Grace, Sarah M.; Trager, Evan; Deas, Deborah; Moss, Howard; Ge, Shaokui; Cheney, Ann M.; & Grinceri, Jennifer (2019). 5.74 COMPARATIVE RISKS OF CHILDHOOD ADVERSITY AND HOMELESSNESS ON YOUNG ADULT MENTAL ILLNESS. Journal of the American Academy of Child & Adolescent Psychiatry.


Objectives In the United States, approximately 1.5 million children experience homelessness each year. Although homelessness is well-recognized as a strong risk factor for PTSD, less is known about its other long-term mental health outcomes. More so, there remains the question of the interaction of trauma childhood experiences and childhood housing insecurity. To this end, we sought to examine whether adverse childhood experiences (ACEs), a means of quantifying exposure to traumatic experiences, which also has been shown to predict higher rates of mental disorders, might further clarify this association. Methods Prospective data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Add Health is a longitudinal study of a nationally representative sample group of adolescents in grades 7–12 in the United States during the 1994–1995 school year. The Add Health cohort has been followed into young adulthood with 4 in-home interviews. The most recent wave was in 2008, when the subjects were aged 24–32 years. ACE scores were derived from Add Health items derived from the CDC-Kaiser Permanente Adverse Childhood Experiences study as a template. Mental health diagnoses were derived from Add Health items whereby the participants self-reported any history of depression (MDD), ADHD, PTSD, and anxiety or panic disorder (ANX). Analyses used survey-based logistic regression models adjusted for demographics, and risks are reported as odds ratios. Results Subjects who were ever homeless had a higher lifetime prevalence of mental illness than those young adults who always lived with their own families ( p < 0.0001). The odds of having mental health disorders increased with the number of endorsed ACEs (OR = 1.34 for 1 ACE, OR = 1.62 for 2 ACEs, OR = 2.55 for 3 ACEs, and OR = 3.08 for 4 or more ACEs). After the risks of young adults with ACEs were adjusted by social demographics, it was shown that homeless young adults were more likely to have more ACEs than their housed peers. For homeless subjects, the risk estimation of 4 or more ACEs compared to family home was significantly elevated (OR = 8.73; p < 0.001). Conclusions We found that homeless youth were at a greater risk for developing higher rates of mental health disorders, as well as at increased odds exposure of ACEs. The experience of multiple ACEs was an even stronger predictor for the development of specific mental health disorders. The results expand the body of research examining the impact of homelessness and childhood adversity on psychopathology in later life.



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Conference proceeding

Book Title

Journal of the American Academy of Child & Adolescent Psychiatry


Grace, Sarah M.
Trager, Evan
Deas, Deborah
Moss, Howard
Ge, Shaokui
Cheney, Ann M.
Grinceri, Jennifer

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