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The prevalence of mental illness in homeless children: a systematic review and meta-analysis
Ellen L Bassuk1, Molly K Richard2, Alexander Tsertsvadze3
1Center for Social Innovation in Needham, MA; Harvard Medical School, Boston, MA.
Insights
Homeless children, especially school-aged ones, face significantly higher rates of mental health issues compared to housed peers. This highlights an urgent need for evidence-based interventions and universal screening for this vulnerable population.
Area of Science:
- Child and Adolescent Psychiatry
- Public Health
- Social Work
Background:
- Rising rates of childhood homelessness necessitate understanding associated mental health and behavioral needs.
- Accurate prevalence data is crucial for developing effective, targeted interventions for homeless youth.
Purpose of the Study:
- To systematically review and synthesize existing research on the prevalence of mental health issues in homeless children.
- To compare mental health prevalence between homeless children and their low-income, housed counterparts.
- To discuss implications for research, clinical practice, and policy.
Main Methods:
- Systematic review of empirical studies published between 1990 and 2014 in the US.
- Inclusion of studies focusing on mental illness prevalence in homeless children.
- Meta-analysis using inverse-variance random effects models to pool prevalence odds ratios.
Main Results:
- 10-26% of homeless preschoolers and 24-40% of homeless school-aged children exhibited mental health problems.
- School-aged homeless children were 1.78 times more likely to have a mental health problem than housed children.
- No significant difference in mental health problems was found between homeless and housed preschool children using specific metrics.
Conclusions:
- Evidence-based mental health interventions for homeless children are critically needed.
- Universal screening, tailored treatment plans, and support systems promoting positive parenting and self-regulation are essential.
- Addressing the mental health needs of homeless children requires integrated research, practice, and policy efforts.
Objective:
The numbers of children experiencing homelessness have increased. To develop responsive interventions, we must understand their mental health/behavioral needs. The purpose of this systematic review was to update the evidence base by identifying, appraising, and summarizing studies on the prevalence of mental health issues among homeless children, comparing these individuals to low-income-housed children, and discussing research, practice, and policy implications.
Method:
We searched 3 electronic databases and included empirical studies investigating the prevalence of mental illness in homeless children in the United States (1990-2014). Retrieved publications were screened, data extracted, and study quality appraised by independent reviewers. Evidence synthesis was based on qualitative and quantitative analyses. Prevalence odds ratios (OR) of individual studies were pooled using an inverse-variance random effects model.
Results:
Twelve studies were included and reviewed. Overall, 10% to 26% of homeless preschoolers had mental health problems requiring clinical evaluation. This proportion increased to 24% to 40% among homeless school-age children, a rate 2 to 4 times higher than poor children aged 6 to 11 years in the National Survey of America's Families. According to our meta-analyses, the difference in prevalence measured by Child Behavior Checklist (CBCL) Total Problems (T score ≥60-64) was not significantly different between homeless and housed preschool children (OR = 1.49; 95% CI = 0.97-2.28). School-age homeless children compared to housed children were significantly more likely to have a mental health problem as defined by the CBCL Total Problems subscale (T score ≥60; OR = 1.78; 95% CI = 1.19-2.66).
Conclusion:
Evidence-based mental health interventions for children experiencing homelessness are long overdue. Universal screening, treatment plan development, and support of adaptive systems that focus on positive parenting and children's self-regulation are essential.
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