Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness
Abstract
:1. Introduction
- Greater urban stress would be associated with increased likelihood of psychological symptoms (i.e., depression and PTSD).
- Greater urban stress would be associated with lower distress tolerance, and greater distress tolerance would be associated with decreased likelihood of psychological symptoms. Thus, the negative impact of urban stress on psychological symptoms would be associated through lower distress tolerance.
- Greater urban stress would be associated with lower perceived social support, and greater perceived social support would be associated with decreased likelihood of psychological symptoms. Thus, the negative impact of urban stress on psychological symptoms would be associated via lower social support.
- Lower perceived social support would be associated with lower distress tolerance. The negative impact of urban stress on psychological symptoms would be associated through the impact of social support on distress tolerance.
2. Materials and Methods
2.1. Study Participants and Data Collection
2.2. Measures
2.2.1. Major Depressive Disorder
2.2.2. PTSD Symptoms
2.2.3. Urban Life Stress
2.2.4. Distress Tolerance
2.2.5. Perceived Social Support
2.2.6. Covariates
2.3. Statistical Analysis
3. Results
3.1. Descriptive Analysis
3.2. Indirect Effect Model for Major Depressive Disorder
3.3. Indirect Effect Model for PTSD Symptoms
4. Discussion
Implications for Practice
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Characteristics | N (%) or Mean (SD) |
---|---|
Mental health outcomes | |
Depression | 174 (30.7%) |
PTSD symptoms | 184 (32.5%) |
Predictor variable | |
Urban life stress | 48.92 (14.86) |
Mediator variables | |
Distress tolerance | 3.10 (0.98) |
Perceived social support | 32.95 (8.73) |
Socio-demographic characteristics | |
Age (years) | 43.56 (12.0) |
Sex | |
Male | 360 (63.5%) |
Female | 207 (36.5%) |
Race/ethnicity | |
White/non-minority | 321 (56.6%) |
Minority | 246 (43.4%) |
Marital status | |
Married | 70 (12.4%) |
Not married | 497 (87.6%) |
Education | |
Less than high school diploma | 147 (25.9%) |
High school diploma or higher | 420 (74.1%) |
Employment status | |
Employed | 66 (11.6%) |
Unemployed/disability limiting employment | 501 (88.4%) |
Sources of income | |
No source of income | 305 (53.8%) |
Have at least one source of income | 262 (46.2%) |
Health insurance | |
No health insurance | 399 (70.4%) |
Insured to any extent | 168 (29.6%) |
Health behaviors | |
Alcohol abuse/dependence | 155 (27.3%) |
Current smoker | 444 (78.3%) |
Homelessness characteristics | |
Total amount of time homeless (years) | 3.17 (4.31) |
Shelter services utilization (number of services used) | 4.48 (2.52) |
Variables | 1 | 2 | 3 | 4 | 5 |
---|---|---|---|---|---|
Main study variables | |||||
Depression | 1.00 | ||||
PTSD symptoms | 0.41 *** | 1.00 | |||
Urban life stress | 0.42 *** | 0.38 *** | 1.00 | ||
Distress tolerance | −0.40 *** | −0.30 *** | −0.49 *** | 1.00 | |
Perceived social support | −0.37 *** | −0.24 *** | −0.35 *** | 0.36 *** | 1.00 |
Covariates | |||||
Age | 0.05 | 0.04 | 0.02 | 0.02 | −0.10 * |
Sex (Female) | 0.11 * | 0.16 *** | 0.10 * | −0.10 * | 0.07 |
Race/ethnicity (White/non-minority) | 0.09 * | 0.01 | 0.01 | −0.01 | −0.05 |
Marital status (Married) | −0.04 | −0.08 | −0.001 | −0.02 | 0.13 ** |
Education (Less than high school) | −0.01 | −0.06 | 0.06 | −0.12 ** | −0.07 |
Employment (unemployed) | 0.06 | 0.03 | 0.08 * | −0.02 | −0.06 |
Income (no source of income) | 0.04 | −0.02 | −0.01 | −0.06 | −0.01 |
Health insurance (uninsured) | −0.05 | −0.06 | 0.02 | −0.04 | 0.07 |
Alcohol abuse/dependence | 0.06 | 0.13 ** | 0.17 *** | −0.12 ** | −0.09 * |
Current smoker | 0.04 | 0.06 | 0.03 | -0.06 | −0.04 |
Total amount of time homeless | −0.02 | 0.06 | 0.02 | 0.001 | −0.08 |
Shelter services utilization | 0.01 | 0.04 | 0.02 | −0.01 | 0.02 |
Indirect Effect | b | SE | 95% Bootstrap CI |
---|---|---|---|
Urban life stress → Distress tolerance → Depression | 0.101 | 0.022 | 0.061, 0.147 |
Urban life stress → Perceived social support → Depression | 0.091 | 0.020 | 0.053, 0.133 |
Urban life stress → Perceived social support → Distress tolerance → Depression | 0.022 | 0.007 | 0.011, 0.037 |
Indirect Effect | b | SE | 95% Bootstrap CI |
---|---|---|---|
Urban life stress → Distress tolerance → PTSD symptoms | 0.065 | 0.022 | 0.023, 0.112 |
Urban life stress → Perceived social support → PTSD symptoms | 0.043 | 0.019 | 0.006, 0.082 |
Urban life stress → Perceived social support → Distress tolerance → PTSD symptoms | 0.014 | 0.006 | 0.005, 0.026 |
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Share and Cite
Hernandez, D.C.; Daundasekara, S.S.; Zvolensky, M.J.; Reitzel, L.R.; Maria, D.S.; Alexander, A.C.; Kendzor, D.E.; Businelle, M.S. Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness. Int. J. Environ. Res. Public Health 2020, 17, 5301. https://doi.org/10.3390/ijerph17155301
Hernandez DC, Daundasekara SS, Zvolensky MJ, Reitzel LR, Maria DS, Alexander AC, Kendzor DE, Businelle MS. Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness. International Journal of Environmental Research and Public Health. 2020; 17(15):5301. https://doi.org/10.3390/ijerph17155301
Chicago/Turabian StyleHernandez, Daphne C., Sajeevika S. Daundasekara, Michael J. Zvolensky, Lorraine R. Reitzel, Diane Santa Maria, Adam C. Alexander, Darla E. Kendzor, and Michael S. Businelle. 2020. "Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness" International Journal of Environmental Research and Public Health 17, no. 15: 5301. https://doi.org/10.3390/ijerph17155301