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Quality of Life and Mental Well-Being: A Gendered Analysis of Persons Experiencing Homelessness in Canada

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Abstract

Homelessness has negative implications for mental well-being and quality of life. This paper identifies the quality of life variables that contribute to positive or negative wellbeing, reporting on a regression analysis from 343 individuals experiencing homelessness in Canada. Results indicate that a lack of sleep duration and quality reduced mental well-being for both genders, not having access to food and/or hygiene facilities decreased men’s well-being, and engaging in illegal subsistence strategies, such as selling drugs, negatively impacted women’s mental well-being. For persons experiencing homelessness, mental well-being and quality-of-life are gendered outcomes of their limited access to social determinants of health.
Vol.:(0123456789)
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Community Mental Health Journal
https://doi.org/10.1007/s10597-020-00596-6
BRIEF REPORT
Quality ofLife andMental Well‑Being: AGendered Analysis ofPersons
Experiencing Homelessness inCanada
KristyBuccieri1 · AbramOudshoorn2· JeannetteWaegemakersSchi3 · BernadettePauly4 · RebeccaSchi5 ·
StephenGaetz6
Received: 10 July 2018 / Accepted: 26 February 2020
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Homelessness has negative implications for mental well-being and quality of life. This paper identifies the quality of life
variables that contribute to positive or negative wellbeing, reporting on a regression analysis from 343 individuals experienc-
ing homelessness in Canada. Results indicate that a lack of sleep duration and quality reduced mental well-being for both
genders, not having access to food and/or hygiene facilities decreased men’s well-being, and engaging in illegal subsistence
strategies, such as selling drugs, negatively impacted women’s mental well-being. For persons experiencing homelessness,
mental well-being and quality-of-life are gendered outcomes of their limited access to social determinants of health.
Keywords Homelessness· Quality of life· Mental well-being· Social determinants of health· Gender· Canada
Introduction
Mental well-being and quality of life are related concepts.
According to the World Health Organization (WHO), qual-
ity of life is a subjective evaluation of well-being that can
be grouped into the 4 domains of one’s physical health,
psychological state, social relationships, and environment
(WHO Quality of Life [QOL] Group 1995, 1998a, b). It is
well recognized that living in poverty and/or experiencing
homelessness have negative implications for mental well-
being (Kertesz etal. 2005) and for quality of life (Lam and
Rosenheck 2000) but the inter-relation between these factors
is not presently clear. In this paper we conduct a regression
analysis to identify the individual variables that are related
to mental well-being and quality of life for those experi-
encing homelessness. Given that gender has been found to
impact experiences of homelessness (Montgomery etal.
2017; Wachter etal. 2015; Winetrobe etal. 2017) we also
incorporate gender as a grouping variable in each analysis.
Our intent is to identify the specific significant interactions
between mental well-being and quality of life variables,
and to determine the directionality of these relationships
using the WHO Quality of Life domains as a conceptual
framework.
* Kristy Buccieri
kristybuccieri@trentu.ca
Abram Oudshoorn
aoudsho@uwo.ca
Jeannette Waegemakers Schiff
schiff@ucalgary.ca
Bernadette Pauly
bpauly@uvic.ca
Rebecca Schiff
rschiff@lakeheadu.ca
Stephen Gaetz
sgaetz@edu.yorku.ca
1 Department ofSociology, Trent University, 1600 West Bank
Dr, Peterborough, ONK9L0G2, Canada
2 Arthur Labatt Family School ofNursing, Western University,
Room 3344 FNB, London, ONN6A5B9, Canada
3 Faculty ofSocial Work, University ofCalgary, Professional
Faculties 4242, 2500 University Drive NW, Calgary,
ABT2N1N4, Canada
4 Canadian Institute forSubstance Use Research, University
ofVictoria, Technology Enterprise Facility Room 273,
Victoria, BCV8P5C2, Canada
5 Health Sciences, Lakehead University, SN 1006B, 955 Oliver
Rd, ThunderBay, ONP7B5E1, Canada
6 Faculty ofEducation, York University, 631 York Research
Tower, Keele Campus, 4700 Keele Street, Toronto,
ONM3J1P3, Canada
Community Mental Health Journal
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Literature Review
Amongst vulnerable populations gender has been found to
be a significant factor in subjective well-being, with males
reporting theirs to be significantly better than females
(Tomyn etal. 2015). The WHO (2004) recognizes gender
as a factor that influences how much control individuals
have over the determinants of their health, which in turn
impacts mental well-being and also a person’s quality of
life. Gender differences have been noted across each of the
4 quality of life domains identified by the WHO (Quality
of Life Group 1995, 1998a, b).
The first domain, physical health, has gendered impli-
cations for those experiencing homelessness. Living in
poverty is a well-documented social determinant that
contributes to poor health (Bryant etal. 2011; Marmot
etal. 2008; Okulicz-Kozaryn 2015). Women who experi-
ence homelessness, in particular, have comparatively more
chronic physical health conditions than their male coun-
terparts (Winetrobe etal. 2017) and additional challenges
accessing sexual health care (Corey etal. 2017; Oliver
and Cheff 2012). Young women experiencing homeless-
ness are also less likely than their male counterparts to
report condom use, but are more likely to be diagnosed
with a sexually transmitted infection and have a sex part-
ner who uses injection drugs (Valente and Auerswald
2013). Additionally, sleep disturbances are a commonly
linked health concern to homelessness (Chang etal. 2015;
Reitzel etal. 2017; Taylor etal. 2019) and studies of the
general population suggest gendered differences exist in
sleep patterns (Röösli etal. 2014) that begin at the onset
of puberty with changes in the hormonal cycle (Krishnan
and Collop 2006).
The second quality of life domain, psychological state,
closely aligns with the concept of mental well-being
and shows gendered differences for persons experienc-
ing homelessness. There is a known association between
social inequity and increased risk of mental health disor-
ders (WHO and Calouste Gulbenkian Foundation 2014).
Compared to the general Canadian population, women
who experience homelessness have substantially higher
prevalence rates of mental disorders (Strehlau etal. 2012)
and women in shelters have reported experiencing ‘dark
thoughts’ that emerge from feelings of resentment, pow-
erlessness, and marginalization (Grabbe etal. 2013). Men
who experience homelessness may struggle with gender
role conflict, such as not expressing emotions, resulting
in higher levels of psychological distress and resistance
to seeking mental health supports (Nguyen etal. 2012).
The third quality of life domain, social relationships,
also has clear gender differences for men and women
experiencing homelessness. Feeling socially excluded is
common for individuals experiencing homelessness (Hali-
fax etal. 2008) and is linked to broader mental well-being
themes of not having choice, stability, respect, and the
same rights as others in society (Palepu etal. 2012). Men
who experience homelessness, in particular, may be per-
ceived by the public as dangerous and requiring social
distance (Markowitz and Syverson 2019). Conversely
women who experience homelessness may seek out social
networks for protection, such as from men on the street
(Watson 2016).
The final quality of life domain, one’s environment, is par-
ticularly relevant in terms of gender differences in housing.
Research shows that men are more likely to be unsheltered
than women, but that the risk of being unsheltered increases
for women associated with substance use and for men associ-
ated with mental illness (Montgomery etal. 2017). Lack of
housing is a clear structural barrier to well-being (Rae and
Rees 2015) and Housing First placements have been shown
to improve quality of life (Patterson etal. 2013). However,
housing is not the only environmental consideration in well-
being and quality of life. Engagement in street activity, such
as illegal income generation, has gender differences (Ferguson
etal. 2015), and predictors for multiple arrest also vary by
gender, including exposure to drug culture as significant for
males and drug distribution as significant for females (Wachter
etal. 2015).
While it is clear that the quality of life domains all show
gender differences, it is not presently clear which variables are
most significantly involved and how they inter-relate to one
another within and across domains. In this paper we report
on a gendered analysis guided by the research question: what
quality of life variables significantly impact mental well-
being for women and for men who experience homelessness
in Canada? By a gendered analysis, we mean that gender is
used as a selection variable in all of the analyses, allowing us
to observe potential gender-based differences. We begin by
discussing the World Health Organization Quality of Life scale
[WHOQOL-100], which was not administered directly but
rather used retroactively to organize the categories of analysis;
Sect.3.3 below provides specific details on how our survey
variables were grouped using the WHOQOL-100 as a concep-
tual framework. We then present the results and conclude with
a discussion of how the findings have practical implications for
increasing quality of life and mental well-being for Canadians
who experience homelessness.
Methods
Sample
Data were collected as part of a multi-site study on human-
acquired influenza (H1N1) in the context of homelessness
Community Mental Health Journal
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in Canada (Buccieri and Schiff 2016). A project total of 343
surveys were administered between 2010 and 2011 in the
4 Canadian cities of Calgary, Regina, Toronto, and Victo-
ria. Participants included individuals who self-identified as
experiencing homelessness at the time of the study, includ-
ing 105 women and 238 men. Female participants ranged in
age from 16 to 64 [35 mean, 11.96 SD], 41.2% were visible
minorities, 51.5% were Indigenous, and 19% identified as
queer. Male participants ranged from 18 to 75 [40.27 mean,
13.38 SD], 27.3% were visible minorities, 26.3% were
Indigenous, and 7.5% were queer. A convenience sampling
method was used in each city and participants were recruited
through social service agencies. A standard survey was used
across all sites. Each participant received $20 remuneration.
Ethics approval was obtained by the authors’ institutions in
all 4 sites.
Mental Well‑Being Variables
According to the WHO (2004), beliefs such as optimism,
personal control, and a sense of meaning are known to be
protective of mental well-being, whereas feelings of insecu-
rity and hopelessness can lead to greater vulnerability and
disadvantaged states. For this analysis, 4 dependent vari-
ables were identified as indicators of positive mental well-
being. Items were based on self-reports from the 30days
preceding the survey and included feeling relaxed, enjoying
life, being hopeful about the future, and feeling happy. Four
dependent variables were identified as indicators of negative
mental well-being. These variables were also based on self-
reports from the 30days preceding the survey and included
feeling very stressed, being lonely, feeling depressed, and
feeling unsafe.
Quality ofLife Variables
Quality of life was assessed through a series of independ-
ent variables that were grouped into categories, within the
4 domains established by WHOQOL Group (1998b); these
included: physical health, psychological state, social rela-
tionships, and environment. These domains are part of the
WHOQOL-100, which is a cross-culturally validated assess-
ment developed by the WHOQOL Group (1998a). Quality
of life assessments, “not only measure mental health but
also usually contain items and domains that directly probe
aspects of mental health” (WHO 2004). While our team did
not administer the WHOQOL-100 or incorporate all items,
the following analysis is informed by its structure and uses
its 4 domains for classification of our independent variables.
All variables were self-reported.
The physical health domain incorporates 4 measures from
our survey that align with the WHOQOL-100, including
sleep and rest, energy and fatigue, mobility, and activities
of daily living. The latter two measures are combined into 1
category, as research has shown that mobility is a large fac-
tor in the daily activities of individuals experiencing home-
lessness in order to meet their subsistence needs (Watson
etal. 2016). Three additional measures are included from
our survey that are not part of the WHOQOL-100 assess-
ment but are important factors in the quality of life of per-
sons experiencing homelessness. These include self-reported
health, age, and meal frequency.
The psychological domain includes the positive feelings
and negative feelings measures from the WHOQOL-100
assessment. The variables in this domain were described
above but are included as independent variables to ascer-
tain the relationship between the psychological domain and
well-being. Positive feelings included 4 positive mental
well-being items. Participants in our survey reported how
often they felt relaxed, happy, hopeful about the future, or
enjoyed life. Negative feelings included 4 negative mental
well-being items. Participants in our survey reported how
often they felt stressed, unsafe, lonely, or depressed.
The social relationships domain includes personal rela-
tionships and social support from the WHOQOL-100. Per-
sonal relationships included 3 items. Participants in our sur-
vey reported the frequency they were by themselves, with
close friends, or with their partner. Social support included 8
items. Participants in our survey also reported the frequency
in the preceding month they slept, spent the day, or ate in
overcrowded places, how often they were able to wash their
hands or clothes, and how often they could eat on a clean
surface, take a shower, or brush their teeth.
The environment domain incorporates 4 measures from
the WHOQOL-100, including physical safety and security,
home environment, financial resources, and health/social
care. Physical safety and security included 8 items from our
survey. Participants reported in the preceding 12months the
frequency they came into contact with police as a victim of
crime, witness to crime, when police stopped to help them,
when making money (such as panhandling or squeegeeing),
being arrested, asked to move on, given a ticket, asked for
identification, or because of being homeless. Home environ-
ment/accommodations included 8 items from our survey.
Participants reported in the past month how many times they
had stayed in a homeless shelter, squat, park, on the streets,
their own house or apartment, a friends’ house or apartment,
hostel, transitional housing, motel/hotel, jail, or hospital.
Financial resources included 11 items from our survey. Par-
ticipants reported how many times in the preceding month
they earned money from panhandling, squeegeeing, sex
trade, theft/B&E/jacking, selling drugs, selling stolen goods,
bottle picking, research studies, doing odd jobs, scamming,
or selling their belongings. Health and social care included 8
items from our survey. Participants reported how often in the
preceding month they got meals from a shelter, soup kitchen
Community Mental Health Journal
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or food bank, drop-in centre, mobile van, a friend, a stranger,
buying it themselves, or from bins outside restaurants.
Analysis
Gender was used as a selection variable in all analyses. A
binary division was used, as only 1.1% of the sample iden-
tified as transgender and all others identified as female or
male. For this analysis, given the small size, transgender
participants were excluded. Linear regression analysis
was conducted for each independent and dependent vari-
able combination. Where a Beta score of 0.300 or greater
was observed, with significance α < 0.05, reciprocal linear
regression analysis was conducted by inverting the depend-
ent and independent variables. This was done to determine
whether there was a one-way or reciprocal significant rela-
tionship between mental well-being and quality of life vari-
ables. Statistical analysis was conducted using SPSS version
24.
Results
The quality of life factors that interacted with women’s nega-
tive mental well-being variables were examined first; num-
bers represent β values that are significant at α < 0.05, with
directionality of the relationship indicated as appropriate.
Within the physical health domain, women reported stress
was reciprocally related to poor sleep (0.451), not enough
sleep (0.402), talking less than usual (0.342), having noth-
ing to do (0.424), and their overall health (0.321). Stress for
women also resulted from being the victim of crime (0.307)
and being in jail (0.422), both within the environmental
domain. For women, feeling lonely was reciprocally related
to poor sleep (0.500), not enough sleep (0.515), talking less
than usual (0.444), not feeling like eating (0.349), and also
resulted from having nothing to do (0.514). Environmental
domain factors such as being in jail (0.434), selling drugs
(0.311), scamming (0.715), and selling possessions (0.559)
contributed to loneliness in women. Feelings of depression
for women reciprocally resulted from poor sleep (0.556),
not enough sleep (0.612), talking less than usual (0.446),
not feeling like eating (0.377), having nothing to do (0.509),
and overall health (0.401). In the psychological domain not
feeling happy was significantly related to feeling depressed
(0.322). Women identified several physical health domain
variables that made them feel unsafe, including poor sleep
(0.478), not enough sleep (0.302), talking less than usual
(0.356), having nothing to do (0.408), spending the day-
time in the park (0.323), and their overall health (0.421).
For women, not being able to shower was associated with
feeling unsafe (0.460) in the social relationships domain.
Feeling unsafe was related to a number of environmental
domain factors for women, including being the victim of
crime (0.410), witness to crime (0.873), being arrested
(0.425), being asked for ID (0.318), stopped by police for
being homeless (0.374), being on the street (0.333), and
being in jail (0.626).
The quality of life variables that improve women’s mental
well-being were examined next, but few were found to be
significant. Women reported that feeling relaxed was related
to environmental domain factors, such as having police stop
to offer help (0.529) and being involved in research studies
(0.594). Enjoying life was related to having good quality
sleep (0.480), having something to do (0.322), eating sup-
per (0.365), not feeling stressed (0.331), and having police
stop to offer help (0.497). Feeling happy was related to hav-
ing good quality sleep (0.350), eating supper (0.335), hav-
ing police stop to offer help (0.488), and being involved in
research studies (0.471). No variables significantly contrib-
uted to women’s sense of hopefulness about the future.
The quality of life variables that decrease men’s mental
well-being were examined next. Within the physical health
domain stress was reciprocally linked to poor sleep (0.603),
not enough sleep (0.531), talking less than usual (0.335),
not feeling like eating (0.428), and uni-directionally with
having gone without food (0.381). Stress was also recipro-
cally related to psychological domain factors of not feeling
relaxed (0.389), not feeling happy (0.369), and not enjoy-
ing life (0.327). Men indicated that in the environmental
domain, scamming to earn money was a source of stress
(0.420). Men reciprocally related loneliness to poor sleep
(0.464), not enough sleep (0.430), talking less than usual
(0.395), not feeling like eating (0.385), and uni-directionally
to having gone without food (0.305). In the environmen-
tal domain, men identified participating in research studies
(0.351) as a factor that decreased their loneliness. Feeling
a sense of depression was reciprocally related to poor sleep
(0.448), not enough sleep (0.404), talking less than usual
(0.380), not feeling like eating (0.341), and uni-direction-
ally to having gone without food (0.323). For men, in the
psychological domain, depression was reciprocally related
to not feeling happy (0.333) and not enjoying life (0.344),
and in the environmental domain depression was related to
scamming for income (0.402). Feeling unsafe for men was
related to poor sleep (0.413), talking less than usual (0.315),
not feeling like eating (0.346), having gone without food
(0.389), not having clean water (0.319), not feeling happy
(0.361), and reciprocally to not enough sleep (0.382).
Finally, the quality of life variables that improved men’s
mental well-being were examined. Relaxation was related to
physical domain factors such as good quality sleep (0.392),
getting enough sleep (0.346), being in good health (0.344),
eating breakfast (0.319), eating lunch (0.383), eating supper
(0.441), and having a snack during the day (0.352). Relaxa-
tion was also related to the psychological domain factors of
Community Mental Health Journal
1 3
feeling safe (0.335), not feeling lonely (0.314), not feeling
depressed (0.408), and reciprocally with not feeling stressed
(0.482). Within the social domain, relaxation for men was
related to washing their hands (0.409), eating on a clean
surface (0.361), taking a shower (0.384), and brushing their
teeth (0.343). Within the environmental domain, relaxation
was related to not being stopped by police and offered help
(0.344), not staying in a squat (0.352) or park (0.511), and
not selling stolen goods for money (0.488). Enjoyment of
life was related to good quality sleep (0.366), good health
(0.330), eating lunch (0.386), and reciprocally to eating
breakfast (0.304) and supper (0.504), and not going with-
out food (0.394). Enjoying life was related to the psycho-
logical domain factors of not feeling depressed (0.415) and
reciprocally to not feeling very stressed (0.347); under the
social relationships domain enjoyment of life was related to
being able to wash one’s hands (0.362). Men’s hopefulness
was related to physical health and environmental domains,
including good quality sleep (0.301), eating lunch (0.316),
eating supper (0.411), not being asked to move on by the
police (0.301), and not sleeping in a park (0.386), on the
street (0.331), or in the hospital (0.427). Men’s sense of hap-
piness was related to good quality sleep (0.321), good health
(0.301), and reciprocally to eating lunch (0.383) and supper
(0.511) under the physical health domain. Men’s happiness
was reciprocally related to not feeling very stressed (0.340)
and not feeling depressed (0.355) under the psychological
domain, washing their hands (0.387) and brushing their teeth
(0.301) under the social relationships domain, and not sleep-
ing in a park (0.312) or on the street (0.308), and not scam-
ming for money (0.372) under the environmental domain.
Discussion
Poor sleep quality and duration are significantly related to
homelessness (Chang etal. 2015; Taylor etal. 2019) and
among the general population women report higher sleep
disturbances (Krishnan and Collop 2006). In this study we
examined sleep quality and whether individuals experi-
enced difficulty getting enough sleep as separate variables.
Both variables were central to negative mental well-being
experienced by women and men; this is a finding that sup-
ports other recent conclusions about the link between lack
of sleep and poor physical and mental health for persons
experiencing homelessness (Reitzel etal. 2017). Poor sleep
quality led women to enjoy life less and feel less happy; it
also decreased men’s sense of relaxation, hopefulness, hap-
piness, and enjoyment of life. For women and men, poor
sleep had a reciprocal relationship with stress, loneliness,
and depression, and also led both to feel unsafe. The places
where women and men sleep are also important factors in
their mental well-being. For women, spending the night in
jail led to stress, loneliness, and feeling unsafe. For men,
sleeping in a park reduced relaxation, hopefulness, and hap-
piness. Poor sleep quality and trouble getting sleep were sig-
nificant variables to negative mental well-being for women
and men. Implementing approaches that improve sleep
duration and quality could be the most important recom-
mendation in promoting the well-being of women and men
experiencing homelessness. Development of permanent and
affordable housing options are needed (Patterson etal. 2013)
to ensure individuals have a safe, secure, and private place
in which to sleep.
The link between poverty and poor health is clearly estab-
lished in the literature (Bryant etal. 2011; Marmot etal.
2008; Okulicz-Kozaryn 2015). In this study, having poor
health led women to feel stressed and unsafe, and had a
reciprocal relationship with depression. Men who reported
being in poor health also reported higher levels of depres-
sion. For men, improved health contributed to enjoying life,
feeling relaxed, and being happy. These links suggest that
physical health may be an underlying factor in negative
mental well-being for women and men. When working with
patients, health care practitioners must recognize the inter-
play between emotions and health, such that negative emo-
tions can be detrimental to one’s mental and physical health.
For those who experience homelessness, the struggle
to find food can lead to a lack of dignity associated with
mealtimes (Watson etal. 2016). Women and men both
reported that not feeling like eating was reciprocally related
to depression; men also reported not feeling like eating was
reciprocally related to stress and loneliness. Not eating may
be indicative that a person is feeling poorly but given the
reciprocal nature, encouraging a person who is depressed,
stressed, or lonely to eat when food is available may help to
alleviate their symptoms. Having regular access to food was
particularly important to the emotional well-being of men,
for whom going without food was linked to stress, lone-
liness, decreased life enjoyment, and feeling unsafe. Con-
versely, drinking clean water and eating breakfast, lunch,
supper, and a daytime snack were all related to positive men-
tal outcomes for men. For women, eating supper was the
only significant factor leading to greater enjoyment of life.
Ensuring food and clean water is readily accessible through-
out the day is key to improving the mental well-being of
individuals experiencing homelessness.
Women and men both reported that when they felt
stressed, lonely, or depressed they talked less and that talk-
ing less in turn increased their feelings of stress, loneliness,
or depression. This lack of self-expression may be indicative
of social exclusion (Markowitz and Syverson 2019; Palepu
etal. 2012). Talking less than usual may be an indicator that
a person is experiencing these negative feelings and, given
their reciprocal nature, actively engaging that person in con-
versation may help improve feelings of stress, loneliness,
Community Mental Health Journal
1 3
or depression. This lends support for relationship-based
practices in health and social care with people experiencing
homelessness (Kahan etal. 2019). Additionally, for women,
not feeling like doing anything increased stress and depres-
sion, which in turn reinforced not wanting to do anything.
Doing nothing further led women to feel lonely, unsafe, and
less joyful. These findings challenge the common neoliberal
discourse that portrays individuals who experience home-
lessness as lazy or not wanting to work. These findings sup-
port a contrary view, that not being active is part of a cycle
that creates and reinforces negative emotional experiences.
Women identified very few psychological quality of life
variables that improved their mental well-being, which is
perhaps not surprising given women report higher rates of
mental disorders (Strehlau etal. 2012) and ‘dark thoughts’
(Grabbe etal. 2013). Men, however, showed a dichoto-
mous relationship between the positive feelings and nega-
tive feelings variables, such that a decrease in one led to an
increase in the other. This effect was observed in the recip-
rocal relationships men reported between several variables,
such as increased happiness resulting from less stress, and
depression leading to less happiness. Men’s positive emo-
tional states were more closely tied to an absence of nega-
tive emotional states (and vice versa) than was reported
by women. This suggests that one approach to improving
men’s emotional well-being may be to address the factors
that contribute to their negative experiences, which could
have particular benefits for men who struggle with gender
role conflict and avoid seeking out mental health supports
(Nguyen etal. 2012). Opportunities to engage in hygienic
maintenance were also particularly important for men’s
emotional well-being. Specifically, showering or eating on a
clean surface contributed to men’s relaxation; brushing their
teeth promoted relaxation and happiness; and washing their
hands led to relaxation, happiness, and greater enjoyment
of life. Having access to private and secure bathing facili-
ties could contribute to enhanced emotional well-being of
individuals experiencing homeless, with particular benefits
for men.
Subsistence strategies on the street, including illegal
income generation, have been shown to be gendered (Fer-
guson etal. 2015). For women in this study, money-making
activities that involved negative encounters, such as selling
drugs, their own possessions, or scamming, increased their
sense of loneliness. Selling drugs has also been found to
increase chances of multiple arrests for women (Wachter
etal. 2015). Men who scammed felt more stressed and
depressed. Earning money in these ways was detrimental to
women’s and men’s emotional well-being, but both benefited
from involvement in research studies (women were more
relaxed and happy; men were less lonely). Engaging indi-
viduals with lived experience of homelessness in research
studies, and potentially as peer researchers, could be one
form among others of creating opportunities to earn money
in a way that promotes mental well-being while decreasing
the need for other money-making pursuits. An additional
benefit of providing alternative income sources is that it may
reduce police encounters. Women could particularly benefit
from having less negative police encounters, such as being
arrested or asked for identification, which led them to feel
unsafe. However, police should be encouraged to stop and
offer help to women who might be experiencing homeless-
ness, as these positive encounters reportedly led women to
enjoy life more, feel more relaxed, and be happier.
Limitations
The data were collected through self-reports and not exter-
nally verified for accuracy. This research was conducted in
the 4 diverse Canadian cities. Further analysis would be
needed to determine whether the locations, or other demo-
graphic factors, affected participant responses. It is noted
that the demographic characteristics show women were
younger, and comprised of more visible minority, Indige-
nous, and LGBTQ respondents. It is unknown whether these
demographics impacted women’s reporting of quality of life
and mental well-being. Additionally, as previously noted,
we used a gender binary of ‘man’ or ‘woman;’ although
‘transgender’ was provided, few respondents selected this
option and the binary may not accurately reflect all partici-
pants’ gender-identities.
There were also limitations in the methodology and anal-
ysis used. While the literature indicates that substance use
is linked to decreased quality of life and mental well-being
(Kertesz etal. 2005; Lam and Rosenheck 2000), our data on
substance use was not thorough enough to include it as a var-
iable in this study. Additionally, because we relied on self-
reporting, the use of ‘depression’ as a variable reflected each
participant’s feelings and not a clinical diagnosis. Finally,
the WHOQOL-100 was not administered to participants but
rather used retroactively as a typology for organizing data. It
is unknown how the results may have differed had the instru-
ment been administered.
Conclusion
We have reported on a gendered analysis of women and men
experiencing homelessness in Canada, using the 4 quality of
life domains of physical health, psychological state, social
relationships, and environment as a conceptual typology.
Health inequity is evident in this research, through the emer-
gence of poor sleep, lack of regular access to food, and lim-
ited economic opportunities as sources of decreased mental
well-being and quality of life. Although homelessness is
related to negative mental well-being, the significant quality
Community Mental Health Journal
1 3
of life variables were different for women and men. Our
analysis strongly supports treating gender as an additional
layer of health inequity that must be considered in concert
with other social determinants of health and well-being.
Funding This study was funded by the Canadian Institutes of Health
Research Planning and Dissemination Grant (Grant 201408PDI)
“Pandemic Preparedness: Knowledge Translation in the Ontario
Homelessness Sector” to Kristy Buccieri. This study was funded by
the Canadian Institutes of Health Research (Grant 200904PAP-203559-
PAM-CEPA-119142), “Understanding Pandemic Preparedness in the
Context of the Canadian Homelessness Crisis” to Stephen Gaetz. This
study was funded by the Canadian Institutes of Health Research (Grant
20100H1N-218568-H1N-CEPA-119142) “Responding to H1N1 in the
Context of Homelessness in Canada” to Stephen Gaetz.
Compliance with Ethical Standards
Conflict of interest The authors declare that they have no conflict of
interest.
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