion and neurocognitive functioning. These patterns elucidate the neurobiological substrates and vulnerabilities that are apt to underlie functional impairments inherent to this complex and heterogeneous population.

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The Hotel Study: Multimorbidity in a Community Sample Living in Marginal Housing

Cited by 84 publications

References 57 publications

Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

Are Substance Use and Mental Illness Associated to an Earlier Onset of Homelessness?

Diffusion tensor imaging of neurocognitive profiles in a community cohort living in marginal housing

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