Relationship between adverse childhood experiences and homelessness and the impact of axis I and II disorders

Am J Public Health. 2013 Dec;103 Suppl 2(Suppl 2):S275-81. doi: 10.2105/AJPH.2013.301323. Epub 2013 Oct 22.


Objectives: We investigated the links between homelessness associated with serious mental and physical healthy disparities and adverse childhood experiences (ACEs) in nationally representative data, with Axis I and II disorders as potential mediators.

Methods: We examined data from the National Epidemiologic Survey of Alcohol and Related Conditions in 2001-2002 and 2004-2005, and included 34,653 participants representative of the noninstitutionalized US population who were 20 years old or older. We studied the variables related to 4 classes of Axis I disorders, all 10 Axis II personality disorders, a wide range of ACEs, and a lifetime history of homelessness.

Results: Analyses revealed high prevalences of each ACE in individuals experiencing lifetime homelessness (17%-60%). A mediation model with Axis I and II disorders determined that childhood adversities were significantly related to homelessness through direct effects (adjusted odd ratios = 2.04, 4.24) and indirect effects, indicating partial mediation. Population attributable fractions were also reported.

Conclusions: Although Axis I and II disorders partially mediated the relationship between ACEs and homelessness, a strong direct association remained. This novel finding has implications for interventions and policy. Additional research is needed to understand relevant causal pathways.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Family Relations*
  • Female
  • Health Status*
  • Humans
  • Ill-Housed Persons / statistics & numerical data*
  • Male
  • Mental Health
  • Middle Aged
  • Personality Disorders / epidemiology*
  • Risk Assessment
  • Risk Factors
  • Socioeconomic Factors
  • Violence*