Mental health in homeless or unstably housed people living with HIV

Background. Homelessness and mental health (MH) problems frequently co-occur, yet few studies have investigated MH in homeless or unstably housed persons living with HIV/AIDS (PLWHA). This study investigates factors associated with poorer mental health in this population.

Methods. Homeless/unstably housed PLWHA (n=644) were recruited through local housing agencies in three cities across the U.S., interviewed, and tested for viral load and CD4 levels. Three self-reported MH scales were used: Center for Epidemiologic Studies–Depression (CESD, range 0-30, score >=10 indicating depressive symptoms), Perceived Stress Scale (PSS, range=10-50, higher score=poorer MH), SF-36 Mental Component Summary (MCS, population normed, mean=50, SD=10, lower score=poorer MH). Multivariable logistic regression analyses examined relationships of these scales with sociodemographic, drug use, and sexual and physical abuse variables.

Results. Respondents were predominantly male (68%), black (79%), and single (69%). Mean age was 41 years. CESD average was 13.73 (SD=7.09). PSS average was 30.00 (SD=7.38). MCS average was 37.82 (SD=12.88). All scale scores indicated poor MH. Multivariable analyses indicated that for all three scales those who were recently homeless (all p<0.01) and had ever been physically abused (all p<0.005) had poorer MH. Additional factors associated with poorer MH were having ever been sexually abused (CESD p<0.05, PSS p<0.05), being younger (PSS p<0.05, MCS p<0.0001), being race other than black (CESD p<0.01), and not having insurance (MCS p<0.05).

Conclusions. Many homeless/unstably housed PLWHA experience poor MH. Some subgroups of PLWHA experience even poorer MH. More resources should be directed toward addressing the needs of those especially at risk.