0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Brief Reports   |    
Religiosity Among Adults Who Are Chronically Homeless: Association With Clinical and Psychosocial Outcomes
Jack Tsai, Ph.D.; Robert A. Rosenheck, M.D.
Psychiatric Services 2011; doi: 10.1176/appi.ps.62.10.1222
View Author and Article Information

Copyright © 2011 by the American Psychiatric Association.

Abstract

Objective:  This study examined changes in religious faith among homeless people enrolled in a supported housing program and their association with clinical and psychosocial outcomes.

Methods:  A total of 582 clients at 11 sites were separated into three groups based on whether they reported a decrease, an increase, or no change in their religiosity scores at one-year follow-up. Groups were compared on outcomes controlled for baseline measures.

Results:  At one-year follow-up, participants who gained faith reported doing more volunteer work, being more engaged in community activities, and having a higher quality of life than those who lost faith. Participants who reported a large gain in faith had better mental health ratings than those who reported a large loss in faith.

Conclusions:  Religious faith is a correlate of improvement among chronically homeless adults and may influence clinical and psychosocial outcomes. (Psychiatric Services 62:1222–1224, 2011)

Abstract Teaser
Figures in this Article

Research suggests that religious beliefs and practices are commonly helpful for people with severe mental illness (1,2). Yet spiritual assessments are not a part of regular mental health care and are not well accepted by psychiatrists (3). There have been no published studies, to our knowledge, that address whether changes in religious faith among adults who are chronically homeless are related to improved functioning.

Most supported housing programs do not adhere to any religious ideology and cannot promote religion through their governmentally funded services. This study examined changes in self-reported religious faith over a one-year period among adults who were chronically homeless and their association with clinical and psychosocial outcomes. We hypothesized that increased religiosity would be associated with better outcomes.

Data were collected from 2004 to 2009 from 582 clients at 11 sites participating in the Collaborative Initiative to Help End Chronic Homelessness, or CICH (4). CICH provided adults who were chronically homeless with permanent housing and supportive primary health care and mental health services. None of the providers were faith-based organizations. All participants provided written informed consent, and study procedures were approved by institutional review boards at each site. All measures described below were collected at baseline and one-year follow-up.

Religiosity was assessed by two items, adapted from a previous study (5), that asked participants to rate on a 4-point scale how important their religious belief or faith had been in their lives and how helpful it had been in dealing with personal problems in the previous three months. Responses are 0, not at all; 1, slightly; 2, somewhat; and 3, extremely. Responses to the two questions were averaged for a total score. An additional item, not included in the total score, asked participants to rate on a 4-point scale how often they attended a service at a church, synagogue, mosque, temple, or other place of worship in the previous three months, from 0 (not at all) to 3 (once a week or more).

Participants reported their nighttime residence every day for the previous three months. Residence was categorized as nights living in one's own place, nights living in an institution, or nights homeless. They were also asked whether they worked for pay or did volunteer work and the average number of hours worked per week of each type in the past month.

The Medical Outcomes Study Short Form-12 (SF-12) (6), the Brief Symptom Inventory (BSI) (7), an observed-psychotic behavior rating scale (8), and the Addiction Severity Index (ASI) (9) were used to assess general physical health, mental health, and substance abuse.

General subjective quality of life was assessed with one item from the Lehman Quality of Life Interview (10), community participation by asking participants about their typical activities during the previous two weeks (11), and social support by asking participants the number of types of persons (such as brother or sister, parent, clergy, friend, or neighbor) they could have counted on for support in the previous three months (12).

Participants were split into three groups on the basis of whether their mean religiosity scores increased, decreased, or did not change during their first year in the program. Baseline differences between groups were tested with one-way analyses of variance and chi square tests.

Outcome data were analyzed with analyses of covariance on outcomes, controlling for baseline religiosity scores and baseline values of dependent variables. Post hoc group comparisons were made with Fisher's least significant difference test.

Outcome analyses were repeated using an extreme groups design on a subsample of participants whose mean religiosity score increased or decreased by ≥1.

The mean±SD age of participants was 45.59±8.38; 75% were male, 86% were white or black, 99% were not married, and 29% were veterans. They had 11.78±2.54 years of education, had been homeless for 8.29±6.28 years, and had a baseline religiosity score of 1.81±.91 (possible range 0–3).

A total of 263 participants were classified as having lost faith, 157 as having had no change in faith, and 162 as having gained faith. There were no significant differences between the groups on any sociodemographic characteristics, homeless history, mental health diagnosis, or measures of housing, work, clinical status, or community life at baseline. One-year follow-up analyses that controlled for baseline religiosity scores and baseline values of dependent variables showed that as expected, the group that gained faith had a significantly higher mean religiosity score than the group that lost faith and reported more frequent attendance at religious services. The group that gained faith also reported doing more volunteer work, having a higher quality of life, and participating in more community activities (Table 1).

Analyses were repeated for only participants with an increase (N=60) or decrease (N=94) ≥1 in religiosity score. After we controlled for baseline differences and baseline values of dependent variables, participants who had a large gain in faith showed significantly more positive functioning on several outcomes, including higher scores for the SF-12 mental health measure (F=4.01, df=1 and 147, p<.05), lower symptom scores on the BSI (F=7.50, df=1 and 147, p<.01), lower scores on the ASI-Alcohol (F=5.56, df=1 and 147, p<.05), higher score on subjective quality of life (F=18.64, df=1 and 147, p<.001), and greater participation in community activities (F=4.00, df=1 and 147, p<.05) than participants who had a large loss in faith.

This study examined religious faith among a sample of adults who had been chronically homeless. A majority of participants rated their religious faith as more than slightly important in their lives and as helpful in dealing with their personal problems. Participants who showed any gain in religious faith during a one-year period did not report greater improvements in clinical symptoms compared with those who lost faith, but they did more volunteer work, engaged in more community activities, and reported a higher quality of life. A subgroup of participants whose faith grew by a relatively large amount reported significant improvements in mental health symptoms compared with participants whose faith was substantially weakened.

These findings were consistent with previous research (1,2). Although encouraging religious faith among participants in supported housing programs may be useful, mental health providers may benefit from specific training in this area to address resistance to discussing religiosity with clients (3) and concerns about infringing on First Amendment rights to the free exercise of religion.

Several limitations deserve comment. Because this study was observational, it is possible that improvements in mental health and psychosocial outcomes led to increases in religious faith, rather than the other way around. However, we speculate that even though none of the providers in CICH were faith based, many adults who are chronically homeless are often exposed to religious encouragement as part of the services and treatment they seek (13). Finally, although we were concerned about regression to the mean on changes in religiosity scores, we controlled for it by entering baseline religiosity scores and baseline values of dependent variables in all analyses.

Religious faith is important to many adults who are chronically homeless, and changes in religious faith may influence clinical and psychosocial outcomes. Assessing religious faith among clients and encouraging religiosity as a coping strategy may be useful to consider as components in supported housing services.

The CICH Funder's Group, representing the Departments of Housing and Urban Development and Health and Human Services and the Department of Veterans Affairs, provided essential support and guidance to this evaluation. This material is also based on work supported by the Veterans Health Administration Office of Research and Development. The views presented here are those of the authors and do not represent the position of any federal agency or of the United States government.

The authors report no competing interests.

Matthews  DA;  McCullough  ME;  Larson  DB  et al:  Religious commitment and health status.  Archives of Family Medicine 7:118–124, 1998
 
Tepper  L;  Rogers  SA;  Coleman  EM  et al:  The prevalence of religious coping among persons with persistent mental illness.  Psychiatric Services 52:660–665, 2001
 
Huguelet  P;  Mohr  S;  Betrisey  C  et al:  A randomized trial of spiritual assessment of outpatients with schizophrenia: patients' and clinicians' experience.  Psychiatric Services 62:79–86, 2011
 
Mares  AS;  Rosenheck  RA:  Twelve-month client outcomes and service use in a multisite project for chronically homelessness adults.  Journal of Behavioral Health Services and Research 37:167–183, 2010
 
Koenig  HG;  Cohen  HJ;  Blazer  DG  et al:  Religious coping and depression among elderly, hospitalized medically ill men.  American Journal of Psychiatry 149:1693–1700, 1992
 
Ware  JE;  Kosinski  M;  Keller  SE:  How to Score the SF-12 Physical and Mental Health Summary Scales , 3rd ed.  Lincoln, RI,  Quality Metric, 1998
 
Derogatis  LR;  Spencer  N:  The Brief Symptom Index: Administration, Scoring, and Procedure Manual .  Baltimore,  Johns Hopkins University Press, 1982
 
Dohrenwend  B:  Psychiatric Epidemiology Research Interview (PERI) .  New York,  Columbia University Social Psychiatry Unit, 1982
 
McLellan  AT;  Luborsky  L;  Woody  GE  et al:  An improved diagnostic evaluation instrument for substance abuse patients: the Addiction Severity Index.  Journal of Nervous and Mental Disease 168:26–33, 1980
 
Lehman  AF:  A quality of life interview for the chronically mentally ill.  Evaluation and Program Planning 51:51–62, 1988
 
Katz  AH:  Social adaptation in chronic illness: a study of hemophilia.  American Journal of Public Health and the Nation's Health 53:1666–1675, 1963
 
Vaux  A;  Athanassopulou  M:  Social support appraisals and network resources.  Journal of Community Psychology 15:537–556, 1987
 
Aron  LY;  Sharkey  PT:  The 1996 National Survey of Homeless Assistance Providers and Clients: A Comparison of Faith-Based and Secular Non-Profit Programs .  Washington, DC,  Urban Institute, 2002
 
References Container
 
Anchor for JumpAnchor for Jump
Table 1

Religiosity and other characteristics of 582 chronically homeless adults with different faith experiences at one-year follow-up

Table 1 

Religiosity and other characteristics of 582 chronically homeless adults with different faith experiences at one-year follow-up

+

References

Matthews  DA;  McCullough  ME;  Larson  DB  et al:  Religious commitment and health status.  Archives of Family Medicine 7:118–124, 1998
 
Tepper  L;  Rogers  SA;  Coleman  EM  et al:  The prevalence of religious coping among persons with persistent mental illness.  Psychiatric Services 52:660–665, 2001
 
Huguelet  P;  Mohr  S;  Betrisey  C  et al:  A randomized trial of spiritual assessment of outpatients with schizophrenia: patients' and clinicians' experience.  Psychiatric Services 62:79–86, 2011
 
Mares  AS;  Rosenheck  RA:  Twelve-month client outcomes and service use in a multisite project for chronically homelessness adults.  Journal of Behavioral Health Services and Research 37:167–183, 2010
 
Koenig  HG;  Cohen  HJ;  Blazer  DG  et al:  Religious coping and depression among elderly, hospitalized medically ill men.  American Journal of Psychiatry 149:1693–1700, 1992
 
Ware  JE;  Kosinski  M;  Keller  SE:  How to Score the SF-12 Physical and Mental Health Summary Scales , 3rd ed.  Lincoln, RI,  Quality Metric, 1998
 
Derogatis  LR;  Spencer  N:  The Brief Symptom Index: Administration, Scoring, and Procedure Manual .  Baltimore,  Johns Hopkins University Press, 1982
 
Dohrenwend  B:  Psychiatric Epidemiology Research Interview (PERI) .  New York,  Columbia University Social Psychiatry Unit, 1982
 
McLellan  AT;  Luborsky  L;  Woody  GE  et al:  An improved diagnostic evaluation instrument for substance abuse patients: the Addiction Severity Index.  Journal of Nervous and Mental Disease 168:26–33, 1980
 
Lehman  AF:  A quality of life interview for the chronically mentally ill.  Evaluation and Program Planning 51:51–62, 1988
 
Katz  AH:  Social adaptation in chronic illness: a study of hemophilia.  American Journal of Public Health and the Nation's Health 53:1666–1675, 1963
 
Vaux  A;  Athanassopulou  M:  Social support appraisals and network resources.  Journal of Community Psychology 15:537–556, 1987
 
Aron  LY;  Sharkey  PT:  The 1996 National Survey of Homeless Assistance Providers and Clients: A Comparison of Faith-Based and Secular Non-Profit Programs .  Washington, DC,  Urban Institute, 2002
 
References Container
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 33.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 32.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 2.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 29.  >
The American Psychiatric Publishing Textbook of Geriatric Psychiatry, 4th Edition > Chapter 32.  >
Topic Collections
Psychiatric News
APA Guidelines
PubMed Articles