A research paper about homeless in Los Angles

My research project is the homeless in Los Angles. I already find 4 resources, please use all the resources I give you to complete this research paper. The paper should conclude the amount of people who are homeless, and the composition of homeless people. The reason that result the people to become homeless is also an important point. These are my resources:Works CitedMcQuistion, Hunter L., et al. “Risk Factors Associated with Recurrent Homelessness After a First Homeless Episode.” Community Mental Health Journal, vol. 50, no. 5, July 2014, pp. 505-513. EBSCOhost, doi:10.1007/s10597-013-9608-4.Works CitedLim, Caroline, et al. “Depressive Symptoms and Their Association with Adverse Environmental Factors and Substance Use in Runaway and Homeless Youths.” Journal of Research on Adolescence, vol. 26, no. 3, Sept. 2016, pp. 403-417. EBSCOhost, doi:10.1111/jora.12200.http://www.latimes.com/local/california/la-me-los-angeles-shelter-shortage-20170929-htmlstory.html
http://www.vchcorp.org/wp-content/uploads/2017/06/2017-Homeless-Count-Results.pdf
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JOURNAL OF RESEARCH ON ADOLESCENCE, 26(3), 403–417
Depressive Symptoms and Their Association With Adverse Environmental
Factors and Substance Use in Runaway and Homeless Youths
Caroline Lim, Eric Rice, and Harmony Rhoades
University of Southern California
We used diathesis-stress and stress-sensitization models to determine whether family maltreatment, street-related traumatic events, stressful life events, and substance use were associated with depressive symptoms in runaway and homeless youths (RHY) in Los Angeles. Greater severity of depressive symptoms was significantly related to family
maltreatment, being exposed to more traumatic stressors during homelessness, and current substance use compared to
no substance use. Family maltreatment was also found to moderate the relationship between traumatic stressors and
depressive symptoms. Importantly, cumulative exposure to the investigated risk factors at varying levels was associated with more severe depressive symptoms. Using a trauma-informed approach to screen for RHY at risk of depression may pave the way for secondary prevention of major depression in RHY.
The prevalence of major depressive disorder
(MDD) varies between settings and populations;
however, findings from cross-sectional and cohort
studies have suggested that MDD is more prevalent among runaway and homeless youths (RHY)
relative to housed youths (Bender, Ferguson,
Thompson, Komlo, & Pollio, 2010; Tyler, Whitbeck,
Hoyt, & Johnson, 2003; Unger, Kipke, Simon,
Montgomery, & Johnson, 1997; Whitbeck, Hoyt, &
Bao, 2000; Whitbeck, Johnson, Hoyt, & Cauce,
2004). The disorder has a lifetime prevalence of
16.6% among adults (Kessler et al., 2005) and
11.7% among adolescents (Merikangas et al., 2010).
In cross-sectional studies of homeless youths in the
United States, Bender et al. (2010) and Tyler et al.
(2003) found that 30% of their samples met criteria
for major depression. In a multisite longitudinal
diagnostic study of homeless and runaway adolescents, Whitbeck et al. (2004) reported a lifetime
prevalence of approximately 30% and concluded
that this rate is two times higher than that found in
the same-age general population. Another multisite
cross-sectional study found that 23% of homeless
adolescent boys and 39% of homeless adolescent
girls experience depressive symptoms sufficiently
severe to meet the diagnostic criteria for clinical
depression (Whitbeck et al., 2000). Depression in
RHY is clearly of special concern; therefore,
research to understand factors correlated with the
Data for this study came from research supported by Grant
MH093336 from the National Institute of Mental Health
awarded to Eric Rice.
Requests for reprints should be sent to Eric Rice, School of
Social Work, University of Southern California, Montgomery
Ross Fisher Building, 669 W. 34th Street, Los Angeles, CA 90089.
E-mail: ericr@usc.edu
development of depression in RHY is both necessary and beneficial to facilitating the development
of preventive mental health programs for this vulnerable population.
The preponderance of depression in RHY might
be attributable to exposure to environmental risk
factors associated with MDD. MDD is recognized
as a multifactorial disorder that results from the
complex interplay among genetic and environmental factors, with 60% of the variance in the risk of
developing the disorder explained by nonshared
environmental factors (Sullivan, Neale, & Kendler,
2000). The evidence base for the relationship
among experiential factors and environmental
adversities and MDD in RHY is considerable. Studies have found that depression in RHY is associated with a history of family abuse (e.g., Bao,
Whitbeck, & Hoyt, 2000), interaction with deviant
peers (Bao et al., 2000), stressful life events (e.g.,
Votta & Manion, 2003), and street victimization
(e.g., Whitbeck et al., 2000).
Although a host of factors can render RHY especially vulnerable to MDD, the focus of this study
was the relationship between depression and environmental risk factors prevalent among RHY,
namely family abuse, stressful life events, and traumatic experiences associated with street life. Family
maltreatment is a common precipitating factor of
early independence in RHY (Ferguson, 2009; Yoder,
Whitbeck, & Hoyt, 2001). Moreover, exposure to
traumatic stressors is a widely endorsed hazard of
homelessness (Coates & McKenzie-Mohr, 2010).
Street life also exposes RHY to multiple and
© 2015 The Authors
Journal of Research on Adolescence © 2015 Society for Research on Adolescence
DOI: 10.1111/jora.12200
404
LIM, RICE, AND RHOADES
prolonged stress stemming from the lack of basic
necessities such as food, shelter, and safety (Coates
& McKenzie-Mohr, 2010). Research has found that
substance use is associated with exposure to
adverse environmental events. The link between
substance use and history of childhood maltreatment (Douglas et al., 2010) and exposure to traumatic stressors (Kilpatrick et al., 2003) is well
documented. Considering the prevalence of trauma
in RHY, this study also examined the relationship
between substance use and depression.
Childhood Maltreatment
The relationship between childhood maltreatment
and depression has been extensively investigated,
with studies producing empirical evidence of an
unequivocal link in adolescents and adults (Chapman et al., 2004; Heneghan et al., 2013). Given that
the experience of maltreatment in their family of
origin is a common contributory factor to leaving
home among youths, the impact of family abuse on
depression in RHY has been widely examined,
with research finding that RHY who experienced
abuse—physical, sexual, neglect, or some combination—by a family member reported higher levels of
depressive symptoms (Ryan, Kilmer, Cauce,
Watanabe, & Hoyt, 2000; Whitbeck et al., 2004).
Additionally, the experience of family abuse
increased the risk of later victimization (Tyler,
Hoyt, & Whitbeck, 2000), and the impact of sexual
victimization during homelessness on the development of posttraumatic stress disorder (PTSD) was
greater in RHY who experienced sexual abuse in
their family of origin (Whitbeck, Hoyt, & Yoder,
1999). Less is known, however, about whether the
experience of family abuse amplifies the negative
impact of exposure to other environmental adversities and precipitates the development of depressive
symptomatology in RHY.
Traumatic Stressors
The effects of exposure to extreme traumatic stressors and subsequent development of MDD have
been well documented. Kilpatrick et al. (2003)
reported that 62% of a nationally representative
sample of adolescents with PTSD had a concurrent
MDD, suggesting that exposure to traumatic stressors is associated with heightened risk of not only
PTSD but also MDD. Kilpatrick et al. (2003) also
found that adolescents who had been physically
assaulted were 2.2 times more likely to experience a
major depressive episode as adolescents who had no
exposure to such a traumatic stressor. In another
study of adolescents, lifetime exposure to parental
and community violence and other traumatic events
significantly increased the likelihood of experiencing
a major depressive episode by an estimated factor of
4.5 and 1.4, respectively (Adams et al., 2013).
Regarding the impact of traumatic stressors on
RHY, findings from prior studies have highlighted
the perils of street life by demonstrating an unequivocal link between exposure to life-threatening events
during homelessness and depression (e.g., Whitbeck
et al., 2004). A limitation of previous studies has
been a focus on the impact of direct exposure to
traumatic stressors, which involve threats to physical integrity indicated by physical or sexual victimization; less is known about the impact of indirect
exposure to or witnessing traumatic events, which
were the most common forms of exposure in our
sample. In this regard, it is important to assess the
influence of these traumatic stressors on the mental
health of RHY.
Stressful Life Events
The diathesis-stress model, one of the prevailing
explanatory theories for the pathogenesis of MDD
and other severe mental illnesses, considers stress a
precipitating factor among individuals with preexisting vulnerability (Hankin & Abela, 2005). This
theory has prompted substantial research on the
impact of experiential stress via the experience of
negative life events on different facets of MDD
(e.g., Johnson, Whisman, Corley, Hewitt, & Rhee,
2012). Longitudinal studies have found that experiencing stressful life events is significantly associated with the onset of MDD in adolescence and
adults (Johnson et al., 2012; McLaughlin, Conron,
Koenen, & Gilman, 2010).
A small body of research has investigated the
association between stressful life events and
depression in RHY, yielding inconsistent findings
that could be attributable to differences in measurement (Unger et al., 1998; Votta & Manion, 2003).
Unger et al. (1998) found that stressful life events
germane to homeless youths (e.g., having an abortion and being admitted to a hospital for psychiatric treatment) were positively associated with
depression, whereas Votta and Manion (2003) did
not find stressful events that commonly affect adolescents (e.g., not doing well on an exam) to be
associated with depression in a sample of homeless
adolescent boys. Clearly, additional studies are
needed to substantiate the intuitive hypothesis that
the experience of more life stressors would be
DEPRESSIVE SYMPTOMS AND RUNAWAY AND HOMELESS YOUTHS
associated with more severe depressive symptoms
in RHY.
Substance Use
Heavy substance use has been reported to be significantly more prevalent in RHY relative to
housed youths (Ensign & Santelli, 1998). The selfmedication theory posits that substances are used
to alleviate distressful psychological symptoms
(Khantzian, 1985). However, the converse of this
theory has also been substantiated by research
demonstrating that substance use during adolescence is a risk factor for later MDD (e.g., Hallfors,
Waller, Bauer, Ford, & Halpern, 2005). Notwithstanding the temporal ordering of depression and
substance use, we expected to find an association
between increased substance use and more severe
depressive symptomatology in RHY.
Conceptual Models
The ecological model considers elements in an
environment to be agents in the etiology of mental
disorders, therefore providing a useful framework
for understanding the link between adverse environmental events and occurrence of depression in
RHY (Bronfenbrenner & Ceci, 1994). The diathesisstress model and the stress-sensitization model
focus on more specific parameters in an environment that increase the risk of later development of
psychiatric disorders. The diathesis-stress model
suggests that among individuals with preexisting
vulnerability, the risk of mental disorder increases
with the level of stress exposure (Hankin & Abela,
2005). According to the stress-sensitization model,
early exposure to severe adversities such as childhood maltreatment creates a diathesis. The model
posits that the experience of childhood maltreatment could damage the neurobiological system,
thereby precipitating a vulnerability to later psychopathology. In response to subsequent experiential stressors of lesser intensity, the damaged
system prompts aberrant neurochemical responses
that manifest as psychological distress (Hammen,
Henry, & Daley, 2000; Slavich, Monroe, & Gotlib,
2011).
The diathesis-stress model posits that RHY with
a history of childhood maltreatment, and thus
increased exposure to higher levels of experiential
stressors including stressful life events and traumatic experiences, are more vulnerable to the
development of psychological distress than RHY
with fewer adverse exposures. The stress-sensitiza-
405
tion model suggests that the experience of childhood maltreatment moderates the effects of
experiential stressors on the development of psychological distress. Both the diathesis-stress model
and the stress-sensitization model acknowledge the
biological consequences of substance use in exacerbating an aberrant neurochemical response to experiential stressors. Despite the popularity of these
theories and the high prevalence of MDD and
depressive symptomatology in RHY, to our knowledge, these theories have not been explicitly
applied to investigate RHY.
Study Aims and Hypotheses
Although considerable research has been devoted
to delineating the correlates of depression in RHY,
these studies have tended to focus on select environmental risk factors independently, rather than
the association between exposure to multiple environmental risk factors and susceptibility to depression in RHY. With the exception of studies by
Whitbeck et al. (2000, 2004) that investigated the
direct and combined effects of family abuse and
street victimization, other studies have typically
examined the single influence of family abuse (e.g.,
Bao et al., 2000) and to a lesser extent stressful life
events (Votta & Manion, 2003). Given the literature
on the negative effects of cumulative adversities on
mental health (e.g., Chartier, Walker, & Naimark,
2010) and that the majority of RHY are exposed to
multiple types of adverse environments, we
expected that youths with more exposures would
have poorer mental health.
The aim of this study was to extend previous
research by investigating the relationships among
separate and cumulative environmental adversities
(i.e., family maltreatment, traumatic stressors associated with street life, and stressful life events) and
substance use, hereafter referred to as risk factors
for depression, and severity of depressive symptoms in RHY. Although the experience of family
maltreatment, particularly physical and sexual
abuse, is considered a traumatic stressor, its association with depressive symptoms was assessed separately from other forms of trauma given the high
prevalence rates in RHY and its unique and
adverse effects on mental health.
Based on the diathesis-stress and stress-sensitization models, we tested the following hypotheses:
(1) family maltreatment, traumatic stressors associated with street life, stressful life events, and substance use would be independently associated with
more severe depressive symptoms; (2) the effect of
406
LIM, RICE, AND RHOADES
experiential stressors including street-related traumatic experiences and stressful life events on severity of depressive symptoms would be greater for
RHY with a history of family maltreatment; and (3)
a dose–response relationship would exist between
exposure to the investigated risk factors and severity of depressive symptoms in that more exposures
would be associated with more severe depressive
symptomatology in RHY. If confirmed, these
results would provide evidence of the additive
effects of environmental risk factors on susceptibility to MDD in RHY. These findings could facilitate
the early identification of high-risk youths for preventive interventions that could preempt the disease progression and reduce the risk of chronic
homelessness in RHY precipitated by psychiatric
disability.
METHOD
Sampling and Recruitment
Data for this study came from a convenience sample of 377 RHY aged 15 to 28 who participated in
the first wave of a four-panel longitudinal study
conducted in Los Angeles, California, designed to
examine the impact of network ties on HIV risktaking behaviors in RHY. Youths were eligible to
participate if they met the following criteria: (1)
were homeless or at imminent risk of homelessness as established by accessing services at one of
two drop-in agencies selected for study involvement and (2) were able to speak and write in
English or Spanish. These drop-in agencies serve
the largest number of homeless youths in their
respective communities by engaging youths from
a myriad of living conditions and thereby served
as gatekeepers to the RHY population. To be eligible for services, youths had to undertake an
assessment administered by agency personnel to
determine that they were homeless or were at
imminent risk of homelessness, broadly defined as
having no viable or stable residence. For this reason, every youth who was receiving services at
either agency was considered eligible for study
participation based on the first criterion. This
resulted in the recruitment of seven participants
over the age of 25, of whom four were homeless
before the age of 25 and three became homeless
at the age of 26.
Youths were approached and invited to participate in the study by research staff members as
they entered the agency for services (e.g., intensive case management services, meals, clothing).
Eighty-three percent of eligible youths using services during the data collection period completed
the interview. Two research staff members were
consistently responsible for recruitment to prevent
duplicate enrollment. The first wave of data collection ran from October 2011 to February 2012.
Prior to any data collection, eligible participants
were required to sign a study consent form. A
waiver of parental consent was obtained for participants who were minors. After the informed
consent process, participants were invited to complete a self-report research survey consisting of
two parts: an audio computer-assisted self-interview (ACASI) and a face-to-face social network
interview (F2F-SNI). The ACASI collected data on
participants’ sexual history and sex-related HIV
risk behaviors, drug and alcohol behaviors, mental
health, trauma history, homeless history, and living situation. The F2F-SNI, administered by master’s-level and doctoral students and research staff
members, collected data on the extent and quality
of participants’ social networks. Interviewers
received approximately 40 hr of training on data
collection. The informed consent process and
research survey took approximately 90 min to
complete and were conducted at the recruitment
site or a public location in the agency neighborhood. Participants received a $20 gift card for
responding to the research survey. The study was
reviewed and approved by the university’s institutional review board.
Measures
Demographic characteristics collected for this study
were age and gender. Gender was determined by
asking participants whether they identified as male,
female, or transgender (male to female or female to
male). This variable was dichotomized into male
(reference category) and female because no participants identified as being transgender.
History of family maltreatment was assessed
with three self-reported items that asked participants whether they had ever experienced physical
or sexual abuse in their family of origin: “Have
you ever become homeless because you experienced physical abuse?” “Have you ever become
homeless because you experienced sexual abuse?”
and “Have you ever been hit, punched, or kicked
very hard at home (do not include ordinary fights
between brothers and sisters)?” The first two items
came from a checklist adapted from a previous
study by Milburn et al. (2009). The last item was
drawn from the University of California, Los
DEPRESSIVE SYMPTOMS AND RUNAWAY AND HOMELESS YOUTHS
Angeles Posttraumatic Stress Disorder Reaction
Index (UCLA-PTSD RI; Steinberg, Brymer, Decker,
& Pynoos, 2004) and had three response categories:
1 (no, this has never happened to me before), 2 (yes, this
happened to me before I became homeless), and 3 (this
happened to me since I have become homeless). Respondents who answered affirmatively to at least one of
the three items were coded as having experienced
family maltreatment. Participants who had never
experienced physical or sexual abuse comprised
the reference group.
Traumatic stressors associated with street life
were assessed using the UCLA-PTSD RI (Steinberg
et al., 2004). Participants were asked whether they
had experienced any of the following traumatic
events during homelessness: (1) seeing a family
member being hit, punched, or kicked very hard at

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