[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to examine the availability of outpatient substance use disorder (SUD) treatment programs in the United States. A geographic information system (GIS) was used to spatially locate outpatient SUD treatment programs, calculate areas, and determine population density within specific areas. Urban areas were mapped using data from the US Census (2000). Addresses of outpatient SUD treatment programs were obtained from the Facility Locator Web site of the Substance Abuse and Mental Health Services Administration. A 15-mile service catchment around each outpatient SUD treatment program was drawn. The amount of urban area not covered by the service catchment represents the underserved. Total underserved urban area and population without access was computed for each state. Significant variability of underserved urban area and population was observed across the states. Moderate correlations among area and population suggest that some states are more effective in locating SUD treatment programs than other states.
[Show abstract][Hide abstract] ABSTRACT: Homeless persons are victims of violent and non-violent crime at higher rates than housed populations. While studies have suggested that victimization can induce or exacerbate mental health problems, there is very little known about factors that may buffer the effects of victimization. This cross-sectional study examined the influence of victimization on depressive symptoms in over 9600 homeless and mentally ill adults participating in the Access to Community Care and Effective Services and Supports study (ACCESS) conducted in multiple cities across the USA relationships between victimization, depressive symptoms, and perceived safety were tested within a structural equation modeling framework using data collected at the baseline interview. The overall model exhibited a good fit with the data. Non-physical victimization was associated with higher levels of depressive symptoms, and physical victimization was associated with lower levels of perceived safety. As hypothesized, perceived safety was a significant partial mediator of depressive symptoms. These results underscore the complexity of the relationships between victimization and depression in homeless adults and the importance of addressing different types of victimization in homeless and mentally ill adults.
Social Science & Medicine 09/2008; 67(9):1475-9. DOI:10.1016/j.socscimed.2008.07.012 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction: Victimization is a common problem among persons who are homeless with a seriously mentally ill (SMI). Previous research has suggested that recent victimization is negatively associated with service use. However, research to date has not examined victimization using longitudinal causal models. This study tested a model in a homeless service-using population, hypothesizing that recent victimization will be associated with increased recent depressive symptoms with perceived safety as a mediating factor. It was also hypothesized that these same effects would be observed at a three-month follow-up.
Method: Data for this study were derived from the Access to Community Care and Effective Services and Supports (ACCESS) program. ACCESS was an 18-site project intended to improve functioning, quality of life, and housing outcomes for homeless persons with SMI. Baseline and three-month follow-up data were used. Hypotheses were tested using a cross-lagged structural equation model.
Results: The overall model exhibited a good fit with the data. As hypothesized, baseline victimization was positively associated with depressive symptoms and negatively associated with perception of safety. Perception of safety was negatively associated with depressive symptoms. At three-three month follow-up, perception of safety was positively associated with depressive symptoms. However, baseline victimization did not predict outcomes at follow-up.
Discussion: The results affirm the importance of assessing for recent victimization in persons who are homeless with a SMI, the need to pair services addressing victimization in this population with attention to depression, and the potential for treatments focusing on increasing perceptions of safety in victims.
135st APHA Annual Meeting and Exposition 2007; 11/2007