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R E S E A R C H Open Access
Correlates of psychological functioning of
homeless youth in Accra, Ghana: a
cross-sectional study
Kwaku Oppong Asante
1,2*
, Anna Meyer-Weitz
1
and Inge Petersen
1
Abstract
Background: Research on homeless youth has shown that this population is at high risk for various mental health
problems. Previous studies conducted among homeless young adults in Ghana have focused primarily on
economic, social and cultural causes of homelessness, their engagement in risky sexual behaviours and the
prevalence of STI including HIV/AIDS. We are therefore not fully informed of the prevalence of psychological
symptoms and their associated factors. The aim of the study was to determine the association between
psychological functioning and social and health risk behaviours among a sample of homeless youth in Ghana.
Methods: A cross-sectional survey of a convenience sample of 227 (122 male and 105 female) homeless youth was
conducted in Ghana in 2013. An interviewer-administered questionnaire was used to collect data due to low level
of literacy among the study population. Pearson-moment correlation coefficient (r) and multiple standard regression
models were fitted to analyse the data.
Results: Approximately 87% of the participants in this study exhibited moderate to severe psychosocial symptoms.
Specifically, emotional, conduct, hyperactivity and peer relationship problems among the participants were 69%,
74%, 54% and 89% respectively. Overall psychosocial functioning was predicted by stigma (self-stigma and
experienced stigma), violent behaviours and suicidal ideation. Substance use and perceived resilience were
significantly associated with emotional problems.
Conclusion: There is a need for holistic interventions to help improve the psychological and social functioning of
homeless youth. Such programmes should strengthen socio-emotional coping strategies in street youth as well as
address contextual risk factors such as stigma and discrimination by the public.
Keywords: Homeless youth, Mental health, Psychological functioning, Resilience, Substance use, Violent behaviours
Introduction
Poor mental health is a major cause of morbidity in low
to middle income countries, with depression accounting
for a large proportion of the disease burden [1]. Among
the general population, several studies have shown that
there are positive relationships between poor mental
health and substance use, traumatic experience and sex-
ual risk behaviours (unprotected sex and multiple sexual
partners) [2-5].
There are significant developmental changes that take
place during the transition from childhood to adoles-
cence, which are accompanied by physical and psycho-
logical challenges [6]. Compared to other adolescents,
these changes are more severe for street children who
have to make this transition in the absence of financial,
social and psychological support in their lives. It is thus
not surprising that homeless youth have been found in
high income countries to be at greater risk for mental
health problems and engaging in high risk behaviours
than those found in housed populations [7-9]. According
to UNICEF [10], the rate of mental illness among home-
less youth is very high, and being two times greater than
youth in the general population [11,12].
* Correspondence: kwappong@gmail.com
1
Discipline of Psychology, School of Applied Human Sciences, University of
KwaZulu-Natal, Howard College Campus, Durban 4041, South Africa
2
Department of Psychology, Regent University College of Science &
Technology, Accra, Ghana
© 2015 Oppong Asante et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public
Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this
article, unless otherwise stated.
Oppong Asante et al. International Journal of Mental Health Systems 2015, 9:1
http://www.ijmhs.com/content/9/1/1
Various studies suggest that psychological well-being of
homeless youth is associated with a variety of risk and pro-
tective factors. Risk factors are those characteristics of indi-
viduals that increase the likelihood of developing a mental
health problem or increasing the severity of the problem,
whilst protective factors on the other hand serve to modify
or ameliorate the effects of mental health problems [13].
Among homeless youth population, risk factors to their
mental health include number of years spent on the street
[14,15]; substance use [16,17]; suicidal ideation [18]; stigma
[19,20] and physical and sexual abuse [11]. Perceived resi-
lience [18,19,21] and social support [22-24] were identified
as protective factors against various mental health prob-
lems. In their study of homeless youth in Canada, Cleverley
and Kidd [18] revealed that perceived resilience was associ-
ated with less suicidal ideation and other life threatening
behaviours. Similarly studies have suggested that perceived
resilience among young adolescents may serve as a pro-
tective factor against health risk behaviour such as smo-
king, alcohol use and physically inactivity [21,25]. There
are currently no data regarding the psychological functio-
ning and its associated factors within the African context.
Most of the previous studies have been conducted from
developed and economically resourced countries, particu-
larly Canada and the United States.
The population of homeless youth is growing in cities
such as Accra. Headcounts of street children ranged
from 35,000 in 2009 [26] to 90,000 in 2013 [27]. Pre-
vious studies conducted among homeless young adults
in Ghana have focused primarily on economic, social
and cultural causes of homelessness [28,29], their en-
gagement in risky sexual behaviours and the prevalence
of Sexually Transmitted Infections (STI) including HIV/
AIDS [30-32]. While Wutoh et al. [32] found that home-
less children were sexually active, and suffered from
both physical and sexual abuse on the street, especially
girls. However, the authors did not examine the psy-
chological functioning of the participants in their study,
although they did suggest the need for interventions that
would address both mental health and risky sexual be-
haviour. In the context of this gap in knowledge on the
psychosocial functioning of street youth in Ghana, the
aims of this study were to determine i) the prevalence of
behavioural and emotional problems among homeless
youth in Accra; and ii) the factors associated with their
psychological functioning. A better understanding of the
psychological functioning of homeless youth and their
correlates may help design appropriate interventions to
improve the mental health status of this vulnerable and
disadvantaged population.
Theoretical framework
The risk and protective factors model [33] served as the
theoretical framework to guide this study in relation to
psychological functioning among vulnerable populations.
This model outlines factors within a particular population
that may ameliorate the effects of psychological problems
(protective factors) or exacerbates the probability of deve-
loping a psychological problem (risk factors). Among vul-
nerable populations, several factors may be associated
with susceptibility to mental health problems. These in-
clude personal and situational characteristics associated
with mental health, as well as physical health, social re-
sources and social support.
Among street connected children and youth, pertinent
socio-demographic factors leading to compromised psy-
chological functioning may include their younger age,
years of living on the street, and lack of education. Poor
health seeking behaviour, vulnerability to physical and
sexual abuse and maladaptive coping strategies, inclu-
ding the use of drugs and alcohol, can have a huge long
term effect on the mental health of homeless youth.
Knowledge of risk and protective factors associated with
psychological functioning of street children and youth is
needed to help develop appropriate harm reduction pro-
grammes to this population.
Methods
Study site and participants
Participants comprised homeless children and adolescents
in the Central Business District of Accra, the capital city
of Ghana. This study area was selected because within
Ghana, it has the second largest number of street children
[26], with street children frequently found in places such
as markets, bus and train stations [34]. A convenience
non-probability sampling strategy was used to recruit
homeless youth in 2013. For this cross-sectional survey,
the sample consisted of 227 homeless children and adoles-
cents, with ages ranging from 8-19 years with a mean age
of 12.58 (SD = 2.51).
Measures
A cross-sectional study was conducted which included
the administration of the following measures:
The Strength and Difficulties Questionnaire (SDQ)
[35], is an internationally validated screening tool for child
and adolescent emotional and behavioural difficulties.
It was used to assess the psychological functioning of the
participants. The SDQ includes subscales for prosocial
behaviour, hyperactivity/attentional, emotional, conduct
and peer-relationship problems. The SDQ is rated on a
3-point Likert scale (Not True, Somewhat True, and
Certainly True) with a score range of 0-40. The sum
ofthefirstfoursubscalesgivesthetotalpsychological
difficulties per child. Scoring is classified from 0 to 15
as normal (no psychological symptoms), 16 to 19 as
borderline (moderate psychological symptom) and 20
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to 40 as abnormal (severe psychological symptoms).
Higher scores on the total SDQ scale reflect poorer
psychological functioning. Acceptable reliability coefficients
have been reported in Ghanaian sample [36,37]. The
Cronbach’s alpha for the SDQ was 0.72 in this study.
Multidimensional Scale Perceived Social Support
(MSPSS) [38] was used to measure perceived social
support along three dimensions: from the family, friends
and significant others in the form of a 12-item, self-
administered questionnaire. The scale is rated on a
5-point Likert type ranging from 5 (strongly agree)
to 1 (strongly disagree). The MSPSS has been found to
be reliable in various different samples internationally
including Ghana [39]. Acceptable reliability coefficients
of 0.89 have been reported in a Ghanaian sample [39].
The overall Cronbach’salphaforthepresentstudywas
0.87.
The Connor-Davidson Resilience Scale (CD-RISC)
[40], a brief self-rated assessment was used to help
quantify resilience in a form of 25 items with responses
in a form of 5-point Likert scale ranging from 0 (not true
at all) to 4 (true nearly all the time). The tool includes
five dimensions, which are focused on personal com-
petence, tolerance of negative effects, adaptability, con-
trol and spiritual influences. The Cronbach’salphafor
the original scale was 0.89. The CD-RISC has been found
to have good internal reliability with Cronbach’salpha
values ranging from 0.89 to 0.93. The total score on the
CD-RISC ranges from 0-100, with higher scores reflecting
greater resilience. A Cronbach’s alpha of 0.90 for CD-
RISCwascalculatedinthisstudy.
Social stigma
This 12-item questionnaire developed by Kidd [20]
was used to assess social stigma experienced by
homeless street youth. The stigma scale includes
items assessing the experience of being stigmatized,
self-blame, and perception of public attitudes. These
items are categorised into two main dimensions: self-
blame (self-stigma) and experienced stigma. The so-
cial stigma scale has an overall internal reliability of
0.87, with the subscales of self-blame and experienced
stigma having reliability coefficients of 0.78 and 0.89
respectively. The overall Cronbach’salphaforthe
study was 0.90.
Suicidal ideation
Four questions adapted from the South African Youth
Risk Behaviour Survey [41] were used to assess the
frequency of suicide-related thought over the past one
month. A high score on this scale indicates higher levels
of suicidal ideation. The Cronbach’s alpha for this scale
in this study was 0.75.
Substance abuse
Five questions adapted from the South African Youth Risk
Behaviour Survey [41] were asked to assess substance use
or abuse. These questions were posed to participants to
elicit information about their engagement in substance
use or abuse. The total score was computed by summing
up the different items. Responses were coded such that
higher score would indicate greater engagement in sub-
stance abuse. The Cronbach’salphaforthisscaleinthis
study was 0.81.
Violence-related behaviours
A violence scale was calculated from 11 questions which
assessed various violent and violence-related behaviours
among street children. These questions were adapted
from the South African Youth Risk Behaviour Survey
[41] and framed to measure specific behaviours related
to violence, violence related and aggressive behaviours.
A total score was created by summing up all 11 items
from the violence measure. The dichotomous responses
(Yes and No) scale were coded in such a way that a
higher score represented higher levels of engagement in
violence and violence related behaviours. The violence
measure yielded an acceptable Cronbach’s alpha relia-
bility coefficient of 0.72.
Data collection and procedures
Two research assistants who were fluent and knowledgeable
of the language spoken by the street youth were recruited
and trained. The research participants were approached at
specific designated places and asked whether they would
be willing to participate in the study. The data was col-
lected through an interviewer-administered questionnaire
(as a result of low level of education) and most of the par-
ticipants listened attentively as they were asked questions
from the research instrument. It took an average of 30 mi-
nutes to administer the full questionnaire and data collec-
tion lasted for 8 weeks. The majority of the participants
were interviewed in Twi and Ga (two predominant local
languages spoken in Accra, Ghana). Each participant was
compensated with a voucher worth approximately US
$2.00 as a reward for participation in the study. While this
amount may seem insignificant, this would enable the
youth to buy a daily meal. None of the participants
expressed the need for psychological service although they
were told of the availability of a psychologist should they
require such a service.
Ethical consideration
Permission to conduct the study was granted from the
Department of Social Welfare, Accra, Ghana and the
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University of KwaZulu-Natal Human and Social Science
Ethics Committee (Ethical Approval number: HSS/1144/
012D).
Data analyses
The questionnaires administered to the participants
were checked for completeness and data was entered
into Microsoft Excel 2007 spreadsheet and imported into
the Statistical Package for the Social Sciences version
21.0 for Window (IBM SPSS) for data analysis. Data
quality was ensured by examining assumption of nor-
mality and homogeneity of variances. To determine the
best predictors of psychological functioning, two ana-
lyses were conducted. First, the Pearson-moment cor-
relation coefficient (r) was conducted to examine the
relationship between psychological functioning, perceived
resilience, suicidal ideation, violence behaviours, substance
abuse, self-stigma, general stigma. The composite scores
derived from the individual items measuring the various
health risk behaviours was used in this analysis. Secondly,
five standard regression fitted models were run using the
total difficulty and its 4 domains (i.e. emotional problems,
conduct problems, hyperactivity and peer problems). This
was used to determine the best predictors of psychological
functioning and its domains, and to ascertain the variables
which made significant contribution in the regression
models. Only predictors that had significant correlation
coefficients with the criterion variables entered into the
regression models.
Results
Demographics characteristics of the sample
The demographic characteristics of the sample are pre-
sented in Table 1. Males comprised approximately 54%
of the sample, and approximately 80% were between the
ages of 8-14. Over 59% of the participants indicated that
poverty was the main reason for being homeless and
about 26% had been abused (both physically and sexually).
Over half (59%) of the participants had up to basic educa-
tion level, and about 43% had lived on the street for 3-8
years. Significantly more females (19.8%) reported sexual
abuse as the cause of leaving home than males (2.5%),
χ
2
(1, 223) = 22.87, p < 0.001.
Psychological functioning of homeless youth
The general psychological functioning of the participants
in the study is presented in Table 2. The overall difficulty
score was very high (M= 22.0, SD = 6.05). Only 12.5% of
the participants were not exhibiting any psychological
symptoms, with approximately 87% exhibiting moderate
to severe psychological symptoms. The results further
revealed that of the sample, emotional problems was re-
ported by 68.9% (M= 6.75, SD = 2.32); conduct problems
by 73.8% (M= 5.04, SD = 2.87), hyperactivity/inattention
problems by 53.9% (M= 5.39, SD = 2.14) and 88.6% re-
ported peer relationship problems (M= 4.88, SD = 1.14)
among the homeless youth.
Relationship between psychological functioning and
other study variables
The Pearson-moment correlation coefficient (r) was con-
ducted to examine the relationship between psychological
functioning, perceived resilience, suicidal ideation, vio-
lence behaviours, substance abuse, self-stigma, and gene-
ral stigma. Table 3 shows small to moderate correlation
coefficients for the predictor variables that are associated
with total difficulty and its 4 domains. A significant posi-
tive relationship existed between overall total difficulty of
a participant and suicidal ideation (r =0.24; p<0.001),
violent behaviour (r=0.14; p<0.05), self-stigma (r=0.33;
p< 0.001) and experienced stigma (r=0.15; p<0.05).
These results suggest that higher scores on the total SDQ
scale (reflecting poor psychological functioning) were as-
sociated with increased levels of violence behaviour, self-
stigma and experienced stigma.
The following analyses were also done on the sub-scale
of the SDQ and their relationship with the various
Table 1 Demographic characteristics of the sample
Characteristics N%
Gender
Male 122 53.7
Female 105 46.3
Ages (M = 12.58, SD = 2.51).
8–10 years 50 22.4
11-14 years 129 57.9
15 years and over 44 19.7
Previous level of education
No formal education 69 30.5
Primary school (Grade 1–6) 133 58.9
Junior secondary school (Grade 7–9) 24 10.6
Years living on the street
<1 year 26 11.6
1-2 years 101 45.1
3-5 years 69 30.8
5 years and more 28 12.5
Reasons for being homeless
Family poverty 132 59.2
Dysfunctional problems 15 6.7
Maltreatment: Sexually abused 23 10.3
Maltreatment: Physical abused 34 15.3
Divorce 12 5.4
Other reasons 7 3.1
N = Number, % = Percentage of N, M = Mean, SD = Standard Deviation.
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independent variables. Emotional problems in homeless
youth correlated positively with suicidal ideation (r=0.30;
p< 0.001), substance abuse (r=0.23; p<0.01), self-stigma
(r=0.47; p< 0.01) and general stigma (r=0.40; p<0.01).
A negative correlation was found between emotional
problems and perceived resilience (r=−0.36; p<0.001).
The results imply that as emotional problems increase,
homeless youth are more likely to report higher levels of
suicidal ideation, general and self-stigma and elevated sub-
stance use. The results further suggest that higher levels
of emotional problems were associated with lower levels
perceived resilience.
Conduct problems positively correlated with suicidal
ideation (r= 0.16; p< 0.01), violent behaviour (r= 0.36;
p< 0.01) and social support (r= 0.47; p< 0.01). The re-
sults suggest that high levels of conduct problems were
associated with high levels of suicidal ideation, violent
behaviour and social support. There was a positive rela-
tionship between hyperactivity and self-stigma (r= 0.38;
p< 0.01). Similarly, hyperactivity correlated with general
stigma (r= 0.15; p< 0.05). This implied that as hyper-
activity levels increase, both self-stigma and experienced
stigma increases. The results as presented in Table 2
show that peer/relationship problems were positively as-
sociated with violence behaviour (r= 0.19; p< 0.01) and
negatively related to social support (r=−0.17; p< 0.05).
Predictors of psychological functioning
To determine the predictors of total difficulty (total score
on the SDQ) and its domain, five (5) regression models
were conducted, using only predictors/independent va-
riables that had significant relationship with the criterion
variable in Table 3. The first regression model used the
overall score of SDQ (psychological functioning) as crite-
rion, and the second to fifth models included the domains
of SDQ as criteria. The predictors included in the regres-
sion analysis were perceived resilience, suicide ideation,
substance abuse, violence behaviour, self-stigma, expe-
rienced stigma and social support. The results of the ana-
lysis are presented in Table 4.
In Model 1, the results showed a significant joint in-
fluence of self-stigma, experienced stigma, violent beha-
viour and suicidal ideation on overall psychological
functioning, (R
2
= 0.22, F= 12.74; p< .001). The results
Table 2 Summary statistics for the SDQ (n = 227)
Percentage in each SDQ category
Category Mean SD Range Normal Borderline Abnormal
Total difficulty 22.00 6.05 9-32 12.5 21.0 66.5
Emotional symptoms 6.75 2.32 0-10 32.0 16.6 53.4
Conduct problems 5.04 2.87 0-10 26.2 12.0 61.8
Hyperactivity/inattention 5.39 2.14 0-9 46.1 21.6 32.3
Peer relationships problems 4.88 1.41 2-10 11.4 54.1 34.5
*Prosocial behaviour 5.42 1.82 0-10 43.6 32.1 24.3
*This sub-scale is excluded from the computation of total difficulty score per participant.
Table 3 Correlation matrix between psychological functioning and other study variables
Variables 1 2 3 4 5 6 7 8 9 10 11
1Total difficulty 1
2Emotional problems .75*** 1
3Conduct problems .73*** .29*** 1
4Hyperactivity .79*** .53*** .39*** 1
5Peer problems .30*** .09 .08 .09 1
6Resilience .13 -.36*** .06 -.08 .04 1
7Suicide ideations .24** .30*** .16* -.03 .03 -.55*** 1
8Substance abuse .10 .23** .07 .07 .12 -.43*** .45*** 1
9Violent behaviour .15* -.14 .36*** .05 .19** -.13* .18* .51*** 1
10 Self-stigma .33*** .47*** -.02 .38*** .06 .09 -.24*** -.01 -.31*** 1
11 Experienced stigma .15* .40*** -.13 .15* -.02 .09 .18** .03 .29*** .80*** 1
12 Social support .14 -.05 .47*** -.01 .17* .12 -.19** -.26** .09 -.18* -.22**
*p< .05; ** p< .01; ***p< .001.
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indicated that 22% of the variance in psychological func-
tioning could be explained by the predictors. The second
model showed a significant joint effect of experienced
stigma, perceived resilience, substance use and violence
behaviour on emotional symptoms, (R
2
=0.391, F=16.91;
p< .001), and explained 39.1% of the variance in emotional
problems. The third model revealed a significant joint
influence of three (3) predictors: suicidal ideation, violence
behaviour and social support on conduct problems,
(R
2
=0.336, F=25.31; p< .001), and explained 33.6% of
the variance in conduct problems. The fourth regression
model indicated that both self-stigma and experienced
stigma had a significant joint influence of the predictors of
hyperactivity, (R
2
=0.20,F=27.17;p< .001), and explained
20% of the variance in hyperactivity. The fifth model re-
vealed that violent behaviour and social support were
the significant predictors of peer problems, R
2
=0.065,
F=7.31; p< .01, explaining only 6.5% of the variance in
peers problems.
Discussion
This study was conducted to examine the prevalence of
psychological problems, and to determine factors that
predicted these psychological problems among homeless
youth. The results showed that approximately 87% of
the participants in this study exhibited moderate to
severe psychological symptoms. Overall psychological
functioning was predicted by stigma (self-stigma and
experienced stigma), violent behaviour and suicidal
ideation. Substance use and perceived resilience were
significantly associated with emotional problems.
The prevalence of emotional, conduct, hyperactivity and
peer relationship problems among the participants were
69%, 74%, 54% and 89% respectively. These findings sug-
gest that homeless youth in this study experienced poor
mental health. This is consistent with previous studies
conducted in developed resourced countries [22,42,43].
Several studies from high-income countries show risk fac-
tors for psychological functioning of homeless youth. A
literature search was unable to access any similar studies
on the risk factors for poor psychological functioning of
street youth within sub-Saharan Africa. The findings of
this study showed that overall psychological well-being
was influenced by experienced stigma, self-stigma, suicidal
ideation and exposure to violence. This is suggestive
of the fact that where these factors are present, the
psychological functioning of a street youth might be
compromised.
Experienced and self-stigma were found to be associated
with the poorer psychological functioning of homeless
youth in this study. These finding lend support to a pre-
vious study conducted in the United States of America
which found that perceived discrimination and negative
stereotypic behaviours towards street youth influenced
their mental health contributing to higher levels of loneli-
ness, social alienation and depression [19,20]. According
to Crocker, Major and Steele [44] individuals who are stig-
matized often have a characteristic that is not valued by a
particular society and stigma directly affected the mental
Table 4 Summary of multiple regression of the best predictors of psychological functioning and its domains
Models/Criterion
variables
Predictors Collinearity statistics
BSE B βtR
2
FTolerance
1. Total difficulty Experienced stigma 2.02 .43 .55 4.67*** .346
Violent behaviour .57 .14 .29 4.01*** .220 12.74*** .887
Self-stigma .27 .14 .23 2.00* .358
Suicide Ideations .99 .33 .22 2.99** .886
2. Emotional problems Experienced stigma .61 .16 .42 3.77*** .390
Resilience -.03 .01 -.27 -3.46*** .791
Violent behaviour .20 .07 .26 3.12** .391 16.91*** .688
Substance use .33 .13 .23 2.58* .646
Self-stigma .06 .05 .13 1.16 .397
3. Conduct problems Violent behaviour .44 .08 .46 5.46*** .336 25.31*** .650
Social support .12 .03 .35 4.69*** .846
Suicide Ideations .39 .15 .22 2.58* .618
4. Hyperactivity Experienced stigma .93 .13 .72 6.98*** .200 27.17*** .361
Self-stigma -.17 .04 -.43 -4.15*** .361
5. Peer problems Violent behaviour .01 .03 .21 2.99** .065 7.31** .993
Social support .03 .01 .19 2.62** .991
*p< .05; ** p< .01; ***p< .001.
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health of homeless youth in this study. Research in Ghana
has shown that public perception to street youth is very
hostile and undesirable [45]. In the study of public percep-
tion about street youth among various stakeholders in
Ghana, Quashie [45] revealed a bleak picture as street
youth are perceived as drug users, and thieves who are in-
volved in petty criminal activities. This is further com-
pounded by use of derogative and belittling words such as
“kubolo”(a derogatory and belittling word used for street
child in the Greater Accra region of Ghana). Given the
literature, it is possible to indicate that stigmatization
(whether self-stigma or perceived stigma by society) has a
deleterious effect on homeless youth and reflects the ex-
tent to which stigma and discrimination of street youth
directly impact the mental health of homeless youth. Dis-
crimination and negative stereotypic attitudes by the pub-
lic towards street youth influence their mental health and
contribute to higher levels of loneliness, social alienation
and depression. This finding also suggest that putting in
place an anti-stigma and discriminations campaign, would
lead to improvement in the psychological health in this
vulnerable population.
The findings of this study also indicate a significant
positive independent influence of suicide ideation on total
psychological difficulty, suggesting that higher levels of
suicidal ideation correspond to poor psychological func-
tioning. This finding supports the research of Frederick
et al. [46] who found that homeless youth who had a diag-
nosis of a mental disorder were twice as likely to expe-
rience suicidal ideation and suicidal attempts than those
without such diagnosis. Previous studies in Ghana have
shown street youth to be adaptable in the face of adversity
[47]. However, there may be limits to this adaptability, as
the cumulative effect of abuse, substance use, public
stigma and other health risk factors affecting their psy-
chological functioning, may lead them to have suicidal
thoughts.
The finding of this study showed that violent beha-
viour was associated with lower levels of psychological
functioning. Violent behaviour measured included ha-
ving abused, having been beaten or coerced (such as
been forced to have sex with someone). These forms of
maltreatment have also been reported as reasons why
homeless youth left home in Ghana [31], and are re-
enacted on the street, with boys more likely to suffer
from physical assault and girls more likely to be sexually
abused or raped [31,42,48]. Our findings indicate that
those exposed to severe forms of abuse and violence dis-
played higher number of psychological symptoms. This
finding corroborates previous studies that draw an asso-
ciation between violence behaviours of homeless youth
and mental health problems [49,50]. For example, using
a purposively selected sample of 601 homeless youth in
Denver, USA, [49] found physical and sexual assault to
significantly predict mental health outcomes such as
major depressive symptoms and PTSD. Similarly, a high
rate of comorbid diagnosis of post-traumatic stress dis-
order (PTSD) has been found in homeless youth who
have been assaulted or injured by a weapon on the street
[50]. Our findings thus corroborate the literature to sug-
gest that engagement in violent behaviours on the street
may have mental health consequences for homeless
youth.
Resilience is a complex construct that involves inter-
action between adversity and an individual’s internal and
external protective factors and competencies that allow
one to overcome adversity [51]. According to some re-
searchers resilience is considered as positive outcomes
despite the experience of adversity, continued positive or
effective functioning in adverse circumstances [40,52].
Thus resilience can be considered as the ability to ‘bounce
back’in the face of adversity [40,52]. Perceived resilience
as measured by the CD-RISC, revealed a negative rela-
tionship with emotional problems, suggesting that higher
perceived resilience was associated with lower emotional
problems. This finding corroborates previous studies that
report resilience as being a protective factor against the
onset of various mental health problems [18,21,25] and
provides support for the protective model of resilience
that suggests that protective factors assist in neutralizing
the effect of risk, thus reducing the impact of a negative
outcome [53]. This finding also suggest that participants
in this study are resilient, and that programmes aimed at
building resilience in youth to cope better with the
stressors of living on the streets should engage youth as
early as possible when they become homeless to decrease
the degree of deterioration in physical and mental health.
Substance use increases the likelihood of individuals en-
gaging in risky sexual behaviours, such as non-condom
use and multiple sexual partners [54] and heightens the
probability of having psychological problems. Substance
use was found in this study to be positively related to
higher emotional problems. This supports previous re-
search that has shown that substance use, including alco-
hol and hard drugs, are associated with greater emotional
distress [23,55]. Substance use among the homeless popu-
lation has, however, also been reported to be a coping
strategy [16,17].
Social support was found to be positively associated
with both conduct problems and peer relationship prob-
lems among homeless youth. In the absence of support
from mainstream society like family and relatives, home-
less youth rely on peers and “street family”for support
to cope with stressful events on the street. However,
these support systems have been shown to further en-
trench them into street life thereby putting them at
greater risk for mental health related problems [56].
While gangs provide social support they also influence
Oppong Asante et al. International Journal of Mental Health Systems 2015, 9:1 Page 7 of 9
http://www.ijmhs.com/content/9/1/1
members to engage in anti-social behavior, hence the
positive relationship between social support and conduct
problems. These findings corroborate past studies that
have indicated that social support available to homeless
youth on the street could have deleterious effect on
mental health [56,57]. This finding shows that although
participants had adequate support on the street, these
available supports can lead to compromised social func-
tioning. There is therefore the need to develop health
enhancing social networks that provide homeless youth
with alternative networks for gaining social support ra-
ther than support from deviant youth groups who pro-
mote anti-social behavior.
The findings of this study must be interpreted with
caution, as several issues might have introduced bias in
this study. The cross-sectional nature of the research did
not allow cause-and-effect relationships to be estab-
lished. Longitudinal research, although challenging espe-
cially with transient populations such as homeless youth
may be necessary to help determine the trend of the re-
lationships between the variables identified in this study.
Second, the practical significance of the relationships ob-
served in this study might be limited as most of the cor-
relation coefficients were small or moderate in strength.
Third, we measured only psychological symptoms, and
therefore could not determine the prevalence of specific
mental disorders such as depression and Post-traumatic
Stress Disorder (PTSD). The need for future studies to
examine the prevalence of specific disorders among this
population is highlighted. Fourth, administering the
questionnaire using an interviewer may have resulted in
under reporting of behaviours such as suicide ideation,
violent behaviour and substance use. Finally, most of the
measures used were modified from the South African
Youth Risk Behaviour Survey [41]. During modification
and translation, it is possible, that the validity and relia-
bility of these measures may have compromised. Notwith-
standing this, most of the measures yield acceptable
Cronbach’s alpha reliability coefficients of 0.70 and above.
Conclusion
This study highlights that the majority of street youth in
Ghana display moderate to severe psychological symp-
toms. The need for mental health services to help youth
cope with multiple mental health problems is thus
highlighted. The findings revealed that risk factors for poor
mental health amongst street youth include experienced
stigma, self-stigma, suicidal ideation and violence behav-
iour. Using an ecological systemic framework [58], the
need for multilevel prevention interventions is highlighted.
Firstly, at the individual level, there is a need for pro-
grammes aimed at building resilience in youth to cope bet-
ter with the stressors of living on the streets, for example,
through access to psychological counselling to address
mental health issues and to develop better coping stra-
tegies to deal with past and current adversities. Secondly,
at the interpersonal level there is a need to develop health
enhancing social networks that provide homeless youth
with alternative networks for gaining social support rather
than support from deviant youth groups who promote
anti-social behavior. Lastly, at the community and societal
levels there is a need for programmes to address the social
determinants of their poor mental health. In this regard,
violence and harm reduction programmes, including early
parenting programmes to reduce exposure to violence in
the home, as well as anti-stigma campaigns are needed.
Competing interests
The authors declare that they have no competing interests.
Authors’contributions
KOA was involved with the design of the study, data analysis of result and
wrote the first draft of the manuscript. AMW and IP were involved in critical
and intellectual review of the initial manuscript. All authors read and
approved the final manuscript.
Acknowledgment
This study was partly supported by the Strategic Research Fund from the
College of Humanities, University of KwaZulu-Natal, South Africa.
Received: 25 July 2014 Accepted: 17 December 2014
Published: 3 January 2015
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doi:10.1186/1752-4458-9-1
Cite this article as: Oppong Asante et al.:Correlates of psychological
functioning of homeless youth in Accra, Ghana: a cross-sectional study.
International Journal of Mental Health Systems 2015 9:1.
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