Background We examined the housing trajectories of homeless people with mental illness over a follow-up period of 6 years, and the association of these trajectories with food security. We then examined the modifying role of psychopathology and alcohol and substance use disorders in this association.
Methods We followed 487 homeless adults with mental illness at the Toronto site of the At Home/Chez-Soi project –a randomized trial of Housing First. Housing data were collected every 3 months (Phase I) or 6 months (Phase II) during follow-up. Food security data were collected 7 times during the follow-up period. Psychopathology (Colorado Symptom Index score) and alcohol and substance use disorders were assessed at baseline. Housing trajectories were identified using group-based trajectory modelling. Logistic regression was used to estimate the association between housing trajectory groups and food security.
Results Three housing trajectory groups were identified: a rapid move to consistent stable housing (34.7%), slow and inconsistent housing (52.1%), and never moved to stable housing (13.2%). Individuals included in the rapid move to consistent housing trajectory group had higher odds of remaining food secure compared to those in the never moved to stable housing trajectory group over the follow-up period [AOR 2.9, 95% CI: 1.3–6.6, P-value: 0.009]. However, when interactions were considered, this association was significant among those with moderate psychopathology but not severe psychopathology. Individuals with substance use disorder and in the group never move to stable house group had the lowest food security status.
Conclusion Severe psychopathology and substance use disorders modified the association between housing trajectories and food security. Housing interventions need to focus on long term housing stability as well as food security, especially among those with severe psychopathology and substance use disorder.
The Toronto AH/CS study received approval from the St. Michael’s Hospital Research Ethics Board (Canada), and all participants gave informed written consent to participate in the AH/CS study. The AH/CS study is also registered with the International Standard Randomized Control Trial Number Register (ISRCTN42520374).