Childhood adversity looms large for older homeless adults

August 18, 2016 by Liz Droge-Young, University of California, San Francisco

A new UC San Francisco report on an understudied population – older homeless adults – reveals that adverse childhood experiences have long-lasting effects. The researchers found that childhood adversities, such as abuse, neglect and parental death, have a strong association with mental health outcomes in a group of 350 homeless adults over the age of 50 in Oakland, Calif. The results indicate that early life challenges have a persistent ripple effect, even in an already challenged population.

"One might think that with all the negative experiences in the lives of these individuals, events that happened fifty years ago would not drive mental , but they do," said UCSF's Margot Kushel, MD, professor of medicine and senior author on the study, published in the American Journal of Geriatric Psychiatry on Aug. 17, 2016.

The younger half of the baby boomer generation has had a consistently higher risk of homelessness, leading to half of all single homeless adults being over 50, Kushel said. In previous work, Kushel has shown that this growing population experiences health challenges common in non-homeless adults who are decades older, but little is known about how experiences shape this group's mental health.

"There is a lot of literature about adversity and psychiatric outcomes, but few studies on older people, and no stories at all on older ," said the study's lead author, Chuan Mei Lee, MD, clinical fellow in Psychiatry at UCSF.

The were part of a longitudinal research project known as the HOPE HOME (Health Outcomes of People Experiencing Homelessness in Older Middle Age) Study, which has been conducted by UCSF since 2013. Individuals have been recruited for the HOPE HOME study at shelters, meal programs, and recycling centers throughout the city of Oakland. The new research was based on data gathered during baseline interviews.

Seven Categories of Negative Childhood Events

The researchers queried study participants on seven categories of negative childhood events: physical neglect, verbal abuse, physical abuse, sexual abuse, parental death, parental incarceration and placement in the child welfare system. The total number of experienced by each participant was then compared to his or her current depressive symptoms and self-reported history of suicide attempts and psychiatric hospitalizations.

The odds that participants had any of these three outcomes was related to the number of childhood adversities they had experienced.

"Even in a population with high prevalence of poor mental health outcomes, you could differentiate the mental health problems at this late age by the number of childhood adversities," Kushel said.

Compared to respondents with no reported adversities, those who experienced one to four or more had two to six times greater odds of having present-day moderate to severe depressive symptoms. Similarly, those with four or more adversities had seven times higher odds of having been hospitalized in the past for psychiatric symptoms. The greatest elevation in risk was in relation to childhood adversity and suicide attempts: those with four or more adversities had 45 times the odds of an attempted suicide at some point in their lives.

"I was humbled by what a potent risk factor childhood adversity was. These childhood events still haunt these individuals and loom very large in their lives," Kushel said.

As compared to the general population, rates of childhood physical abuse were higher in the older homeless population, at 33 percent versus 15 percent in a previously surveyed, non-homeless population.

Parental death showed the largest gap between study participants and the general public. Nationally, 0.3 percent of children experience the death of a parent, as compared to 21 percent of the respondents. Kushel suggests that the racial makeup of the study group, which was 80 percent African-American, may underlie this difference. "African-Americans dying at younger ages creates this disparity and leads to intergenerational negative effects," Kushel said.

Suggestion to Screen for Early Life Adversities

Due to the strong relationship between childhood adversity and outcomes, the researchers suggest healthcare providers screen for early life adversities. Though lagging behind the general population, half of those surveyed have a primary care provider and 70 percent had received care from a non-emergency department source in the past six months, which represent opportunities to screen for childhood adversity, Kushel and Lee said.

The researchers emphasize that the study's results are not simply a reflection of "bad" parenting. Kushel pointed to the intergenerational transmission of traumas, which in turn are highly influenced by larger societal issues. "Because its effects are so wide, childhood adversity is really an issue of public health" Lee said.

Explore further: Link found between witnessing parental domestic violence during childhood and attempted suicide

More information: Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study DOI:

Related Stories

Link found between witnessing parental domestic violence during childhood and attempted suicide

June 9, 2016
A new study by the University of Toronto (U of T), found the lifetime prevalence of suicide attempts among adults who had been exposed to chronic parental domestic violence during childhood was 17.3% compared to 2.3% among ...

Study links self-reported childhood abuse to death in women years later

August 17, 2016
A study of a large number of middle-aged adults suggests self-reported childhood abuse by women was associated with an increased long-term risk of death, according to an article published online by JAMA Psychiatry.

Arthritis linked to suicide attempts

June 15, 2016
One in every 26 men with arthritis have attempted suicide compared to one in 50 men without arthritis. Women with arthritis also had a higher prevalence of lifetime suicide attempts than women without arthritis (5.3% vs 3.2%), ...

Childhood abuse and chronic parental domestic violence linked to later addictions

June 22, 2016
Adults who have drug or alcohol dependency have experienced very high rates of early adversities, according to a new study published by University of Toronto researchers. One in five drug dependent Canadian adults and one ...

Childhood adversities, including witnessing parental domestic violence, linked to later migraines

June 24, 2015
Adults who were exposed to childhood adversity, including witnessing parental domestic violence, childhood physical and sexual abuse have higher odds of experiencing migraine headaches in adulthood, according to a new study ...

Childhood abuse, parental death and divorce are linked to adult insomnia symptoms

June 14, 2016
According to a new study, child adversities, which are known to play an important role in mental and physical health, are also associated with poor sleep.

Recommended for you

People are more honest when using a foreign tongue, research finds

August 17, 2018
New UChicago-led research suggests that someone who speaks in a foreign language is probably more credible than the average native speaker.

Research eyes role of stress in mental illnesses

August 17, 2018
We all face stress in our lives. Even researchers seeking to understand why some people shrug it off while others face battles against disorders like depression or PTSD.

It's okay when you're not okay: Study re-evaluates resilience in adults

August 16, 2018
Adversity is part of life: Loved ones die. Soldiers deploy to war. Patients receive terminal diagnoses.

Expecting to learn: Language acquisition in toddlers improved by predictable situations

August 16, 2018
The first few years of a child's life are crucial for learning language, and though scientists know the "when," the "how" is still up for debate. The sheer number of words a child hears is important; that number predicts ...

Men and women show surprising differences in seeing motion

August 16, 2018
Researchers reporting in the journal Current Biology on August 16 have found an unexpected difference between men and women. On average, their studies show, men pick up on visual motion significantly faster than women do.

Stress during pregnancy increases risk of mood disorders for female offspring

August 16, 2018
High maternal levels of the stress hormone cortisol during pregnancy increase anxious and depressive-like behaviors in female offspring at the age of 2, reports a new study in Biological Psychiatry. The effect of elevated ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.