A Retrospective Observational Study of Violent Deaths Among Transitional-aged, Unhoused Youth

Housing instability of transitional-aged youth, 18 to 24 years-old, has not been well described. These individuals may be susceptible to sexual exploitation, mental health disorders, illicit substance use, and gang activity. This study characterizes violent death among transitional-aged, unhoused individuals.

We conducted a retrospective cohort study using the National Violent Death Reporting System, a database of police and medical examiner state records, from 2003 to 2021. Demographic variables were included. We conducted two comparisons using Chi-square and Mann-Whitney U tests. We compared transitional-aged (18-24 y old) to nontransitional-aged youth individuals. We then compared housed to unhoused individuals. Variables included the presence of substance abuse, mental health problems, gang involvement, and prostitution, among others.

From 2003 to 2021, the National Violent Death Reporting System had complete housing data for 518,829 individuals of which 9217 were unhoused and 72,239 transitional-aged, with 710 victims as both transitional-aged and unhoused. Most transitional-aged, unhoused victims were White and male. Compared to housed counterparts, unhoused transitional-aged youth had higher proportions of substance use (P < 0.001), mental health disorders (P < 0.001), and prostitution involvement (P < 0.001). Unhoused transitional-aged youth had no difference in substance use (P = 0.532), mental health disorders (P = 0.833), or prostitution (P = 0.340) compared to their older similarly unhoused counterparts, yet death among transitional-aged youth was more likely to be gang-related (P = 0.002).

This study found that experiencing homelessness has important associations between violent death and higher rates of substance use, mental health disorders, and prostitution in the transitional-aged, unhoused population. This highlights a potentially critical intervention point for this vulnerable population.