Title: A Syndemic Framework of Homelessness Risks Among Women Accessing Medical Services in an Emergency Department in New York City
Description: Objective: Although factors that promote initial and recurring homelessness among inner city women have been long explored, impoverished women continue enter and re-enter shelters at troubling rates. This trend is projected to increase over time. This longitudinal study uses Sydemics as a framework to advance our understanding of the relationship between depression, PTSD, trauma and intimate partner violence and the loss of housing among impoverished women using inner city Emergency Departments. We hypothesized that depression, PTSD, childhood trauma and IPV are positively associated with homelessness at baseline and that women with higher rates of a combination of these variables (e.g. PTSD and IPV) in wave 1 will have higher odds of experiencing both an initial and repeat bout of homelessness in the second and/or third waves, controlling for all other variables in the study. Method: Multivariate analyses and logistic regression, at baseline and longitudinally, were conducted to test study hypotheses with homelessness as the dependent variable.

Six multivariate logistic regression models were used. Odds ratios (OR) with their 95% confidence intervals are reported. Results: Depression and childhood trauma were individually associated with homelessness at the .05 level in this sample of low income women. IPV was marginally related to homelessness (p=0.0917). PTSD however was not. Importantly, although IPV and PSTD were not individually associated with homelessness in bivariate analyses, housed, never homeless women, and women who had previously experienced homelessness had a greater odd of becoming homeless than those who experienced only one of these risk variables. Specifically, housed, never homeless women who had PTSD and IPV had a 2.2 odd of becoming homeless for the first time in waves 2 and 3, whereas those who experienced PTSD only had a 1.3 odds of becoming homeless for the first time; never homeless participants who experienced IPV only a 1.7 greater odds of becoming homeless (CI.0.348, 14.84; p=0.385), adjusting for all other variables.

Similarly, the odd of becoming homeless again among participants who had PTSD and experienced IPV was 1.7 whereas the odds of recurrent homelessness was 1.2 among those who experienced PTSD only and 1.1 among those who experienced IPV only (CI.0.397, 7.46; p=0.463), controlling for all other variables in the study. Conclusion: Our findings confirm our hypotheses that low-income women who have PTSD, depression, histories of childhood trauma, and/or IPV have a higher odds of initial and recurrent homelessness when compared with women who do not have these risk variables. Our findings further confirm that women who have combinations of risk variables have even higher odds of future homelessness. Due to the low sample size of women with histories of homelessness in the study, there was lack of power. Despite this challenge, the results of these explorations (in determining heretofore unidentified effect sizes) utilizing Syndemics as a conceptual framework are promising. Future research with larger sample sizes (and sufficient power) are important to further the initial findings from this study.