Unmet Subsistence and Mental Health Needs in Women Experiencing Homelessness: Rethinking Care Models for Improved...

Area of Science:

• Public Health
• Mental Health Research
• Social Determinants of Health

Background:

• Women experiencing homelessness or unstable housing (WEH) face high rates of depression and anxiety.
• Existing research links unmet subsistence needs to mental health (MH), but interactions with health and social factors are understudied.

Purpose of the Study:

• Examine associations between unmet subsistence needs and MH symptoms among WEH.
• Investigate interactions with sleep disturbances, pain, and HIV status.

Main Methods:

• Cross-sectional analysis of baseline data from the PULSE cohort study.
• 245 women recruited from shelters, meal programs, and street encampments.
• Anxiety measured by GAD-7, depression by PHQ-9; unmet needs included lack of shelter, food, clothing, hygiene.

Main Results:

• 49% of WEH had moderate-to-severe depression; 36% had moderate-to-severe anxiety.
• ≥2 unmet needs associated with 4x odds of depression and 3x odds of anxiety.
• Sleep disturbance and pain increased odds of depression and anxiety; HIV status modified unmet needs' effect on anxiety.

Conclusions:

• Unmet subsistence needs, sleep disturbances, and pain drive depression and anxiety in WEH, especially those with HIV.
• Low-barrier care models addressing social needs alongside medical care can improve MH outcomes.