Correlates of Depressed Mood among Young Stimulant-Using Homeless Gay and Bisexual Men

Homeless gay and bisexual (G/B) men are at risk for suicide attempts and have high risk of depressed mood, defined as elevated level of depressive symptoms. This study describes baseline socio-demographic, cognitive, psychosocial, and health- and drug-related correlates of depressed mood in 267 stimulant-using homeless G/B young men who entered a study designed to reduce drug use. G/B men without social support were 11 times more likely to experience depressed mood than their counterparts who had support; those who reported severe body pain were almost six times more likely to report depressed mood than those without pain. Other factors that increased risk of depressed mood included being homeless in the last four months, injecting drugs, reporting poor or fair health status, and high levels of internalized homophobia. This study is one of the first studies to draw a link between pain experienced and depressed mood in homeless young G/B men. Understanding the correlates of depressed mood among homeless G/B young men can help service providers design more targeted treatment plans and provide more appropriate referrals to ancillary care services.     

Predictors of perceived health status of tuberculosis-infected homeless

This study examines the predictors of perceived health status among homeless adults with latent tuberculosis (TB) in Los Angeles, especially in relation to gender differences. Total, 415 men and women enrolled in a TB-adherence trial completed baseline assessments concerning health status. Results indicated that women were more likely than men to report being in fair or poor health and to have experienced health problems. More women than men self-reported daily drug use and poor mental health. Homeless women were also more likely than their male counterparts to receive support from non-drug-users. Homeless adults who reported fair or poor health were also more likely than those who reported better health to have used injection drugs, to report experiencing depressive symptoms and poor mental health, and to have been homeless more than 3 years. Predictors of fair or poor health included being female and experiencing more depressive symptoms.     

Differential reporting of drug use among gay,bisexual and transgender stimulant-using homeless adults post intervention

Homeless gay and bisexual (G/B) men, and transgender female stimulant users are at high risk for continued substance use and dependency; yet, there is a limited understanding of reasons for differential reporting of drug use (defined as different outcomes of drug use when assessed by self-report versus urinalysis) post intervention among this population. This study examined self-reported drug use versus urinalysis reporting at four-month follow-up evaluation of a longitudinal study conducted among 166 G/B and transgender stimulant-using homeless adults. Follow-up data were collected from a two-group intervention focused on reducing stimulants and other illicit drug use as well as promoting HBV, HCV and HIV disease prevention. Findings of logistic regression revealed that transgender women and those who reported fair-or-poor health were more likely to self-report drug use which differed from the urinalysis biomarker. Amphetamines were the drugs most often differentially reported, possibly due to the fact that methamphetamine was cut with amphetamine or that the majority of the sample used methamphetamine which was metabolized into amphetamine. While the numbers of other drugs differentially reported were small, one-third to one half of the sample who were positive on urine testing for cocaine and opiates, respectively, did not report the use of these drugs. Findings highlight the need for biomarker assessment of drug use, especially post intervention.     

Homelessness in the Medical Curriculum: An Analysis of Case-Based Learning Content From One Canadian Medical School

Phenomenon: Homelessness is a major public health concern. Given that homeless individuals have high rates of mortality and morbidity, are more likely to be users of the healthcare system, and often report unmet health needs, it is important to examine how homelessness is addressed in medical education. We wanted to examine content and framing of issues related to homelessness in the case-based learning (CBL) curriculum and provide insights about whether medical students are being adequately trained to meet the health needs of homeless individuals through CBL. Approach: CBL content at a Canadian medical school that featured content related to homelessness was analyzed. Data were extracted from cases for the following variables: curriculum unit (e.g., professionalism/ethics curriculum or biomedical/clinical curriculum), patient characteristics (e.g., age, sex), and medical and social conditions. A thematic analysis was performed on cases related to homelessness. Discrepancies in analysis were resolved by consensus. Findings: Homelessness was mentioned in five (2.6%) of 191 CBL cases in the medical curriculum. Homelessness was significantly more likely to be featured in professionalism/ethics cases than in biomedical/clinical cases (p = .03). Homeless patients were portrayed as socially disadvantaged individuals, and medical learners were prompted to discuss ethical issues related to homeless patients in cases. However, homeless individuals were largely voiceless in cases. Homelessness was associated with serious physical and mental health concerns, but students were rarely prompted to address these concerns. Insights: The health and social needs of homeless individuals are often overlooked in CBL cases in the medical curriculum. Moreover, stereotypes of homelessness may be reinforced through medical training. There are opportunities for growth in addressing the needs of homeless individuals through medical education.     

Meeting the healthcare needs of older homeless people

Older homeless people have complex needs that are unmet because of their lifestyle. Consequently their general health may suffer, which has implications for health workers. This article raises awareness of the multiple problems and needs of older homeless people, and highlights the role of healthcare professionals in meeting such needs.     

Mental Ill Health in Homeless Women: A Review

Research indicates that homeless women are reported to experience more mental health issues than women who are not homeless and are an increasing proportion of the overall homeless population. In addition, homeless women are more likely to have alcohol and/or other drug use disorders. We provide a comprehensive review of the contemporary literature that revealed homeless women experience a range of mental health problems including depression, anxiety, post-traumatic stress disorder and alcohol and other drug use disorders. Studies in this literature review indicate that some women have pre-existing mental health issues which precipitate homelessness while others develop mental illness because of their homelessness; domestic violence was also recognised as an antecedent to homelessness, although further research is needed in this area. The results of this study indicate that the homeless cohort is a complex one with distinct needs. We provide information that can help refine assessment processes and plan appropriate services to address the mental health needs of homeless women. Finally, recommendations for mental health nursing practice in regard to caring for homeless women are made.     

Quality of life and most prevalent unmet needs of Chinese breast cancer survivors at one year after cancer treatment

PurposeThis study aims to examine the supportive care needs of Chinese breast cancer survivors, and investigate the relationships with participant characteristics and quality of life.MethodsA total of 163 participants were recruited from a local public hospital and completed a self-administered questionnaire: the 34-item Supportive Care Needs Survey, the supplementary module of access to healthcare and ancillary support services, and the Functional Assessment of Cancer Therapy.ResultsThe five most commonly reported unmet needs were all in the health system information domain (range: 55–63%), and the majority (84%) reported at least one unmet need in relation to information on healthcare. Stepwise multivariable regression analyses revealed that the time spent on travelling from home to hospital, receiving hormonal therapy, and physical and psychological unmet needs were independently associated with poorer quality of life among the participants.ConclusionsBreast cancer survivors perceive various unmet needs, and health system information is the most common one. Those who have more unmet needs in the physical and psychological domains were more likely to perceive a poorer quality of life.     

Patterns of e-cigarette use and self-reported health outcomes among smokers and non-smokers in the United States: A preliminary assessment

Background: This preliminary assessment evaluates the patterns of e-cigarette use and self-reported health outcomes in the United States. Methods: Multinomial logistic regressions were (baseline wave 2013-2014) performed by using a nationally representative sample with self-reported health measures, including overall, physical, and mental health, and quality of life, as outcomes of interest. Measurements were based on “excellent,” “very good,” “good,” “fair,” and “poor” responses. Results: Among non-cigarette smokers, e-cigarette users had lower chance of reporting good mental health, compared with those non-users (RRR[Relative Risk Ratio] = 0.66). When the respondents used e-cigarette products containing nicotine, the risk for reporting poor mental health was higher (RRR = 1.87). Among cigarette smokers, more use of e-cigarette cartridges was associated with higher risk of mental health (RRR = 1.12). Poor quality of life was associated with regular e-cigarette use. If smokers used e-cigarette products with nicotine, the risk of reporting poor quality of life was lower than individuals who did not use such products (RRR = 0.49). Higher concentration of nicotine in e-cigarette cartridges was associated with higher risks of poor physical and poor overall health, and with lower chance of excellent mental health. Conclusions: Health practitioners should evaluate the benefits and harms of using e-cigarettes and the effects on human health.     

Racial and ethnic differences in the mental health problems and use of mental health care

OBJECTIVES: We compared rates of mental health problems and use of mental health care across multiple racial and ethnic groups using secondary data from a large, nationally representative survey. METHODS: We pooled cross-sectional data from the 2001-2003 National Surveys on Drug Use and Health. Our sample included 134,875 adults classified as white, African American, American Indian/Alaskan Native, Asian, Mexican, Central and South American, Puerto Rican, other Hispanic-Latino, or those with multiple race and ethnicities. For each group, we estimate the past year probability of: (1) having 1 or more mental health symptoms in the past year, (2) having serious mental illness in the past year, (3) using mental health care, (4) using mental health care conditional on having mental health problems, (5) reporting unmet need for mental health care, and (6) reporting unmet need for mental health care conditional on having mental health problems. RESULTS: We found significantly higher rates of mental health problems and higher self-reported unmet need relative to whites among American Indian/Alaskan Natives and lower rates of mental health problems and use of mental health care among African American, Asian, Mexican, Central and South American, and other Hispanic-Latino groups. These differences generally were robust to the inclusion of clinical and socio demographic covariates. CONCLUSIONS: Overall, our study shows wide variation in mental health morbidity and use of mental health care across racial and ethnic groups in the United States. These results can help to focus efforts aimed at understanding the underlying causes of the differences we observe.     

Health Status and Access to Care for Homeless Adults with Problem Alcohol and Drug Use

Problem alcohol and drug use by adult homeless persons may put them at higher risk for other health problems and impact their access to health care. The purpose of this study was to determine if those with a positive screen for problem alcohol or drug use were at increased odds for having a lower health status and less access to care than those without problem alcohol or drug use. This was a secondary analysis of health survey data from a study related to the health of homeless adults. The survey included the Alcohol Use Disorders Identification Test (AUDIT) and the Drug Abuse Screening Test 10 (DAST-10) for evaluating problem substance use; health related quality of life, health care utilization, and medical history were also included. The impact of problem alcohol use or drug use on the odds of reporting lower general health status, a history of physical or mental illness, use of the emergency department (ED), and problems getting health care when needed, were estimated using logistic regression. A total of 112 adult homeless participants completed the survey. Participants with problem alcohol use tended to be less likely to obtain health care when needed (OR = 2.3, p = 0.05). Those with problem alcohol or drug use were not at increased odds of reporting a lower general health status, a positive medical history, or ED use. Problem alcohol use was associated with decreased access to health care when needed. Screening for problem alcohol use among homeless adults may not only help to identify those in need of interventions related to alcohol use but also help to identify those in need of help in accessing general health care.     

Illicit drug use as a challenge to the delivery of end-of-life care services to homeless persons: perceptions of health and social services professionals

Homeless persons tend to die younger than the housed population and have complex, often unmet, end-of-life care needs. High levels of illicit drug use among this population are a particular challenge for health and social services professionals involved in end-of-life care services delivery. This article explores the challenges of end-of-life care services to homeless illicit drug users based on data collected during a national study on end-of-life care services delivery to homeless persons in Canada. The authors conducted qualitative interviews with 50 health and social services professionals involved in health services delivery to homeless persons in five cities. Interviews were transcribed verbatim and analysed thematically. Themes were organised into two domains. First, barriers preventing homeless illicit drug users from accessing end-of-life care services, such as competing priorities (e.g. withdrawal management), lack of trust in healthcare providers and discrimination. Second, challenges to end-of-life care services delivery to this population in health and social care settings, including non-disclosure of illicit drug use, pain and symptom management, interruptions in care, and lack of experience with addictions. The authors identify a need for increased research on the role of harm reduction in end-of-life care settings to address these challenges.     

Perception of Access to Health Care by Homeless Individuals Seeking Services at a Day Shelter

Homeless individuals experience significant physical, mental health and substance abuse issues. This study describes the prevalence of health issues and perceptions of access to care among 300 homeless individuals who use a day shelter. Approximately 43% described a serious/chronic physical health problem, 53% a serious mental health problem, and 49% a substance use disorder. Those reporting a serious problem were more likely to have insurance and to report greater perceived access to care but perceived access to care was less than expected. Having insurance was also related to longer duration of homelessness. Targeting interventions to better match services to homeless individuals is the next challenge for advanced practice psychiatric and other nursing groups. Implications for doctoral level nurses in ways of evaluating models of care for this marginalized group are discussed.     

“I just don’t focus on my needs.” The unmet health needs of partner and offspring caregivers of people with dementia: A qualitative study

BackgroundFamily caregivers of people with dementia have significant unmet health needs. There is a lack of research that differentiates between the needs that are specifically relevant to partner and offspring caregivers.ObjectiveThe aim of this study was to examine the health needs of partner and offspring caregivers of older people with dementia, including the barriers they experience in meeting their needs.MethodSemi-structured interviews were conducted with 24 family caregivers of community-dwelling people with dementia. Of these, 12 were partner caregivers (4 men, 8 women) and 12 were offspring caregivers (2 men, 10 women). The interviews were transcribed and analysed using thematic analysis.ResultsFive themes were identified within the data. The first theme represents caregivers’ overall assessment and perception of their health needs. The remaining four themes represent the most important aspects of caregivers’ health needs; mental health, emotional support and social relationships, healthy diet and exercise, and personal time. While these themes were similar for offspring and partner caregivers, the specific needs and barriers within these areas were different. A prominent barrier for partner caregivers was that they had difficulty in acknowledging their needs. Despite this, partner caregivers demonstrated unmet emotional support needs, as they no longer had emotional support from their partner with dementia. They also had an unmet need for time away from the care-giving role, yet they were reluctant to leave the person with dementia. Offspring caregivers’ unmet health needs were easily identified and were focused on their unmet mental health needs and feeling socially isolated. These unmet mental health and social support needs were related to their unmet health needs in other areas such as exercise, diet and having time to themselves.ConclusionCaregivers have significant unmet needs and these are often complex, multidimensional, and they often differ between partner and offspring caregivers. Gaining a more detailed understanding of the needs and barriers that are particularly relevant to either partner or offspring caregivers will assist in the development of interventions that are tailored to the unique needs of caregivers.     

Hepatitis C virus infection among homeless men referred from a community clinic

In this study of factors related to Hepatitis C virus (HCV) infection in 104 homeless HCV-infected men and 94 uninfected homeless men, findings reveal that homeless men with HCV infection are older and more likely to be cocaine injectors than those not infected. Moreover, the sharing of needles, use of injected cocaine during the past 6 months, previous incarceration, veteran status, fair or poor health, and having multiple tattoos are also associated with HCV infection. Reports of having completed the HBV vaccination series, weekly marijuana use, and snorting cocaine or methamphetamine are negatively associated with HCV infection. Among men not reporting lifetime injection drug use, factors such as sharing toothbrushes, having multiple tattoos, being in fair or poor health, and past incarceration are associated with HCV infection. These findings may need to be considered when making screening decisions and counseling homeless male patients about HCV.     

A prospective study of the effects of sexual or physical abuse on back pain

A prospective investigation of the effects of abuse on future pain and disability was conducted in order to understand better the possible causal role of abuse. Participants were 422 females from a previous population study (Pain 73 (1997) 47-53) who either reported no spinal pain (n=194) or some spinal pain (n=228) at the baseline. A standardized questionnaire was used to assess self-reported physical and sexual abuse during childhood and as an adult. One year later, a follow-up questionnaire was used to evaluate pain and physical function outcomes. Results for the No Pain Group showed that only self-reported physical abuse at baseline was associated with an increased occurrence of new episodes of back pain (odds RATIO=2.65). Both sexual and physical abuse were linked to as much as four-fold increase in the occurrence of a new episode of functional problems at follow-up. However, for the Pain Group, no significant differences were found between those reporting and not reporting abuse at baseline and either pain or disability at follow-up. This unique prospective study with individuals from the general population underscores the probable importance of abuse in the etiology of a pain or disability problem. Nevertheless, since no clear relationship between abuse and pain was shown for those already reporting pain at baseline, the role of abuse in the development of persistent pain is still not comprehensible. There is a need for investigations with prospective designs employing patients as well as nonpatients as subject.     

Nurses’ perceptions on the skills,knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia: A qualitative study

BackgroundPeople experiencing homelessness have unmet healthcare needs often related to chronic health conditions and injury. Nurses are often the first and only point of contact for people experiencing homelessness accessing healthcare. However, education that prepares them to meet the needs of this vulnerable population is limited.AimTo qualitatively explore nurses’ perceptions on the skills, knowledge, and attributes required to provide healthcare to people experiencing homelessness in Australia that could underpin an educational pathway.DesignSemi-structured interviews with registered nurses and nurse practitioners.MethodsParticipants of a national survey were invited to undertake an interview. Interview data were analysed thematically and reported here in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.FindingsThe registered nurses (n = 11) and nurse practitioners (n = 6) had varying levels of experience providing care for homeless Australians. Overarching themes that arose from the registered nurse and nurse practitioner participants included equitable access to care, knowledge around homelessness, contribution of nursing, and nurses’ role. However, nurse practitioners had a greater sense of agency and empowerment to enact care, while registered nurses perceived being underprepared and overwhelmed by the unmet needs of people experiencing homelessness.ConclusionsThe findings suggest that nursing practice holds opportunities to improve access and care provision for people experiencing homelessness. Capitalising on these opportunities requires that nurses are educationally prepared with the skills, knowledge, and attributes to meet the needs of this vulnerable population without necessarily becoming nurse practitioners. These findings will be used to underpin the development of an educational pathway for nurses to enhance their response to homeless populations.     

Healthcare experiences of the homeless

Purpose: To explore the healthcare experiences of homeless individuals and inform providers of the barriers created by the situation of homelessness.
Data sources: This was a qualitative research study using a grounded theory approach. The sample included homeless individuals older than 18 years living in northeastern Wisconsin.
Conclusions: This research provided rich insight into the healthcare experiences of the homeless. Five key conclusions were made: (a) the great majority of homeless people have an external locus of control; (b) most homeless individuals lack the necessary resources to meet their physical needs of shelter, air, water, and food; (c) most homeless individuals lack the financial resources to seek adequate health care; (d) access to resources is limited because of poor transportation, telephones, and mail; and (e) all those interviewed felt that healthcare providers lack compassion for the homeless.
Implications for practice: Healthcare providers can use the concepts discovered in this study to help improve their skills and comfort level when working with homeless individuals. A decrease in acute illnesses and an increase in the effective management of chronic disease resulting in fewer long-term complications and medical costs because of these unnecessary complications could be seen. Healthcare professionals may also volunteer to become more involved with the care of the homeless if they are confident in their skills. Improving the health of the homeless in the community will result in improvements in the overall health of the community.     

Information and service needs for young adult cancer survivors

Background  The intent of this study was to examine supportive care needs and preferences among young adult cancer survivors. Method  Eight hundred seventy-nine young adults aged 18–39 years at time of study and diagnosed with cancer between the ages of 15–35 completed an online survey. Questions assessed the extent to which subjects had utilized various information and supportive care services and/or expressed a desire to use those services either now or in the past. Results  Upwards of 60% of respondents expressed a desire or need for age-appropriate cancer information, information about diet, exercise, nutrition, complementary and alternative health services, infertility information, mental health counseling, and camp or retreat programs for young adults. In most cases, more than 50% of respondents indicated that their needs for information and services have been unmet. In addition, unmet needs were more likely reported by respondents who were younger at age of diagnosis, of poor physical health status, and less likely to be advanced in work, school, or a committed/marital relationship. Other significant differences in unmet need were observed across sociodemographic and health status variables. Conclusion  Findings suggest a need to enhance the provision of supportive care services to adolescent and young adult cancer survivors along a continuum of care, from diagnosis through treatment and on to off-treatment survivorship.