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Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia

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Abstract

Purpose

This study used an experimental design to examine longitudinal changes in subjective quality of life (QoL) among homeless adults with mental illness after assignment to different types of supported housing or to treatment as usual (TAU, no housing or supports through the study). We hypothesized that subjective QoL would improve over time among participants assigned to supported housing as compared to TAU, regardless of the type of supported housing received or participants’ level of need.

Methods

Participants (n = 497) were stratified by level of need (“high” or “moderate”) and randomly assigned to Housing First (HF) in scattered-site apartments, HF in a congregate setting (high needs only), or TAU. Linear mixed-effects regression was used to model the association between study arm and self-reported QoL at baseline and at 6 and 12 months post-baseline by need level.

Results

Based on the adjusted overall score on the QoL measure, participants randomized to HF reported significantly greater overall QoL as compared to TAU, regardless of need level or type of supported housing at both 6 and 12 months post-baseline. Scores on the safety and living situation subscales were significantly greater for both high and moderate need participants assigned to supported housing regardless of type at both 6 and 12 months post-baseline as compared to TAU.

Conclusions

Despite multiple health and social challenges faced by homeless individuals with mental illness, HF in both scattered-site and congregate models results in significantly greater perceived QoL as compared to individuals who do not receive HF even after a relatively short period of time.

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Notes

  1. Support services were available to participants assigned to Housing First (ACT, CONG, and ICM) but were not mandatory. The only requirement for housing was compliance with the terms of the rental lease and weekly visits with a case manager to ensure safety and well-being [28].

  2. The CONG residence was located in downtown Vancouver in a neighborhood consisting of primarily businesses, including an inner-city hospital and a number of affluent condominiums.

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Acknowledgments

Special thanks to the Vancouver At Home service teams who are working with participants to increase their QoL, the Vancouver field research team, and the participants who gave their time to answer our questionnaires. The authors also thank the At Home/Chez Soi Project collaborative at national and local levels; National project team: J. Barker, PhD (2008–2011) and C. Keller, National Project Leads; P. Goering, RN, PhD, Research Lead; approximately 40 investigators from across Canada and the US; five site coordinators; numerous service and housing providers; and persons with lived experience.

Conflict of interest

This research was funded by Health Canada and the Mental Health Commission of Canada. The views expressed herein solely represent the authors. The authors declare no conflicts of interest.

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Correspondence to Michelle Patterson.

Appendix

Appendix

See Tables A1, A2, and A3.

Table A1 Comparison of baseline characteristics by study arm for high needs (n = 297) and moderate needs (n = 200) study arms
Table A2 Linear mixed-effects regression analysis to estimate the effects of Study Arm on QOLI-20 total score among high needs (HN) participants with imputed missing values
Table A3 Linear mixed-effects regression analysis to estimate the effects of Study Arm on QOLI-20 total score among moderate needs (MN) participants with imputed missing values

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Patterson, M., Moniruzzaman, A., Palepu, A. et al. Housing First improves subjective quality of life among homeless adults with mental illness: 12-month findings from a randomized controlled trial in Vancouver, British Columbia. Soc Psychiatry Psychiatr Epidemiol 48, 1245–1259 (2013). https://doi.org/10.1007/s00127-013-0719-6

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