A DECADE OF DECLINE: PHYSICAL AND MENTAL HEALTH OF HOMELESS MOTHERS WORSENS BETWEEN 1993 AND 2003 
Findings have implications for service providers and shelter programs throughout the country 

July 18, 2006 

WORCESTER, Mass. - The perils faced by homeless women and their children are numerous and well known. Estimates suggest that each year more than 400,000 families are homeless; placing nearly one million children at risk of compromised developmental and behavioral outcomes. From hunger to violence, these most vulnerable of citizens face daily serious threats to health and wellbeing. While the more immediate emotional, financial and physical effects of many of these threats have been studied, researchers at the University of Massachusetts Medical School have completed a comparative study of homeless families in 1993 and 2003 and found that homeless mothers interviewed in 2003 were not only poorer but also experienced more physical health limitations, major depressive illness and posttraumatic stress disorder than those interviewed in 1993.  

In "A Comparison of Homeless Mothers in Worcester, Massachusetts: 1993 vs. 2003," which will be published in the August issue of the American Journal of Public Health (the paper can currently be found online at http://www.ajph.org/first_look.shtml ), UMass Medical School's Linda F. Weinreb, MD, the Joy McCann Professor for Women in Medicine and professor of family medicine and community health, Joanne Nicholson, PhD, professor of psychiatry, and Valerie F. Williams, MA, MS, research instructor in psychiatry, and John C. Buckner, PhD, an assistant professor at Harvard Medical School and Children's Hospital Boston, examined the health and mental health status among homeless mothers in Worcester, a mid-sized city in central Massachusetts and the third largest in New England. The research was based on data from two previous studies that included interviews with 148 homeless mothers living in shelters in 2003 (The Worcester Homeless Families Program Study) and with 220 homeless mothers in 1993 (The Worcester Family Research Project).   Both federally funded, the 1993 study was undertaken in collaboration with researchers at the National Center on Family Homelessness in Massachusetts and the 2003 study was part of a multi-site investigation in which communities across the nation participated. 

"There have been few opportunities to compare the characteristics of homeless mothers over time and little is known about how the characteristics and needs of homeless families have changed in recent years," Dr. Weinreb explained.  "We capitalized on a unique opportunity to look at these two studies, which involved similar methodologies, and analyze the key variables of interest over ten years. Although these studies enrolled different participants, their methodologies were sufficiently similar to enable meaningful comparisons." 

The resultant comparisons were troubling. Although average total incomes were equivalent in the 2 studies, families in the 2003 study were poorer when the effects of inflation on spending power over the decade between the studies were taken into account. Rates of reported childhood abuse were high among women in both the 1993 and 2003 studies. Overall, women in the 2003 study appeared to be suffering from more acute as well as chronic mental health problems. Despite equivalent rates of reported chronic health conditions in the 2 studies, women taking part in the 2003 study reported significantly poorer overall health status and more limitations in physical functioning than did women taking part in the 1993 study. These women also reported more limitations in social functioning resulting from physical or emotional health problems. 

Of particular note were the considerably higher rates of current major depressive illness and posttraumatic stress disorder in the more recent study. There was a startling four-fold increase in current depression rates between 1993 and 2003. Past research has shown that homeless mothers with depression are unlikely to receive mental health services and the debilitating effects of untreated depression on both mothers and their children's development and well-being have been well defined. Bolstered by their findings, the authors assert that ensuring that mental health services are available and accessible to homeless mothers must be a critical priority in efforts to respond to the needs of this population. 

The researchers believe that a number of factors may have contributed to the worsening picture. Shifts in social and economic policies, such as cuts in welfare, decreases in affordable housing stocks, and a freeze in the federal housing rental subsidy program may have increased the burden experienced by many poor female-headed families. It also appears that mothers in 2003 were less likely to receive mental health services compared to those in 1993, which suggests potential barriers to accessing services and may partially explain the higher rate of observed mental health problems in the 2003 study. In addition, because of these changes, the authors contend that it is conceivable that shelters may be attracting more families with higher illness burdens than in the past. However, regardless of the reason, it appears that shelters may now be dealing with mothers with more mental health problems than in the 1990s.
 
Although there are limitations to the data given that the researchers compared 2 studies involving similar methodologies but different participants, the results bear further validation to determine whether the findings are applicable outside of central Massachusetts. The population characteristics of homeless families in Worcester are similar to those in many cities across the country and these findings may be indicative of broader changes between 1993 and 2003 in the needs of homeless families.
 

"These results warrant further investigation in other regions of the country. The replication of these results may have important implications for policymakers and service providers addressing the needs of homeless families in the years ahead," said Weinreb.  "In order to be responsive to such evolving needs, services will simultaneously need to be refined so that they enhance their effectiveness in identifying and managing physical and mental health needs of families." 

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The University of Massachusetts Medical School, one of the fastest growing academic health centers in the country, has built a reputation as a world-class research institution, consistently producing noteworthy advances in clinical and basic research.  The Medical School attracts more than $174 million in research funding annually, 80 percent of which comes from federal funding sources. UMMS is the academic partner of UMass Memorial Health Care, the largest health care provider in Central Massachusetts. For more information visit www.umassmed.edu . 

Contact: Kelly Bishop, 508-856-2000; ummsnews@umassmed.edu