Skip to main content

Advertisement

SpringerLink
Log in

Multidimensional Social Support and the Health of Homeless Individuals

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

Homeless individuals often suffer from serious health problems. It has been argued that the homeless are socially isolated, with low levels of social support and social functioning, and that this lack of social resources contributes to their ill health. These observations suggest the need to further explore the relationship between social networks, social support, and health among persons who are homeless. The purpose of this study was to examine the association between multidimensional (cognitive/perceived and behavioral/received) social support and health outcomes, including physical health status, mental health status, and recent victimization, among a representative sample of homeless individuals in Toronto, Canada. Multivariate regression analyses were performed on social support and health outcome data from a subsample of 544 homeless adults, recruited from shelters and meal programs through multistage cluster sampling procedures. Results indicated that participants perceived moderately high levels of access to financial, emotional, and instrumental social support in their social networks. These types of perceived social supports were related to better physical and mental health status and lower likelihood of victimization. These findings highlight a need for more services that encourage the integration of homeless individuals into social networks and the building of specific types of social support within networks, in addition to more research into social support and other social contextual factors (e.g., social capital) and their influence on the health of homeless individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hwang SW, Dunn JR. Homeless people. In: Galea S, Vlahov D, eds. Handbook of Urban Health: Populations, Methods, and Practice. New York: Springer; 2005: 21-41.

    Google Scholar 

  2. Khandor E, Mason K. The Street Health Report 2007. Toronto: Street Health; 2007.

    Google Scholar 

  3. La Gory M, Ritchey F, Fitzpatrick K. Homelessness and affiliation. Sociol Q. 1991; 32(2): 201-218.

    Article  Google Scholar 

  4. Fischer PJ, Shapiro S, Breakey WR, Anthony JC, Kramer M. Mental health and social characteristics of the homeless: a survey of mission users. Am J Public Health. 1986; 76(5): 519-524.

    Article  PubMed  CAS  Google Scholar 

  5. Solarz A, Bogat GA. When social support fails: the homeless. J Commun Psychol. 1990; 18: 79-96.

    Article  Google Scholar 

  6. Hall A, Wellman B. Social networks and social support. In: Cohen S, Syme SL, eds. Social Support and Health. Orlando: Academic; 1985.

    Google Scholar 

  7. Berkman LF, Glass T. Social integration, social networks, social support, and health. In: Berkman LF, Kawachi I, eds. Social Epidemiology. New York: Oxford University Press; 2000: 137-173.

    Google Scholar 

  8. Kawachi I, Berkman LF. Social ties and mental health. J Urban Health. 2001; 78(3): 458-467.

    PubMed  CAS  Google Scholar 

  9. Noh S, Kaspar V. Perceived discrimination and depression: moderating effects of coping, acculturation and ethnic support. Am J Public Health. 2003; 93(2): 232-238.

    Article  PubMed  Google Scholar 

  10. Cornman JC, Goldman N, Glei DA, Weinstein M, Chang MC. Social ties and perceived social support: two dimensions of social relationships and health among the elderly in Taiwan. J Aging Health. 2003; 15(4): 616-644.

    Article  PubMed  Google Scholar 

  11. Sarason BR, Sarason IG, Pierce GR. Social Support: An Interactional View. New York: Wiley; 1990.

    Google Scholar 

  12. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991; 32(6): 705-714.

    Article  PubMed  CAS  Google Scholar 

  13. Calsyn RJ, Winter JP. Social support, psychiatric symptoms and housing: a causal analysis. J Commun Psychol. 2002; 30(3): 247-259.

    Article  Google Scholar 

  14. Bao WN, Whitbeck LB, Hoyt DR. Abuse, support and depression among homeless and runaway youth. J Health Soc Behav. 2000; 41(4): 408-420.

    Article  PubMed  CAS  Google Scholar 

  15. Nyamathi A, Leake B, Keenan C, Gelberg L. Type of social support among homeless women: its impact on psychosocial resources, health and health behaviors, and use of health services. Nurs Res. 2000; 49(6): 318-326.

    Article  PubMed  CAS  Google Scholar 

  16. Schutt RK, Meschede T, Rierdan J. Distress, suicidal thoughts, and social support among homeless adults. J Health Soc Behav. 1994; 35(2): 134-142.

    Article  PubMed  CAS  Google Scholar 

  17. Nyamathi A, Wayment H, Dunkel-Schetter C. Psychosocial correlates of emotional distress and risk behavior in African–American women at risk for HIV infection. Anxiety Stress Coping. 1993; 6: 133-148.

    Article  Google Scholar 

  18. Abdul-Quader A, Tross S, Friedman S, Kouzi A, Des Jarlais D. Street-recruited drug users and sexual risk reduction in New York City. AIDS. 1990; 4: 1075-1079.

    Article  PubMed  CAS  Google Scholar 

  19. Toro PA, Tulloch E, Ouellette N. Stress, social support and outcomes in two probability samples of homeless adults. J Commun Psychol. 2008; 36(4): 483-498.

    Article  Google Scholar 

  20. Irwin J, LaGory M, Ritchey F, Fitzpatrick K. Social assets and mental distress among the homeless: exploring the roles of social support and other forms of social capital on depression. Soc Sci Med. 2008; 67: 1935-1943.

    Article  PubMed  Google Scholar 

  21. Lam JA, Rosenheck R. Social support and service use among homeless persons with serious mental illness. Int J Soc Psychiatry. 1999; 45(1): 13-28.

    Article  PubMed  CAS  Google Scholar 

  22. McCarthy B, Hagan J, Martin MJ. In and out of harm’s way: violent victimization and the social capital of fictive street families. Criminology. 2002; 40(4): 831-862.

    Article  Google Scholar 

  23. Wenzel SL, Tucker JS, Elliott MN, Marshall GN, Williamson SL. Physical violence against impoverished women: a longitudinal analysis of risk and protective factors. Women’s Health Issues. 2004; 14: 144-154.

    Article  PubMed  Google Scholar 

  24. Lam JA, Rosenheck R. The effect of victimization on clinical outcomes of homeless persons with serious mental illness. Psychiatr Serv. 1998; 49: 678-683.

    PubMed  CAS  Google Scholar 

  25. Kushel MB, Evans JL, Perry S, Robertson MJ, Moss AR. No door to lock: victimization among homeless and marginally housed persons. Arch Intern Med. 2003; 163: 2492-2499.

    Article  PubMed  Google Scholar 

  26. Hwang SW, Chiu S, Kiss A, et al. Use of meal programs and shelters by homeless people in Toronto. J Urban Health. 2005; 82(Supplement 2): ii46.

    Google Scholar 

  27. Robertson MJ, Winkleby MA. Mental health problems of homeless women and differences across subgroups. Annu Rev Public Health. 1996; 17: 311-336.

    Article  PubMed  CAS  Google Scholar 

  28. Wellman B, Wortley S. Different strokes from different folks: community ties and social support. Am J Sociol. 1990; 96(3): 558-588.

    Article  Google Scholar 

  29. Meeks S, Murrell SA. Service providers in the social networks of clients with severe mental illness. Schizophr Bull. 1994; 20(2): 399-406.

    PubMed  CAS  Google Scholar 

  30. Ware JE, Kosinski M, Keller SD. SF-12: How to Score the SF-12 Physical and Mental Health Summary Scales. 2nd ed. Boston: The Health Institute, New England Medical Center; 1995.

    Google Scholar 

  31. McGahan PL, Griffith JA, Parente R, et al. (2007). Addiction Severity Index: Composite Scores Manual. Philadelphia, PA: The University of Pennsylvania/Veterans Administration Centre for Studies of Addiction. Available at: http://www.tresearch.org/resources/compscores/CompositeManual.pdf. Accessed on: September 4, 2007.

  32. McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the Addiction Severity Index. J Subst Abuse Treat. 1992; 9: 199-213.

    Article  PubMed  CAS  Google Scholar 

  33. Interagency Council on the Homeless. Homelessness: Programs and the People They Serve. Findings of the National Survey of Homeless Assistance Providers and Clients. Washington, DC: Interagency Council on the Homeless; 1999.

    Google Scholar 

  34. Zanis DA, McLellan AT, Canaan RA, Randall M. Reliability and validity of the Addiction Severity Index with a homeless sample. J Subst Abuse Treat. 1994; 11: 541-548.

    Article  PubMed  CAS  Google Scholar 

  35. Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996; 49: 1373-1379.

    Article  PubMed  CAS  Google Scholar 

  36. Sarason IG, Sarason BR, Shearin EN, Peirce GR. A brief measure of social support: practical and theoretical implications. J Soc Pers Relatsh. 1987; 4: 497-510.

    Article  Google Scholar 

  37. Antonucci TC, Israel BA. Veridicality of social support: a comparison of principal and network members’ responses. J Consult Clin Psychol. 1986; 54: 432-437.

    Article  PubMed  CAS  Google Scholar 

  38. McKenzie K, Harpham T. Meanings and uses of social capital in the mental health field. In: McKenzie K, Harpham T, eds. Social Capital and Mental Health. London: Jessica Kingsley; 2006: 11-23.

    Google Scholar 

  39. Harpham T, Grant E, Rodriguez C. Mental health and social capital in Cali, Colombia. Soc Sci Med. 2004; 58(11): 2267-2277.

    Article  PubMed  Google Scholar 

  40. Lin N. Building a network theory of social capital. In: Lin N, Cook K, Burt RS, eds. Social Capital: Theory and Research. New York: Aldine de Gruyter; 2001: 3-29.

    Google Scholar 

  41. Portes A. Social capital: its origins and applications in modern sociology. Annu Rev Sociology. 1998; 24: 1-12.

    Article  Google Scholar 

  42. Putnam RD. Making Democracy Work: Civic Traditions in Modern Italy. Princeton: Princeton University Press; 1993.

    Google Scholar 

  43. Coleman JS. Social capital in the creation of human capital. Am J Sociol. 1988; 94: S95-S120.

    Article  Google Scholar 

  44. Fitzpatrick KM, Irwin J, LaGory M, Ritchey F. Just thinking about it: social capital and suicide ideation among homeless persons. J Health Psychol. 2007; 12(5): 750-760.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This project was supported by operating grants from the Agency for Health Care Research and Quality (1 R01 HS014129-01) and the Canadian Institutes of Health Research (MOP-62736) and by an Interdisciplinary Capacity Enhancement grant on Homelessness, Housing, and Health from the Canadian Institutes of Health Research (HOA-80066). The Center for Research on Inner City Health gratefully acknowledges the support of the Ontario Ministry of Health and Long-Term Care and the Institute for Clinical Evaluative Sciences. Dr. Hwang is the recipient of a New Investigator Award from the Canadian Institutes of Health Research. Dr. Kirst acknowledges support from the Canadian Institutes of Health Research and the Ontario Ministry of Health and Long-Term Care.

Author information

Authors and Affiliations

  1. Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 30 Bond St., Toronto, Ontario, M5B 1W8, Canada

    Stephen W. Hwang, Maritt J. Kirst & Shirley Chiu

  2. Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada

    Stephen W. Hwang

  3. Crohn’s and Colitis Foundation of Canada, Toronto, Canada

    George Tolomiczenko

  4. Department of Psychiatry, University of Toronto, Toronto, Canada

    George Tolomiczenko

  5. Department of Research Design and Biostatistics, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada

    Alex Kiss

  6. Street Health Community Nursing Foundation, Toronto, Canada

    Laura Cowan

  7. Department of Medicine, University of Toronto, Toronto, Canada

    Wendy Levinson

Authors
  1. Stephen W. Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maritt J. Kirst
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shirley Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. George Tolomiczenko
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alex Kiss
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Laura Cowan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wendy Levinson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maritt J. Kirst.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hwang, S.W., Kirst, M.J., Chiu, S. et al. Multidimensional Social Support and the Health of Homeless Individuals. J Urban Health 86, 791–803 (2009). https://doi.org/10.1007/s11524-009-9388-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-009-9388-x

Keywords

Search

Navigation