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LETTER |
Correspondence: Requests for reprints should be sent to Benjamin E Alexander-Eitzman, MSW, LCSW, George Warren Brown School of Social Work, Campus Box 1196, Washington University in St. Louis, St Louis, MO 63130-4899 (e-mail: baeitzman{at}gwbmail.wustl.edu).
The study of the risk factors associated with the length of homeless episodes in a group of New York shelter residents1 by Caton et al. tells an important and detailed story of the natural history of housing problems, but the individual-level approach taken by the authors represents a problematic trend in research on homelessness. Caton et al. focus on etiological risk factors among the usual suspects—substance use, personality characteristics, demographics, and mental health diagnoses—with some surprising additions, such as childhood family environment and psychosocial adjustment as measured by the Modified Erikson Psychosocial Stage Inventory.2
The assumption inherent in Caton and colleagues’ study is that a complex social problem such as homelessness has defined personal-level determinants that may be dissected by means of the common methods of epidemiology. In my opinion, this represents a "public healthification"3(p1189) of homelessness, to use Meyer and Schwartz’s words, in that homelessness is "studied as if it were a disease, an outcome defined as residing in the individual."3(p1190) In this case, the tools have defined the problem. Caton et al. chose predictors of homelessness from a common pool of psychopathology, childhood family environment, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV )4 criteria, and psychosocial adjustment. It is not surprising that in the final Cox regression analysis of risk factors associated with duration of homeless episodes, the only significant parameters were for older age group and arrest history.
The suggestion by Caton et al., that we should focus on the stability of housing arrangements prior to homeless episodes, only touches on possible avenues to homelessness beyond the aforementioned usual suspects. Where, in a geographically specific sense, did this population come from? What were the economic, environmental, or neighborhood characteristics of previous living arrangements or of potential local living arrangements? An accurate assessment of the determinants of the course of homelessness must include multiple levels of analysis, including dynamic interactions between personal, environmental, and social factors. Longitudinal studies of the course of homelessness present the opportunity for new insights into these interactions in what is clearly a heterogeneous population. My hope is that we will use this opportunity to expand, rather than narrow, our field of inquiry.
References
1. Caton CL, Dominguez B, Schanzer B, et al. Risk factors for long-term homelessness: findings from a longitudinal study of first-time homeless single adults. Am J Public Health. 2005;95:1753–1759.
2. Darling-Fisher CS, Leidy NK. Measuring Eriksonian development in the adult: the Modified Erikson Psychosocial State Inventory. Psychol Rep. 1988; 62:747–754.[ISI][Medline]
3. Meyer IH, Schwartz S. Social issues as public health: promise and peril [editorial]. Am J Public Health. 2000;90:1189–1191.
4. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC: American Psychiatric Association; 1994.
This article has been cited by other articles:
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  C. L. M. Caton, P. E. Shrout, D. S. Hasin, A. Felix, B. Schanzer, L. A. Opler, H. McQuistion, and B. Dominguez CATON ET AL. RESPOND Am J Public Health, May 1, 2006; 96(5): 764 - 765. [Full Text] [PDF]
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