Mental health problems of homeless children and families: longitudinal study

British Medical Journal, March 21, 1998 by Panos Vostanis, Eleanor Grattan, Stuart Cumella

Introduction

Following research on the health problems of single adult homeless people, there has been interest in the characteristics and needs of homeless children and their families, who constitute a different and rapidly growing population.[1] At any one time, at least 60 000 families, with between 140 000 and 170 000 children, are defined as homeless by local authorities in England.[2, 3] In addition, the number of single homeless teenagers living on the streets is increasing, as is the number of homeless families living with friends and relatives or in squats.

The causes of homelessness in this group are diverse: many are victims of domestic violence,[4] and the group also includes refugee families, mainly in the London area.[5] Homeless children are significantly more likely than the general population, or comparison children in stable housing, to have delayed development,[6] learning difficulties,[7] and higher rates of mental health problems (behavioural problems such as sleep disturbance, eating problems, aggression, and overactivity, and emotional problems such as depression, anxiety, and self harm).[6, 8-10] Such problems are not specific to homeless families. They occur in other families living in adversity and have been found to be related to adverse life events that precipitate homelessness--for example, family breakdown, abuse, exposure to domestic violence, and poor social networks.[10]

Because many homeless families have changed address frequently or urgently, they are less likely than the rest of the population to be registered with a general practitioner. This reduces their access to primary and secondary medical care, as well as to immunisations and other preventive health procedures. Homeless families therefore tend to rely on accident and emergency departments for medical treatment, and they have high rates of hospital admission.[11] To date, there has been no research on the long term impact of homelessness on the mental health of children and their families. This cross sectional longitudinal study was designed to establish the extent of mental health problems among homeless children and their parents one year after rehousing by the local authority.

Subjects and methods

Subjects

Subjects were selected from a sample described in an earlier cross sectional study on homeless families.[10] This included 113 homeless families who had applied for rehousing to the City of Birmingham's housing department and who had been admitted to the seven homeless centres managed by the department over one year. These were initially interviewed within two weeks of becoming homeless and being admitted to the hostel. A comparison group of 29 housed, low income families had been selected from two schools where homeless children attended at the time, by random selection from the school list All families were of socioeconomic class V.[12] A relatively small comparison sample was selected because of the expected "homogeneity" (low variance of family and social variables) in a stable community population. Parents were asked to give informed consent, after approval by two local research ethics committees.

Our study was conducted one year after the initial assessment of both groups. Homeless families had already given consent to be contacted at follow up, and their new address was sought from the housing department. Although only seven families (6%) refused to be interviewed again at this stage, a substantial proportion (40 families, 35%) had already moved from their follow up address and were untraceable, and 8 (7%) had left the centre before being rehoused by the local authority. At one year, we interviewed 58 families (51% of initial sample) with 103 children aged 2-16 years who were in housing and constituted the study group, and 21 comparison families (72% of initial sample) with 56 children aged 2-16 years. Families lost to follow up did not differ from those interviewed at one year in regard to family composition, demographic factors, or reasons for becoming homeless. Children younger than 2 years were not included because there is no reliable way of establishing behavioural and emotional problems for such a young age group. Because of the small number of fathers involved at intake[10] and follow up (table 1), data analysis was confined to mothers. All comparison families interviewed at follow up had remained in the same residence over the 12 month period.

Table 1 Characteristics of homeless families (one year after
rehousing) and of low income families stable housing

                              Rehoused       Comparison
Characteristic                (n=58)         (n=21)

No (%) single mothers         40 (69)         7 (33)
No (%) two parent
 families                     18 (31)        14 (66)
Median (range) No of
 children                      2 (1-5)        3 (1-7)
Mean (range) age of
 mother (years)               31 (20-44)   32.4 (26-46)
Mean (range) age of
 children (years)            8.5 (3-16)     9.4 (3-16)
No (%) boys                   54 (52)        28 (52)

Mother's ethnic group:

White                         48 (83)        14 (67)
Afro-Caribbean                 6 (10)         2 (10)
Asian                          4 (7)          5 (24)

Mother's occupation:

Unemployed                    47 (81)        14 (67)
Full time work                 1 (2)          2 (10)
Part time work                 7 (12)         5 (24)
Full time education            3 (5)          0

Characteristic               Difference

No (%) single mothers     [chi square] = 21.2, P [is less
                           than] 0.001
No (%) two parent         [chi square] = 21.2, P [is less
 families                 than] 0.001
Median (range) No of
 children                 t=1.1, NS
Mean (range) age of
 mother (years)           t=1.1, NS
Mean (range) age of
 children (years)         t=1.7, NS
No (%) boys               [chi square] = 0.005, NS

Mother's ethnic group:

White                     [chi square] = 7.7, P = 0.02
Afro-Caribbean            [chi square] = 7.7, P = 0.02
Asian                     [chi square] = 7.7, P = 0.02

Mother's occupation:

Unemployed                [chi square] = 6.5, NS
Full time work            [chi square] = 6.5, NS
Part time work            [chi square] = 6.5, NS
Full time education       [chi square] = 6.5, NS