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Part I:Select an article from a peer-reviewed journal in your domain. After reading the article, copy and paste it into a document and make annotations in the margin area that address: the situation, the writer’s purpose, the writer’s claim, and the writer’s audience. Refer to the Chapter 2 sections for more guidance: Reading as an Act of Composing: Annotating Reading as a Writer: Analyzing a Text Rhetorically Part II:Using the same article, select one paragraph and perform a rhetorical analysis following guidance from your eTextbook, in the section “Identify the Writer’s Audience,” and the call out box titled “Steps to Analyzing a Text Rhetorically.” Your analysis should be two pages in length. Adhere to APA Style when constructing this entire assignment, including in-text citations and references for all sources that are used.
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International Journal of
Environmental Research
and Public Health
Article
Adverse Childhood Experiences and Depression among
Homeless Young Adults: A Social Determinants of
Health Perspective
Shiyou Wu 1, * , Lac Ta 2 , Jaime Vieira 2 , Kendall Schwartz 2 , Joshua Perez 2 , Justin Zeien 3 , Danyi Li 4
and Jennifer Hartmark-Hill 2
1
2
3
4
*
Citation: Wu, S.; Ta, L.; Vieira, J.;
Schwartz, K.; Perez, J.; Zeien, J.; Li, D.;
Hartmark-Hill, J. Adverse Childhood
Experiences and Depression among
Homeless Young Adults: A Social
Determinants of Health Perspective.
School of Social Work, Arizona State University, Phoenix, AZ 85004, USA
College of Medicine–Phoenix, University of Arizona, Phoenix, AZ 85004, USA; [email protected] (L.T.);
[email protected] (J.V.); [email protected] (K.S.); [email protected] (J.P.);
[email protected] (J.H.-H.)
Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; [email protected]
Keck School of Medicine Preventive Medicine, University of Southern California,
Los Angeles, CA 90032, USA; [email protected]
Correspondence: [email protected]
Abstract: Homelessness is a pervasive issue in the United States that presents significant challenges
to public health. Homeless young adults (HYAs) are at particular risk for increased incidence and
severity of depression. Using primary survey data (n = 205) collected in the Phoenix Metropolitan
Area, Arizona, from June to August 2022, this study aims to examine the relationship between
adverse childhood experiences (ACEs) and depression among HYAs. We adopted the ACEs 10-item
scale to measure childhood traumatic experiences, whereas depression was measured by using a
PHQ-4 depression scale and diagnosed depression. Regression models were conducted to test the
relationships between ACEs and depression outcomes while controlling for the covariates at the
individual, interpersonal, and socioeconomic/living environment levels. The average PHQ-4 score
was 5.01 (SD = 3.59), and 59.69% of HYAs reported being diagnosed previously with depression.
The mean ACEs score was 5.22 out of 10. Other things being equal, for every one unit increase
in ACEs scores, the odds of being diagnosed with depression increased by 11.5%, yet it was not
statistically significant, while the PHQ-4 score increased by 0.445 (p < 0.001). Overall, HYAs were
disproportionately affected by depression. This study elucidates the complex relationship between
ACEs and depression among HYAs.
Int. J. Environ. Res. Public Health 2024,
21, 81. https://doi.org/10.3390/
ijerph21010081
Keywords: adverse childhood experiences (ACEs); depression; social determinants of health;
homeless; young adults; PHQ-4
Academic Editor: Paul B.
Tchounwou
Received: 25 November 2023
1. Introduction
Revised: 2 January 2024
Homelessness is a pervasive, expanding issue in the United States that presents significant challenges to public health and social welfare [1]. People experiencing homelessness
are more likely to be victims of violent crime and struggle with substance abuse disorders
and untreated health issues, which can limit their access to social services [2]. Additionally,
people experiencing homelessness may have fewer educational and job opportunities and
may feel socially isolated [3]. The combination of these challenges can make it difficult
for homeless individuals to break out of the cycle of homelessness and achieve stability
and improved well-being. This study aims to investigate the risk and protective factors of
depression among homeless population, and specifically focus on the associations between
traumatic events experienced before the age of 18 (i.e., adverse childhood experiences
[ACEs]) and depression among homeless young adults.
In 2022, the Annual Homeless Assessment Report to Congress from the Department
of Housing and Urban Development demonstrated that an alarming number of people
Accepted: 8 January 2024
Published: 11 January 2024
Copyright: © 2024 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Int. J. Environ. Res. Public Health 2024, 21, 81. https://doi.org/10.3390/ijerph21010081
https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2024, 21, 81
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in the United States—approximately 582,000, or 18 out of every 10,000—experienced
homelessness of at least one night’s duration [4]. According to the same report, Arizona
ranks fifth in the nation for homelessness per capita and is currently experiencing the fifth
fastest growing rate of homelessness relative to all other states. In addition, homelessness in
Arizona youth populations has increased by nearly 45% between 2020 and 2022 [4]. Overall,
these statistics necessitate further investigation into the root causes and contributing factors
for homelessness in young adults.
Young adulthood is a critical period of physical, social, emotional, mental, and cognitive development [5–7]. Young adults make significant choices about their health behaviors,
attitudes, and habits, which can have lasting effects over their lifetime [8]. Trauma, whether
physical, mental, or psychosocial, that occurs during this timeframe can lead to changes in
brain chemistry and neural connections, with consequential implications for future chronic
illnesses. Furthermore, it is suggested that homelessness can increase all-cause mortality
and decrease life expectancies by up to 30 years (average 42–52 years old) compared to
those not experiencing homelessness [9–11].
The causes of homelessness among young adults are complex and varied [12–15].
Homeless young adults’ behaviors are influenced by factors across multiple domains
(e.g., individual, interpersonal, and institutional levels), as understood from a social determinants of health (SDoH) framework [16,17]. This framework suggests that good health is
produced by the complex interrelationships of genetic make-up, age, gender, behavioral factors, social determinants, and other environmental factors. An increasing number of studies
have demonstrated a significant impact of social influences on an individual’s health status.
Among other factors, SDoH include quality of housing, suitability of work, and access to
healthcare and social welfare services [17–19]. These resource gaps can contribute to poor
health [20].
1.1. Homelessness and Depression
Depression is a complex pathology that is associated with a spectrum of difficulties that
interfere with daily life and activities [21]. It is important to note that current prevalence and
incidence rates of depression may not accurately reflect true depression rates seen in young
people [22]. Several challenges exist that inhibit individuals from finding help, including
limited supply of mental health providers, limited access to care, and prohibitive costs of
care [23]. Furthermore, it is likely that the recent COVID-19 pandemic has exacerbated
this problem. Young adults lost many protective factors against depression including
socialization, working opportunities, in-person activities, and environmental protective
factors such as sunlight, exercise, and diet [24]. Additionally, they may have been exposed
to increased risk factors such as toxic home environments and limited healthcare access.
The totality of these complications, among others, makes data that accurately reflects the
contemporary landscape of mental health near impossible to come by.
Previous research has suggested an increased prevalence of depressed mood in Hispanic and Black young adults when compared to White and Asian young adults [25].
This may be attributed to poorer educational prospects and problematic relationships [25].
Furthermore, minoritized populations may be less likely to utilize mental health services,
worsening outcomes for these populations [26]. Females are also at increased risk for
depression, especially in adolescence and young adulthood [27]. It is noteworthy that this
discrepancy begins around the age of puberty.
Community-level stressors also play a significant role in depression. Factors with
measured associations include poverty or violent neighborhoods, homelessness, and
refugees/displacement [28]. Further, access to proper medical and mental healthcare
may be limited, and resources may be instead spent on basic necessities of living [29].
While there is a genetic component to depression, its development and severity is heavily
influenced by environmental factors, including demographics, that predispose people to
constant stressors, significantly altering depression’s prevalence and severity [30]. This
Int. J. Environ. Res. Public Health 2024, 21, 81
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concept is of particular relevance when observing populations who face some level of
social marginalization.
The aforementioned demographic factors set the context for why homeless young
adults are at particular risk for increased incidence and severity of depression. Homeless
young adults are disproportionately made up of ethnic minorities, such as Blacks and
Hispanics, and tend to come from impoverished backgrounds and face more stressors
during development [31]. Add in the societal stigma tied to housing status within the
United States, and the positionality of young adults experiencing homelessness becomes all
the more complex. One way to bring clarity to the complexity associated with the homeless
young adult demographic is through the use of adverse childhood experiences (ACEs)
scores, which can help quantify the impact of the aforementioned stressors.
1.2. ACEs and Depression among Young Adults
ACEs are potentially traumatic events experienced between the ages of 0 and 17 that
are demonstrated to negatively impact future health outcomes [32,33]. These experiences
are divided into two categories: abuse and household dysfunction [33]. The research
literature demonstrates a strong dose–response relationship between higher ACEs scores
and increased risky health behaviors (e.g., smoking, drug use, physical inactivity, and
risky sexual behavior), adverse health outcomes (e.g., liver disease, chronic lung disease,
kidney disease, and arthritis), and psychosocial/behavioral measures (e.g., interpersonal
violence, suicidal ideation, depressed mood, and behavior problems) [33–36]. Of note,
ACEs scores higher than four are considered high risk, whereas ACEs scores of 1–3 are
considered intermediate risk unless associated with other health conditions which raise the
level of concern to high risk [37]. Similar to other SDoH, ACEs scores are also experienced
in higher frequencies by individuals who identify as female, non-white, LGBTQIA+, of
lower education level, and of lower socioeconomic status [34,38]. When further evaluating
age discrepancies, one study found all correlates of ACEs scores to be higher in younger
populations (ages 18–34), except for depression which was highest in the oldest population [39]. Studies that further divide this age group found those ages 25–34 had the highest
scores [36,38]. In young adults, ACEs scores are correlated with mental health disorders
including an increased risk of suicidal ideation [40] and depression [40–42].
Individuals experiencing homelessness struggle with a multitude of the aforementioned challenges; however, evaluating the past experiences of these individuals may
provide further insight into the current morbidities they face. Consistent with other
measures of health, ACEs scores are unsurprisingly elevated in individuals experiencing
homelessness [43–45]. Additionally, although not based on the specific ACEs questionnaire
developed by Felitti et al. [33], Herman et al. found that individuals experiencing homelessness had much higher rates of experiencing the ACEs of lack of parental care, physical
abuse, and lack of parental care in tandem with either physical or sexual abuse compared to
their housed counterparts [46]. While prevalence varies by study, some of the most common
ACEs experienced by those that are experiencing homelessness include physical abuse,
physical neglect, general household dysfunction, and emotional abuse [44,47]. Prevalence
of ACEs scores amongst the homeless population is estimated to be 89.8% of individuals
experiencing at least one ACE, and 53.9% experiencing four or more ACEs with significant
associations with depression, suicidality, substance misuse, and victimization [45]. Sexual
abuse is also prominent, with one study reporting 45% of women experiencing this form of
abuse [44] and another study citing 33% of all participants experiencing sexual abuse [47].
Liu et al. found an average ACEs score of 4.1 for a homeless population in Canada, which
is much higher than the aforementioned average, although the former was measured in the
U.S. population [47]. Comparatively, in a study of indigenous individuals experiencing
homelessness, the average ACEs score was 6.06 with 82% of individuals experiencing four
or more ACEs [48]. Interestingly, this study found no significant differences between ACEs
scores and health outcomes with the exception of an association between higher ACEs
scores and mental illness [48].
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Similar to the general population, ACEs are also predictive of poor mental health in
those experiencing homelessness [44,45,47,48]. Roos et al. found a significant association between Axis I and Axis II Disorders (categorized in the DSM-IV as Mental Health/Substance
Abuse and Personality Disorders/Mental Retardation, respectively, and have since been removed in the DSM-V) and ACEs scores with these disorders having a mediator effect on the
risk of lifetime homelessness, although ACEs alone were also predictive [44]. ACEs scores
are associated with a broad range of psychiatric disorders in the homeless population such
as PTSD, mood disorder with psychotic features, depression, suicidality, and substance
dependence [47,49,50]. However, depression more specifically has demonstrated mixed
results with some studies reporting significant associations with total ACEs score [49,50],
and others finding no relationship [47]. Additionally, no study to our knowledge specifically examines depression in regard to ACEs scores in a young homeless population. To
address this literature gap, this study will use first-hand data to explore the mechanisms
underlying the relationship between ACEs and depression among homeless young adults.
2. Materials and Methods
2.1. Survey and Sample
The current study uses survey data from the Social Determinants of Health among
Homeless Young Adults (SDoH-HYA) pilot project in the Phoenix, Arizona metropolitan
area. The metropolitan Phoenix area is defined as the downtown area of Phoenix and
its surrounding cities, such as Chandler and Mesa. Survey sites consist of areas where
community outreach partners provide services, including Street Medicine Phoenix, Salvation Army Chandler, Grace Lutheran Church (Phoenix), Phoenix Rescue Mission, and
Solutions of Sobriety. In addition, we collected data at some Phoenix Heat Relief Network
cooling center sites (e.g., Tumbleweed park, downtown Phoenix, and Chandler library),
the Maricopa County Human Services Campus, and the surrounding encampments. Survey administrators included graduate students from Arizona State University (ASU) and
medical students from the University of Arizona College of Medicine, Phoenix.
Participants were recruited at various aforementioned survey sites on variable days of
the week from June to August 2022. For inclusion in the survey, we screened participants
to find individuals who identified as homeless (i.e., a person who does not have a fixed,
regular, and adequate nighttime residence), either sheltered or unsheltered, and were
between the ages of 18 and 34. This study was reviewed and approved by the Arizona
State University Institutional Review Board. Potential adult participants were identified
and recruited at survey sites on varying days of the week, typically during the morning to
early afternoon.
A total of 205 participants completed the survey, utilizing both paper and online surveys. The SDoH-HYA survey was developed by researchers from ASU as a comprehensive
tool to collect data regarding the social determinants of health based on the theoretical
framework of the wider determinants of health model [17,51]. The questionnaire items
were reviewed and categorized into four domains: (a) individual characteristics, (b) individual health-related factors, (c) interpersonal/relationship to community resources, and
(d) societal, policy, and governmental factors. Prior to the administration of the survey, participants were read the IRB-approved consent script and screened based on two questions:
“How old are you?” and “Do you agree to participate in this study?” All of the survey
participants were informed that the survey was voluntary, anonymous, would not affect
services in any way, and that they could stop at any time during the survey process. On
average, participants completed the survey within 45 min. Participants who completed the
survey were offered a USD 20 gift card to local restaurants/services.
2.2. Measures
Dependent variables of depression. The dependent variables were measured as
two dimensions of depression among homeless young adults: self-report depression scores
and diagnosed depression. We examined self-reports of depression based on the PHQ-4
Int. J. Environ. Res. Public Health 2024, 21, 81
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depression scale score [52]. This scale is composed of four items that ask respondents to rate
how often they are bothered by “feeling nervous, anxious, or on edge”, “worrying”, “little
interest or pleasure in doing things”, and “feeling down, depressed, or hopeless” over the
last two weeks. Responses to the items were captured using a 4-point (0 to 3) scale, with
higher scores indicating a greater number of days feeling bothered by the aforementioned
problems. Responses for the four items were summed, with higher values indicating a greater
severity of depression (normal [0–2], mild [3–5], moderate [6–8], and severe [9–12]) [52]. The
PHQ-4 scale also has good internal consistency based on SDoH-HYA data, with an overall
Cronbach’s alpha of 0.80.
The variable of diagnosed depression was measured by asking the participants
whether they had ever been clinically diagnosed with depression by a doctor, nurse practitioner, or other healthcare professional. It was treated as a dichotomous variable (Yes = 1,
No = 0).
Variable of interest: ACEs. This study aims to examine the relationship between
ACEs and depression among homeless young adults. We adopted the ACEs 10-item scale
to measure childhood traumatic experiences [33] including physical abuse, verbal abuse,
sexual abuse, physical neglect, and emotional neglect. In addition, the ACEs scale asks
participants about family, such as a parent who’s an alcoholic, a mother who’s a victim
of domestic violence, a family member in jail, a family member diagnosed with a mental
illness, and the disappearance of a parent through divorce, death or abandonment. Each of
the ACEs was dummy coded (Yes = 1, No = 0). Responses for the 10 items were summed,
with higher values indicating a greater severity of childhood traumatic experiences. The
ACEs scale has good internal consistency based on SDoH-HYA data, with an overall
Cronbach’s alpha of 0.82.
Measures of covariates. For this study, based on the wider determinants of health
framework [51], we controlled for covariates from demographics, interpersonal, and socioeconomic/living environment levels (see detailed measurement information in Table 1).
At the individual characteristic level, we included participants’ demographic information: age, gender identity, sexual orientation, race/ethnicity, marital status, employment
status, and the highest level of education completed. We also recorded how many children
study participants have, and any children currently living with them.
At the interpersonal and community level, we examined whether participants keep
in touch with their support system (friends/family), regularly attend religious services,
use social media, have experienced domestic violence (defined as any violence from an
intimate partner), have a criminal history, and if they consider themselves to be homeless.
At the socioeconomic/living environment levels, we examined whether participants felt
they have sufficient income, whether aging out of foster care caused them to be homeless,
whether they have enough food to eat, have health insurance, can access transportation
to go anywhere they want to, have Internet access, have a smartphone to use, feel the
available support services are adequate, experienced discrimination as a homeless person,
and whether they can get the help that they need.
2.3. Analytic Strategies
Descriptive statistics were conducted to illustrate the sample characteristics
(see Table 1). To understand the extent to which ACEs and depression outcomes were
related while controlling for the covariates at the individual, interpersonal, and socioeconomic/living environment levels, logistic regression was used for the diagnosed depression
outcome whereas ordinary least squares (OLS) regression was used for the self-reported
depression score outcomes. A listwise deletion approach was used to handle the missing
data. Stata 15.0 was used to conduct the data analyses.
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Table 1. Sample descriptive statistics.
(1)Variables
Dependent Variables
PHQ-4 for depression
Normal/minimal depression
Mild depression
Moderate depression
Severe depression
Depression diagnosis
Variable of interest
Adverse childhood experiences (ACEs)
Covariates
Demographics
Age
Gender identity
Sexual orientation
Race/Ethnicity
White
Black
Latinx
Native American
Mixed or other
Marital Status
Married or in-relationship
Divorced or separated
Never married
Employment Status
Fully employed
Part-time job
Not employed but looking for job
Not employed and unable to work
Education
Less than high school
High school
Some college and higher
Have child/children
Living with child/children
Interpersonal
Family and friends support
Attend religious services
Use social media
Domestic violence
Criminal history
Self-perception as homeless
Socioeconomic/Living Environment
Sufficient income
Aged out of foster care
Enough food to eat
Have health insurance
Can go anywhere (transportation)
Had internet Access
Had smartphone
Adequate support services
Social discrimination
Can get help
(2) Measures
(3) Mean/%
(4) SD
Total score (0–12)
Score 0–2 on PHQ-4
Score 3–5 on PHQ-4
Score 6–8 on PHQ-4
Score 9–12 on PHQ-4
Yes = 1; no = 0
5.01
29.27%
22.93%
30.73%
17.07%
59.69%
3.59
Total score (0–10)
5.22
2.97
By year (18–34)
Male = 1; female = 0
Straight = 1; others = 0
29.06
66.67%
83.42%
4.5
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
31.71%
13.17%
14.15%
22.93%
18.05%
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
18.32%
18.32%
63.37%
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
9.05%
13.57%
42.71%
34.67%
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
24.87%
58.03%
17.10%
49.27%
8.78%
Yes = 1; no = 0
54.95%
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
29.06%
78.92%
56.86%
48.98%
64.39%
Yes = 1; no = 0
17.07%
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
Yes = 1; no = 0
7.80%
38.92%
88.00%
53.92%
64.71%
62.25%
63.68%
42.08%
79.70%
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3. Results
3.1. Descriptive Statistics
As shown in Table 1, based on respondents’ reported depression symptoms over the
past two weeks using the PHQ-4 scale, the average score was 5.01 (SD = 3.59) out of a total
of 12. Specifically, about 29.27% of participants’ scores indicated a normal (0–2) depression
status, 22.93% indicated mild (3–5) severity of depression, 30.73% indicated moderate
(6–8) severity of depression, and 17.07% indicated severe (9–12) severity of depression.
Meanwhile, 59.69% of respondents reported being diagnosed previously with depression.
For this study, we were most interested in the relationship between depression outcomes
and ACEs; the average score among our participants for the ACEs questionnaire was
5.22 (±2.97) out of a total of 10.
Overall, the average age of participants was 29.06 years old (±4.5 years) and the
majority identified as male (66.67%). There were 16.58% of participants who identified as
LGTBQIA+. The largest racial/ethnic group was White, non-Hispanic, followed by Native
American and mixed race or other. The majority of participants had never married (63.37%)
and have a high school diploma or GED (58.03%). In regard to employment status, only
9.05% have a full-time job while most are not employed but are looking for a job (42.71%).
Nearly half have at least one child but only 8.87% are currently living with their child(ren).
We found that more than half of the participants try to keep in touch with their support
system, such as friends and family. About one-third attend religious services regularly and
a vast majority use social media of some kind. Domestic violence, defined as any violence
from an intimate partner, was common for our participants (56.86%). Nearly half have a
criminal history, such as history of incarceration, arrest, or accused of a crime. Only 64.39%
consider themselves to be homeless.
Only 17.07% reported having enough sufficient income to support themselves and
only 38.92% reported having enough food to eat. Of the reasons for becoming unstably
housed or homeless, a few listed “aged out of foster care” as a reason (7.80%). Almost
9 in 10 participants have health insurance of some kind. Slightly more than half had the
freedom to go anywhere that they want to and a majority had Internet access as well as
a smartphone. Most participants felt that the support services that are available to them
are adequate to meet their needs (63.68%). Slightly less than half of participants faced
discrimination of some kind due to their perceived status as homeless. Many reported that
they are able to access help if they need it (79.70%).
3.2. Relationship between ACEs and Depression
Table 2 shows the two sets of regression results of testing the relationship between
ACEs and depression outcomes, while controlling for all the covariates from the individual,
interpersonal, and socioeconomic/living environment levels. Table 2, Column (a) shows
the logistic regression results of the diagnosed depression outcome. Other things being
equal, for every one unit increase in ACEs scores, the predicted odds of being diagnosed
with depression increased by 11.5%, yet it was not statistically significant. Table 2, Column
(b) shows the OLS regression results of PHQ-4 total depression scores. The results indicated
that other things being equal, for every one unit increase in the ACEs score, the depression
score increased by 0.445 (p < 0.001).
For the individual-level demographic covariates, results showed that males had
lower odds of being diagnosed with depression (OR = 0.174, p = 0.005) and lower selfreported depression scores than females. Homeless young adults who identified themselves as straight/heterosexual had significantly lower odds of being diagnosed with
depression (OR = 0.043, p = 0.001) and lower self-reported depression scores (B = −1.214,
p = 0.018) than LGBTQIA+ peers. As compared with White homeless young adults, Latinx
(OR = 10.818, p = 0.035), Native American (OR = 11.204, p < 0.001), and multi-racial or other
race group (OR = 5.771, p = 0.001) participants had significantly higher odds of being diagnosed with depression. However, only Native American (B = 0.15, p = 0.030) participants
reported significantly higher depression scores than White participants. In addition, as
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compared with married homeless young adults or those in a relationship, those who were
divorced or separated from partners (OR = 5.44, p = 0.03) or never married (OR = 4.185,
p = 0.003) had significantly higher odds of being diagnosed with depression. Compared
with full-time employed participants, those who were part-time employed (OR = 0.008,
p < 0.001) or not employed and unable to work (OR = 0.035, p < 0.001) had significantly
lower odds of being diagnosed with depression. Results also showed that homeless young
adults that had children indicated significantly higher odds of being diagnosed with depression (OR = 3.877, p = 0.006), whereas those living with their children had significantly
lower odds of being diagnosed with depression (OR = 0.064, p < 0.001).
Table 2. Regression results of ACEs and depression.
Variables
(a) Diagnosed Depression
Variable of interest
ACEs
Covariates
Demographics
Age
Gender identity (Male = 1)
Sexual orientation (Straight = 1)
Race/Ethnicity (ref. = White)
Black
Latinx
Native American
Mixed or other
Marital Status (ref. = married or in relationship)
Divorced or separated
Never married
Employment status (ref. = full-time job)
Part-time job
Not employed but looking for job
Not employed and unable to work
Education (ref. = some college or higher)
Less than high school
High school
Have child/children
Living with child/children
Interpersonal
Family and friends support
Attend religious services
Domestic violence
Use social media
Criminal history
Self-perception as homeless
Socioeconomic/Living environment
Sufficient income
Aged out of foster care
Enough food to eat
Have health insurance
Can go anywhere (transportation)
Had Internet access
Had smartphone
Adequate support services
Social discrimination
Can get help
Constant
(b) PHQ-4 Total Scores
OR
[95% CI]
p
Coef.
[95% CI]
p
1.115
[0.970, 1.281]
0.125
0.433
[0.271, 0.595]
0.000
0.916
0.174
0.043
[0.765, 1.097]
[0.052, 0.589]
[0.007, 0.279]
0.342
0.005
0.001
−0.025
1.014
−1.192
[−0.193, 0.144]
[−0.359, 2.387]
[−2.274, −0.110]
0.753
0.133
0.033
0.300
10.818
11.204
5.771
[0.041, 2.214]
[1.181, 99.071]
[3.352, 37.449]
[2.083, 15.988]
0.238
0.035
0.000
0.001
0.998
0.950
1.277
0.646
−[1.852, 3.849]
[−0.037, 1.936]
[0.252, 2.302]
[−0.888, 2.179
0.460
0.058
0.019
0.377
5.440
4.185
[1.305, 22.667]
[1.638, 10.696]
0.020
0.003
1.007
0.063
[−1.006, 3.020]
[−0.808, 0.933]
0.297
0.878
0.008
0.246
0.035
[0.001, 0.054]
[0.016, 3.668]
[0.005, 0.228]
0.000
0.309
0.000
−0.244
1.027
1.529
[−3.785, 3.298]
[−1.874, 3.928]
[−1.286, 4.345]
0.883
0.455
0.260
0.741
0.594
3.877
0.064
[0.303, 1.816]
[0.183, 1.922]
[1.481, 10.149]
[0.019, 0.210]
0.513
0.384
0.006
0.000
−0.676
0.247
−0.131
−0.499
[−2.361, 1.010]
[−1.382, 1.877]
[−1.523, 1.260]
[−3.114, 2.117]
0.399
0.746
0.840
0.685
2.823
2.362
2.423
1.182
2.693
1.339
[0.698, 11.412]
[0.463, 12.047]
[0.444, 13.222]
[0.241, 5.792]
[1.485, 4.884]
[0.412, 4.354]
0.145
0.301
0.307
0.836
0.001
0.628
−1.061
0.591
0.357
−0.385
−0.044
1.057
[−2.254, 0.133]
[−1.914, 3.096]
[−0.443, 1.158]
[−1.837, 1.068]
[−1.191, 1.103]
[−0.005, 2.120]
0.077
0.617
0.350
0.575
0.934
0.051
0.747
2.565
0.347
5.998
1.223
0.049
1.036
6.007
2.369
0.369
57.870
[0.191, 2.922]
[0.070, 93.908]
[0.239, 0.506]
[0.875, 41.142]
[0.365, 4.098]
[0.017, 0.141]
[0.418, 2.568]
[2.521, 14.314]
[0.761, 7.377]
[0.024, 5.559]
[1.963, 1706.1]
0.676
0.608
0.000
0.068
0.744
0.000
0.940
0.000
0.137
0.471
0.019
1.054
0.342
−0.432
1.778
−0.149
0.650
−0.867
−0.605
0.733
−1.147
1.391
[−0.444, 2.552]
[−1.175, 1.860]
[−2.170, 1.306]
[−0.215, 3.770]
[−1.299, 1.001]
[−0.484, 1.783]
[−1.774, 0.039]
[−1.467, 0.257]
[−0.819, 2.285]
[−2.546, 0.253]
[−5.159, 7.941]
0.151
0.632
0.598
0.076
0.782
0.236
0.059
0.152
0.324
0.100
0.652
Notes: OR: odds ratio, CI: confidence interval, significant ORs (p < 0.05) were in bold.
Regarding the interpersonal level covariates, results only showed that participants
who had criminal history had significantly higher odds of being diagnosed with depression
(OR = 2.693, p = 0.001). For socioeconomic and living environmental factors, homeless
young adults who had enough food to eat (OR = 0.347, p < 0.001) and had Internet access
(OR = 0.049, p < 0.001) showed significantly lower odds of being diagnosed with depression,
compared with their counterparts. However, participants who reported that they had
Int. J. Environ. Res. Public Health 2024, 21, 81
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adequate support services had significantly higher odds of being diagnosed with depression
(OR = 6.007, p < 0.001).
4. Discussion
This study adds further evidence to the research lite
