Individual-Level Predictors for Becoming Homeless and Exiting Homelessness: a Systematic Review and Meta-analysis

TY - JOUR

T1 - Individual-Level Predictors for Becoming Homeless and Exiting Homelessness: a Systematic Review and Meta-analysis

AU - Nilsson, Sandra Feodor

AU - Nordentoft, Merete

AU - Hjorthøj, Carsten

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Homelessness remains a societal problem. Compiled evidence of predictors for becoming homeless and exiting homelessness might be used to inform policy-makers and practitioners in their work to reduce homeless-related problems. We examined individual-level predictors for becoming homeless and exiting homelessness by searching PubMed, EMBASE, PsycINFO, and Web of Science up to January 2018. Becoming homeless and exiting homelessness were the outcomes. Observational studies with comparison groups from high-income countries were included. The Newcastle Ottawa Quality Assessment Scale was used for bias assessment. Random effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). We included 116 independent studies of risk factors for becoming homeless and 18 for exiting homelessness. We found evidence of adverse life events as risk factors for homelessness, e.g., physical abuse (OR 2.9, 95% CI 1.8–4.4) and foster care experiences (3.7, 1.9–7.3). History of incarceration (3.6, 1.3–10.4), suicide attempt (3.6, 2.1–6.3), and psychiatric problems, especially drug use problems (2.9, 1.5–5.1), were associated with increased risk of homelessness. The heterogeneity was substantial in most analyses (I2 > 90%). Female sex (1.5, 1.1–1.9; I2 = 69%) and having a partner (1.7, 1.3–2.1; I2 = 40%) predicted higher chances whereas relationship problems (0.6, 0.5–0.8), psychotic disorders (0.4, 0.2–0.8; I2 = 0%), and drug use problems (0.7, 0.6–0.9; I2 = 0%) reduced the chances for exiting homelessness. In conclusion, sociodemographic factors, adverse life events, criminal behaviour, and psychiatric problems were individual-level predictors for becoming homeless and/or exiting homelessness. Focus on individual-level vulnerabilities and early intervention is needed. PROSPERO registration number: CRD42014013119.

AB - Homelessness remains a societal problem. Compiled evidence of predictors for becoming homeless and exiting homelessness might be used to inform policy-makers and practitioners in their work to reduce homeless-related problems. We examined individual-level predictors for becoming homeless and exiting homelessness by searching PubMed, EMBASE, PsycINFO, and Web of Science up to January 2018. Becoming homeless and exiting homelessness were the outcomes. Observational studies with comparison groups from high-income countries were included. The Newcastle Ottawa Quality Assessment Scale was used for bias assessment. Random effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). We included 116 independent studies of risk factors for becoming homeless and 18 for exiting homelessness. We found evidence of adverse life events as risk factors for homelessness, e.g., physical abuse (OR 2.9, 95% CI 1.8–4.4) and foster care experiences (3.7, 1.9–7.3). History of incarceration (3.6, 1.3–10.4), suicide attempt (3.6, 2.1–6.3), and psychiatric problems, especially drug use problems (2.9, 1.5–5.1), were associated with increased risk of homelessness. The heterogeneity was substantial in most analyses (I2 > 90%). Female sex (1.5, 1.1–1.9; I2 = 69%) and having a partner (1.7, 1.3–2.1; I2 = 40%) predicted higher chances whereas relationship problems (0.6, 0.5–0.8), psychotic disorders (0.4, 0.2–0.8; I2 = 0%), and drug use problems (0.7, 0.6–0.9; I2 = 0%) reduced the chances for exiting homelessness. In conclusion, sociodemographic factors, adverse life events, criminal behaviour, and psychiatric problems were individual-level predictors for becoming homeless and/or exiting homelessness. Focus on individual-level vulnerabilities and early intervention is needed. PROSPERO registration number: CRD42014013119.

KW - Homeless persons

KW - Predictors

KW - Housing

KW - Psychiatry

KW - Meta-analysis

KW - Social marginalization

U2 - 10.1007/s11524-019-00377-x

DO - 10.1007/s11524-019-00377-x

M3 - Review

C2 - 31388823

SN - 1099-3460

VL - 96

SP - 741

EP - 750

JO - Journal of Urban Health

JF - Journal of Urban Health

IS - 5

ER -