摘要：Objectives. We estimated the effects of maternal depression during the postpartum year, which is often an unexpected event, on subsequent homelessness and risk of homelessness in a national sample of urban, mostly low-income mothers. Methods. We used logistic regression models to estimate associations between maternal depression during the postpartum year and both homelessness and risk of homelessness 2 to 3 years later, controlling for maternal and family history of depression, prenatal housing problems, and other covariates. Risk factors for homelessness included experiencing evictions or frequent moves and moving in with family or friends and not paying rent. Results. We found robust associations between maternal depression during the postpartum year and subsequent homelessness and risk of homelessness, even among mothers who had no history of mental illness, whose own mothers did not have a history of depressive symptoms, and who had no previous housing problems. Conclusions. This study provides robust evidence that maternal mental illness places families with young children at risk for homelessness, contributes to the scant literature elucidating directional and causal links between mental illness and homelessness, and contributes to a stagnant but important literature on family homelessness. Homelessness is a significant and often glaring social problem in the United States, particularly in urban areas. 1 A 2012 point-in-time assessment revealed that there were more than 600 000 homeless people in the country, among whom 38% were members of families with children. 2 In 2011, more than 500 000 individuals in families used emergency housing at least once, representing an increase of almost 14% since 2007. 2 Although most homeless individuals are single male adults, children and families make up a larger percentage of homeless individuals today than they did in the past. 1 One study of annual prevalence rates (rather than point-in-time measurements) revealed a higher risk of sheltered homelessness among young children than among men in the 1990s. 3 Recent data show that 1.6 million children (1 in 45) experienced homelessness in the United States during 2010. 4 A recent systematic review showed that studies of family homelessness have been on the wane despite the fact that the problem has been worsening. 5 The federal government recently broadened the official definition of homelessness to recognize and serve individuals and families previously not considered homeless but who are at risk. The 2009 Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act (Pub L No. 111-22) expanded the definition of homelessness to include the “imminently homeless,” outlining several categories under which one can qualify for homelessness assistance. These categories include experiences such as eviction, residential instability, and not having one’s own home. 6 A recent study showed that 3% of mothers with young children experienced homelessness in the preceding 12 months but that a much larger share (10%) experienced evictions, multiple moves, and doubling up with family or friends without paying rent or sharing living quarters with an adult other than a spouse or partner. 7 Homelessness is strongly associated with mental illness. According to the US Department of Housing and Urban Development, 29% of homeless adults in the United States suffer from some disabling form of mental illness, 2 and data from the Substance Abuse and Mental Health Services Administration indicate that 6% of American women are afflicted with a serious mental illness. 8 More refined mental illness prevalence data (e.g., among women or mothers) allowing comparisons between homeless and nonhomeless individuals in the United States are scarce, and existing published figures are based on small or very specific samples. Most existing studies exploring links between mental illness and homelessness were based on data from the 1980s and 1990s or did not focus on women or families. This literature reveals strong positive associations between mental illness and homelessness. 9–13 Robertson and Winkleby synthesized and critically reviewed studies focusing specifically on women and found that the literature was largely cross sectional and descriptive. 14 Some studies produced evidence of increases in mental illness among homeless mothers in the 1980s and 1990s 15,16 and pointed to inadequate availability of community-based mental health services as an exacerbating factor. 15–17 Recent studies provide evidence that mental illness is associated with subsequent family homelessness, 18,19 although it is difficult to rule out that the observed associations reflect unobserved confounding factors. Overall, it is widely assumed that homelessness and mental illness are linked and that the connections may be bidirectional. However, there is little strong evidence of causal links in either direction. Furthermore, more research on mental illness and family homelessness is needed. We addressed these gaps by estimating the effects of a form of mental illness that is often unexpected and has a known timing of onset—depression during the postpartum year—on subsequent homelessness in a national sample of urban, mostly low-income, childbearing women. We estimated effects among mothers overall as well as among subgroups of mothers with no prenatal history of mental illness, whose own mothers had no history of depressive symptoms, and who had not experienced housing problems or homelessness prior to the episode of mental illness. In the spirit of the HEARTH Act, we considered both homelessness itself and risk of homelessness as outcomes.
