Predictors of First Mental Health Service Utilization among Homeless and Runaway Adolescents

Purpose: To describe and explain variations in first mental health service utilization before and after running away from home for homeless adolescents. Methods: Survey interviews were conducted with homeless and runaway youth in several Midwestern locations. The effects of family of origin factors and street experiences on the likelihood of seeing a mental health professional for the first time before running away and after running away for the first time were examined. Bivariate and multivariate logistic regression methods are used to analyze these data. Interactions are tested across race and gender sub-groups. Results: Caretaker education, caretaker rejection, and family transitions increase the probability that an adolescent first sees a mental health professional before running away from home. Post-run intervention is more likely for females, younger runaways, shelter users, youths with social support networks, and youths abused by their caretakers. A gender gap in first service use exists for Whites but not for minority youth. Minority youth who experienced family abuse were less likely than abused Whites to report ever seeing a mental health professional. Conclusions: Analyses indicate homeless youth’s utilization patterns are differentiated by family of origin factors, street experiences, timing of first utilization, and by race and gender interactions. Our findings suggest that youths whose first contact with mental health service use follows running away for the first time may experience higher levels of mental distress compared with other homeless runaways. The significant differences in first service use across race and gender subgroups should be further explored. The racial-ethnic gap in first mental health intervention for abused youths indicates this sub-group is not receiving services that are available to other homeless youths. Our findings suggest that homelessness does not homogenize racial/ethnic differences in first mental health service utilization

Coercive Sexual Strategies

This study examines the use of coercive sexual strategies by men and the outcomes of these behaviors for women. Using a sample of 541 college undergraduates, data were gathered from men on their use of three types of coercive sexual strategies and from women on their experiences with these same forms of behaviors. For women, there is a positive association between being sexually active, having sexually permissive attitudes, drinking alcohol and being a victim of certain types of sexual coercive strategies. For men, sexually permissive attitudes and attitudes toward rape are found to be significant predictors of their use of verbal coercion. Furthermore, being a fraternity member is associated with the use of verbal coercion and physical force and being a sorority member is associated with being a victim of alcohol/drug coercion and physical force. Reports from both men and women give a more comprehensive interpretation of the specific mechanisms through which different coercive strategies are played out

Coercive Sexual Strategies

This study examines the use of coercive sexual strategies by men and the outcomes of these behaviors for women. Using a sample of 541 college undergraduates, data were gathered from men on their use of three types of coercive sexual strategies and from women on their experiences with these same forms of behaviors. For women, there is a positive association between being sexually active, having sexually permissive attitudes, drinking alcohol and being a victim of certain types of sexual coercive strategies. For men, sexually permissive attitudes and attitudes toward rape are found to be significant predictors of their use of verbal coercion. Furthermore, being a fraternity member is associated with the use of verbal coercion and physical force and being a sorority member is associated with being a victim of alcohol/drug coercion and physical force. Reports from both men and women give a more comprehensive interpretation of the specific mechanisms through which different coercive strategies are played out

A Dimensional Model of Psychopathology Among Homeless Adolescents: Suicidality, Internalizing, and Externalizing Disorders

The present study examined associations among dimensions of suicidality and psychopathology in a sample of 428 homeless adolescents (56.3% female). Confirmatory factor analysis results provided support for a three-factor model in which suicidality (measured with lifetime suicidal ideation and suicide attempts), internalizing disorders (assessed with lifetime diagnoses of major depressive episode and post-traumatic stress disorder), and externalizing disorders (indicated by lifetime diagnoses of conduct disorder, alcohol abuse, and drug abuse) were positively intercorrelated. The findings illustrate the utility of a dimensional approach that integrates suicidality and psychopathology into one model

The Effects of a High-Risk Environment on the Sexual Victimization of Homeless and Runaway Youth

Based on the structural-choice theory of victimization, the current study examines the effects of a high-risk environment on the sexual victimization of 311 homeless and runaway youth. Results from logistic regression revealed that survival sex, gender, and physical appearance were significantly associated with sexual victimization. Results from a series of interactions also revealed that the effects of deviant behaviors on sexual victimization varied by gender and age. Although males and females engaged in similar activities, young women were more likely to be victims of sexual assault. These findings suggest that engaging in high-risk behaviors predispose some people to greater risks but it is the combination of these behaviors with gender and/or age that determines who will become victimized

Familial and “On-the-Street” Risk Factors Associated with Alcohol Use among Homeless and Runaway Adolescents

Objective: This study investigated factors associated with alcohol use among homeless and runaway adolescents, using a risk amplification model.Method: Homeless and runaway adolescents (N = 536, 60% female) were recruited and interviewed by outreach workers directly on the streets, in shelters and in drop-in centers in four Midwestern states. The average age was 16 years; ages ranged from 12 to 22. Results: Parent alcohol problems were indirectly linked to adolescent drinking through familial abuse and its relationship to deviant peers, time on own and risky subsistence behaviors. Parent alcohol problems also predicted offspring alcohol use through parental rejection and its association with deviant peers and with risky subsistence behaviors. The strongest direct effects on alcohol use were hanging out with antisocial friends and participating in deviant behaviors in order to survive on the street. Conclusions: This study sheds light on the nature of alcohol use in a high-risk population. Family background and “on-the-street” (time on own) factors must be taken into consideration when treating alcohol misuse in street youth. The alternative is a vicious cycle whereby homeless youth may become homeless adults

The Effects of a High-Risk Environment on the Sexual Victimization of Homeless and Runaway Youth

Based on the structural-choice theory of victimization, the current study examines the effects of a high-risk environment on the sexual victimization of 311 homeless and runaway youth. Results from logistic regression revealed that survival sex, gender, and physical appearance were significantly associated with sexual victimization. Results from a series of interactions also revealed that the effects of deviant behaviors on sexual victimization varied by gender and age. Although males and females engaged in similar activities, young women were more likely to be victims of sexual assault. These findings suggest that engaging in high-risk behaviors predispose some people to greater risks but it is the combination of these behaviors with gender and/or age that determines who will become victimized

Familial and “On-the-Street” Risk Factors Associated with Alcohol Use among Homeless and Runaway Adolescents

Objective: This study investigated factors associated with alcohol use among homeless and runaway adolescents, using a risk amplification model.Method: Homeless and runaway adolescents (N = 536, 60% female) were recruited and interviewed by outreach workers directly on the streets, in shelters and in drop-in centers in four Midwestern states. The average age was 16 years; ages ranged from 12 to 22. Results: Parent alcohol problems were indirectly linked to adolescent drinking through familial abuse and its relationship to deviant peers, time on own and risky subsistence behaviors. Parent alcohol problems also predicted offspring alcohol use through parental rejection and its association with deviant peers and with risky subsistence behaviors. The strongest direct effects on alcohol use were hanging out with antisocial friends and participating in deviant behaviors in order to survive on the street. Conclusions: This study sheds light on the nature of alcohol use in a high-risk population. Family background and “on-the-street” (time on own) factors must be taken into consideration when treating alcohol misuse in street youth. The alternative is a vicious cycle whereby homeless youth may become homeless adults

Diagnostic Prevalence Rates from Early to Mid Adolescence among Indigenous Adolescents: First Results from a Longitudinal Study

Objective: To investigate change in prevalence rates for mental and substance abuse disorders between early and mid-adolescence among a cohort of indigenous adolescents. Method: The data are from a lagged, sequential study of 651 indigenous adolescents from a single culture in the northern Midwest United States and Canada. At waves 1 (ages 10-12 years) and 4 (ages 13-15 years), one adult caretaker and one tribally enrolled adolescent completed a computer-assisted personal interview that included Diagnostic Interview Schedule for Children- Revised assessment for 11 diagnoses. Multivariate analyses investigate effects of wave 1 adolescent diagnosis and wave 1 biological mother diagnosis (University of Michigan Composite International Diagnostic Interview) on wave 4 diagnostic outcomes. Results: The findings show a increase in prevalence rates for substance abuse disorders and conduct disorders between ages 10 and 12 years and 13 and 15 years among indigenous adolescents, with these disorders affecting more than one fourth of the children. The rate of lifetime conduct disorder is about twice that expected in general population studies (23.4% versus 5%– 10%), and the rate of lifetime substance abuse disorder (27.2%) is three times that reported in the 2004 National Survey on Drug Use and Health (9.4%) for individuals 12 years or older. Prevalence rates for any single mental or substance use disorder (44.8 lifetime) for the 13-to 15-year-olds are similar to the lifetime prevalence rates reported in the National Comorbidity Survey- Replication (46.4%) for individuals 18 years and older. Conclusions: A mental health crisis exists on the indigenous reservations and reserves that participated in this study. Current service systems are overwhelmed and unable to meet the demands placed upon them

Diagnostic Prevalence Rates from Early to Mid Adolescence among Indigenous Adolescents: First Results from a Longitudinal Study

Objective: To investigate change in prevalence rates for mental and substance abuse disorders between early and mid-adolescence among a cohort of indigenous adolescents. Method: The data are from a lagged, sequential study of 651 indigenous adolescents from a single culture in the northern Midwest United States and Canada. At waves 1 (ages 10-12 years) and 4 (ages 13-15 years), one adult caretaker and one tribally enrolled adolescent completed a computer-assisted personal interview that included Diagnostic Interview Schedule for Children- Revised assessment for 11 diagnoses. Multivariate analyses investigate effects of wave 1 adolescent diagnosis and wave 1 biological mother diagnosis (University of Michigan Composite International Diagnostic Interview) on wave 4 diagnostic outcomes. Results: The findings show a increase in prevalence rates for substance abuse disorders and conduct disorders between ages 10 and 12 years and 13 and 15 years among indigenous adolescents, with these disorders affecting more than one fourth of the children. The rate of lifetime conduct disorder is about twice that expected in general population studies (23.4% versus 5%– 10%), and the rate of lifetime substance abuse disorder (27.2%) is three times that reported in the 2004 National Survey on Drug Use and Health (9.4%) for individuals 12 years or older. Prevalence rates for any single mental or substance use disorder (44.8 lifetime) for the 13-to 15-year-olds are similar to the lifetime prevalence rates reported in the National Comorbidity Survey- Replication (46.4%) for individuals 18 years and older. Conclusions: A mental health crisis exists on the indigenous reservations and reserves that participated in this study. Current service systems are overwhelmed and unable to meet the demands placed upon them