Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness

Abstract

Stigma and discrimination toward individuals experiencing homelessness and mental disorders remain pervasive across societies. However, there are few longitudinal studies of stigma and discrimination among homeless adults with mental illness. This study aimed to identify the two-year group trajectories of stigma and discrimination and examine the predictive role of mental health characteristics among 414 homeless adults with mental illness participating in the extended follow-up phase of the Toronto At Home/Chez Soi (AH/CS) randomized trial site. Mental health-related perceived stigma and discrimination were measured at baseline, one, and two years using validated scales. Group-based-trajectory modelling was used to identify stigma and discrimination group trajectory memberships and the effect of the Housing First treatment (rent supplements and mental health support services) vs treatment as usual on these trajectories. The associations between mental healthrelated characteristics and trajectory group memberships were also assessed using multinomial logistic regression. Over two-years, three group trajectories of stigma and discrimination were identified. For discrimination, participants followed a low, moderate, or increasingly high discrimination group trajectory, while for stigma, participants followed a low, moderate or high stigma group trajectory. The Housing First treatment had no significant effect on discrimination or stigma trajectories groups. For the discrimination trajectories, major depressive episode, mood disorder with psychotic features, alcohol abuse, suicidality, severity of mental health symptoms, and substance use severity in the previous year were predictors of moderate and increasingly high discrimination trajectories. History of discrimination within healthcare setting was also positively associated with following a moderate or high discrimination trajectory. For the stigma trajectories, substance dependence, high mental health symptoms severity, substance use severity, and discrimination experiences within healthcare settings were the main predictors for the moderate trajectory PLOS ONE | https://doi.

Associations of resilience with quality of life levels in adults experiencing homelessness and mental illness: a longitudinal study

“…Those experiencing homelessness are often exposed to stressful conditions (e.g., lack of safety or a private space, perceived powerlessness and loss of social networks) commonly associated with shelter environments [ 2 ]. Additional traumatic and stressful experiences such as street victimisation, physical and sexual abuse, exposure to crime-related activities, and discrimination further compound the psychological effects of homelessness[ 4 , 7 , 8 ]. These traumatic events are often intertwined with trauma experienced prior to homelessness, such as adverse childhood experiences [ 9 , 10 ], family dysfunction [ 11 ], or hazardous military service [ 12 ].…”

Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site

“…For example, people with substance use disorders are less likely to gain stable housing [60], exit homelessness [69], or achieve better recovery trajectories [25]. People experiencing homeless frequently have a high prevalence of mental and substance use [13], which often cluster with other poor health, behavioral, and social characteristics (e.g., poor physical health, victimization, adherence to the rehabilitation programs, discrimination/stigma, and criminal activity involvement) [27,[70][71][72]. Thus, these associated and intertwined adverse consequences of mental health and substance use disorders diminish further the possibility of positive wellbeing trajectories for this population group.…”

“…For instance, Housing First (HF) interventions, which promote housing without preconditions, and support mental health needs based on a consumer-choice approach [19], have consistently shown effectiveness in improving housing stability [20]. Nonetheless, HF has shown limited effects on other outcomes such as quality of life [21][22][23], substance use [20,24], recovery [25,26] and discrimination [27].…”

Effect of Housing First on violence-related traumatic brain injury in adults with experiences of homelessness and mental illness: findings from the At Home/Chez Soi randomised trial, Toronto site

“… 53 HF may also contribute to reducing the number of physical violence-related TBI events by facilitating access to mental health services that may reduce the experience of violence-related TBI to mental health problems. Given the pervasive stigma attached to mental illness, 54 people with mental disorders are often targets of interpersonal violence as they are perceived as dangerous. 55 56 Some individuals with unmanaged or untreated mental disorders may also be more likely to engage in violent or criminal-linked behaviours, 55 57 increasing their risk of interpersonal violence.…”