Original Research ARTICLE
Housing Stability and Neurocognitive Functioning in Homeless Adults with Mental Illness: A subgroup analysis of the At Home/Chez Soi study
- 1Li Ka Shing Knowledge Institute, St Michael's Hospital, Canada
- 2Centre for Addiction and Mental Health (CAMH), Canada
- 3Department of Psychiatry, University of Toronto, Canada
- 4Ontario HIV Treatment Network, Canada
- 5Dalla Lana School of Public Health, University of Toronto, Canada
- 6School of Psychology, University of Moncton, Canada
- 7Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Canada
- 8Department of Psychiatry, McGill University, Canada
- 9Douglas Hospital Research Centre, Canada
- 10Institute of Mental Health, Department of Psychiatry, University of British Columbia, Canada
- 11Department of Psychiatry, School of Medicine, University of California, San Diego, United States
- 12Center of Excellence for Stress and Mental Health (CESAMH), United States
Objective: This study examined the association of housing stability with neurocognitive outcomes of a well-characterized sample of homeless adults with mental illness over 18 months and sought to identify demographic and clinical variables associated with changes in neurocognitive functioning. Method: A total of 902 participants in the At Home/Chez Soi study completed neuropsychological measures 6 and 24 months after study enrollment to assess neurocognitive functioning, specifically verbal learning and memory, cognitive flexibility and complex processing speed. Multivariable linear regression was performed to assess the association of housing stability with changes in neurocognitive functioning between 6 and 24 months and to examine the effect of demographic and clinical variables on changes in neurocognitive functioning. Results: Overall neurocognitive impairment remained high over the study period (70% at 6 months and 67% at 24 months) with a small but significant improvement in the proportion of those experiencing more severe impairment (54% vs 49% p<0.002). Housing stability was not associated with any of the neuropsychological measures or domains examined; improvement in neurocognitive functioning was associated with younger age, and bipolar affective disorder at baseline. Conclusions: The high prevalence and persistence of overall neurocognitive impairment in our sample suggests targeted approaches to improve neurocognitive functioning merit consideration as part of health interventions to improve everyday functioning and outcomes for this population. Further efforts are needed to identify potential modifiable factors that contribute to improvement in cognitive functioning in homeless adults with mental illness.
Keywords: Homelessness, mental illness, neurocognitive functioning, intervention, Housing stability, neurocognition
Received: 29 Jun 2019;
Accepted: 04 Nov 2019.
Copyright: © 2019 Stergiopoulos, Naidu, Schuler, Bekele, Nisenbaum, Jbilou, Latimer, Schütz, Twamley and Rourke. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Vicky Stergiopoulos, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, M5B 1W8, Ontario, Canada, Vicky.Stergiopoulos@camh.ca