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Ellen L. Bassuk, MD; Linda F. Weinreb, MD; John C. Buckner, PhD; Angela Browne, PhD; Amy Salomon, PhD; Shari S. Bassuk

JAMA. 1996;276(8):640-646.

Abstract
Objective.
—To compare characteristics of homeless and low-income housed mothers across economic, psychosocial, and physical health domains.

Design.
—Case-control study.

Setting.
—Community of Worcester, Mass.

Participants.
—A cross-sectional sample of 220 sheltered homeless mothers and 216 low-income housed (never homeless) mothers receiving welfare.

Main Outcome Measures.
—Income, housing, life events, social support, history of abuse and assault, and mental and physical health.

Results.
—Comparison of homeless and housed mothers revealed some important similarities and differences. The proportion of homeless mothers with annual incomes of less than $7000 was 46% vs 17% for housed mothers (P<.01). Homeless mothers experienced more residential instability than the housed mothers (3.8 moves vs 1.8 moves; P<.001) and had smaller support networks (P<.001). More homeless mothers reported severe physical and sexual assault over the lifespan than housed mothers (91.6% vs 81.1%; P<.003). No significant differences were found between the groups in mental and physical health. However, the lifetime prevalence of major depressive disorder, posttraumatic stress disorder, and substance use disorders was overrepresented compared to the general female population. Both groups had lower physical functioning compared to the general population and a higher prevalence of chronic health conditions.

Conclusion.
—Sheltered homeless mothers had fewer economic resources and social supports and higher cumulative rates of violent abuse and assault over their lifespans than their housed counterparts. However, both groups faced extreme adversity that compromised family well-being. Practitioners and social policymakers need to be cognizant of the multiple economic, psychosocial, and physical health needs of these mothers in providing treatment and developing program interventions.

Author Affiliations
From The Better Homes Fund, Newton, Mass (Drs Bassuk, Browne, Buckner, and Salomon, and Ms Bassuk); the Department of Family and Community Medicine, University of Massachusetts Medical Center, Worcester (Dr Weinreb); the Department of Psychiatry, Harvard Medical School, Cambridge, Mass (Drs Bassuk and Buckner); and the Department of Epidemiology, Harvard School of Public Health, Boston, Mass (Ms Bassuk).

Footnotes
Reprints: Ellen L. Bassuk, MD, The Better Homes Fund, 181 Wells Ave, Newton, MA 02159.

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