In a recently released issue of Pediatrics (10.1542/peds.2019-2674), Dr. Gewirtz O’Brien and colleagues compare the mental health of teens who have run away from home with those who experienced unaccompanied homelessness. Their findings are emotionally impactful for pediatricians, and shed light on critical mental health issues among teens who already must face personal, social and educational challenges. The authors conducted a secondary analysis of survey responses from 9th and 11th graders from the statewide, school-based 2016 Minnesota Student Survey, which included 68,795 participants. While 95% of surveyed youth were stably housed, the remaining 5% of teens were not, and the authors readily acknowledge the survey likely undercounted this group, since many are not attending school (where the survey was administered). A key take away here is the distinction between different types of unstable housing status: the authors distinguish between (1) unaccompanied homeless youth (i.e. those living in a shelter, in someone else’s home or in a place not intended as a living place without their parents), (2) runaway youth (those who had run away from home in the past 12 months once or more times), (3) those who were both runaways and unaccompanied homeless youth, and (4) those stably housed.
Several mental health outcomes were measured, including self-injury, suicidal ideation, suicide attempts and depressive symptoms. Figure 1 depicts rates of mental health outcomes by housing status, and the results are truly concerning. For example, one third (32.6%) of those who are both homeless and runaway attempted suicide in the past year, with lower but still elevated rates among homeless youth (19.9%) and runaway youth (11%). Rates of intrafamilial physical and verbal abuse (ranging from 36.3-60.9%) were much higher in each subgroup of youth not stably housed, as compared (10.9 and 9.4%) to the majority of teens in safe living conditions. This study made me realize how many teens do not have a safe place to live, and how great the need for care and service is.
As the authors note, multiple meaningful indicators and contextual factors were not measured, which does not diminish the value of the study, but rather reminds us of the many potential risk factors runaway and homeless youth may experience. Whether or not the survey participants were using substances, were justice involved, were trafficked and for what duration were not assessed. Despite these limitations, this study has important policy implications, as the authors point out. Not all youth in unstable living situations have similar experiences, and tailored interventions that are driven by evidence-based policy are desperately needed.