Depression is associated with poor physical health through lower distress tolerance among adults experiencing homelessness

ABSTRACT

Research is limited on the association between depression and perceived health status and the underlying mechanisms linking these variables among adults experiencing homelessness. The purpose of the current study was to evaluate the association between probable major depressive disorder (MDD) and perceived health status among a sample of adults experiencing homelessness and to determine whether this association is indirectly linked through distress tolerance. Adults experiencing homelessness were recruited from six homeless shelters in Oklahoma City, OK (n = 568). Participants self-reported their health status as poor/fair, probable MDD was assessed using Patient Health Questionnaire-8, and distress tolerance was assessed via the Distress Tolerance Scale (DTS with four subscales). Covariate-adjusted structural equation model indicated a significant indirect effect of MDD on health status through total distress tolerance (indirect effect = 0.070, 95% CI = 0.027, 0.118). The multiple mediation model with four DTS subscales indicated that only the appraisal subscale contributed independent variance to the indirect effect model (indirect effect = 0.067, 95% CI = 0.026, 0.111). Adults experiencing homelessness are at higher risk of probable MDD, negatively influencing their perception of health and quality of life. Results suggest the need for providing support to improve distress tolerance skills among those diagnosed with probable MDD to improve their health perception.

KEYWORDS:

• Major depressive disorder
• perceived health
• appraisal
• structural equation model
• indirect effect

Acknowledgements

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by an Oklahoma Tobacco Settlement Endowment Trust (TSET) [grant number 092-016-0002 (to MSB)].

Notes on contributors

Sajeevika S. Daundasekara

Dr Sajeevika S. Daundasekara is a Postdoctoral Research Fellow at the Cizik School of Nursing at the University of Texas Health Science Center at Houston. Her research focuses on investigating the health and nutrition of underserved vulnerable populations including low income families, individuals expiring homelessness, racial and ethnic minorities, pregnant women and women with children.

Chisom N. Iwundu

Dr Chisom N. Iwundu is an Assistant professor in the Department of Rehabilitation and Health Services, at the University of North Texas, Denton. Prior to joining the University of North Texas, she was a Postdoctoral Fellow in a partnership program supported by the University of Houston and MD Anderson Cancer Center. Her research is focused on understanding the social determinants of health that accounts for disparities in health and health risk behaviors among marginalized groups, such as homeless adults. Dr. Iwundu is a member of the American Academy of Health Behavior, American Public Health Association, and the Society for Epidemiologic Research.

Daphne C. Hernandez

Dr Daphne C. Hernandez is the Lee and Joseph Jamail Distinguished Professor and Associate Professor at the University of Texas Health Science Center – Houston, Cizik School of Nursing. Dr. Hernandez is a developmental psychologist who has extensive experience studying gender and race/ethnic health disparities resulting from poverty-related issues, including food insecurity and obesity across the life span. Her areas of expertise also include investigating the health of low-income Latino immigrants, housing insecurity and homelessness, and barriers to physical activity. She on the board of directors for the American Academy of Health Behavior and the Chair of the Inclusion and Diversity Committee and Secretary/Treasurer for the Family Health section for the National Council on Family Relations. She is also an Associate Editor for Family and Community Health. Her research efforts are currently funded by the National Institute of Child Health and Human Development, William T. Grant Foundation, and the USDA.

Diane Santa Maria

Dr Diane Santa Maria is an Associate Professor and Dean at the Cizik School of Nursing at the University of Texas Health Science Center at Houston. She has developed, implemented, and tested interventions among youth and young adults experiencing homelessness using person-centered research methods including randomized controlled trials with a particular focus on HIV/STI/pregnancy prevention and treatment.

Michael J. Zvolensky

Michael J. Zvolensky is a Distinguished Professor in the Department of Psychology at University of Houston and Director of the Anxiety and Health Research Laboratory and Substance Use Treatment Clinic. He has published over 750 peer-reviewed articles and books/book chapters on the co-occurrence of anxiety and stress-related psychopathology with substance use disorders, health behavior problems, and physical illness (e.g. chronic pain). His work is globally aimed at eliminating inequalities in psychopathology, addictive, and other health risk behaviors through translational research.

Darla E. Kendzor

Darla E. Kendzor is a tenured Associate Professor in the Department of Family and Preventive Medicine at the University of Oklahoma Health Sciences Center, Co-Director of the Health Promotion Research Center (HPRC), and Co-Leader of the Cancer Prevention and Control Program of the NCI-Designated Stephenson Cancer Center. She is the founding director of the Tobacco Treatment Research Program (TTRP), which offers tobacco cessation counseling and pharmacotherapy free-of-charge to the public while (1) collecting data relevant to the process of quitting and (2) facilitating recruitment into ongoing research studies. Broadly, her research has focused on tobacco use and cessation interventions, cancer prevention through lifestyle change, health disparities, and mobile health.

Michael S. Businelle

Dr Michael S. Businelle is a tenured Associate Professor in the Department of Family and Preventive Medicine at the University of Oklahoma Health Sciences Center (OUHSC), Co-Director of the Health Promotion Research Center (previously the Oklahoma Tobacco Research Center), and Director of the mHealth Shared Resource at the NCI Designated Stephenson Cancer Center. He has a flourishing program of nationally recognized research that has primarily focused on using smartphone based ecological momentary assessment methods in underserved populations to: (1) identify barriers to health behavior change, (2) predict imminent smoking lapse and heavy drinking days, and (3) develop and test novel smartphone based just-in-time adaptive interventions (JITAI) for health behavior change.