Modeling Victimization and Depression in Homeless Persons with Severe Mental Illness

Introduction: Victimization is a common problem among persons who are homeless with a seriously mentally ill (SMI). Previous research has suggested that recent victimization is negatively associated with service use. However, research to date has not examined victimization using longitudinal causal models. This study tested a model in a homeless service-using population, hypothesizing that recent victimization will be associated with increased recent depressive symptoms with perceived safety as a mediating factor. It was also hypothesized that these same effects would be observed at a three-month follow-up.

Method: Data for this study were derived from the Access to Community Care and Effective Services and Supports (ACCESS) program. ACCESS was an 18-site project intended to improve functioning, quality of life, and housing outcomes for homeless persons with SMI. Baseline and three-month follow-up data were used. Hypotheses were tested using a cross-lagged structural equation model.

Results: The overall model exhibited a good fit with the data. As hypothesized, baseline victimization was positively associated with depressive symptoms and negatively associated with perception of safety. Perception of safety was negatively associated with depressive symptoms. At three-three month follow-up, perception of safety was positively associated with depressive symptoms. However, baseline victimization did not predict outcomes at follow-up.

Discussion: The results affirm the importance of assessing for recent victimization in persons who are homeless with a SMI, the need to pair services addressing victimization in this population with attention to depression, and the potential for treatments focusing on increasing perceptions of safety in victims.