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Factors Associated With Symptoms of Depression and Anxiety Among Women Experiencing Homelessness and Unstable Housing During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The prevalence of depression among individuals in the US has increased 300% during the COVID-19 pandemic, with a greater burden of illness in individuals with lower incomes.1 With the goal of informing adaptation of services for socioeconomically marginalized individuals, we surveyed mental health symptoms and social challenges experienced during the COVID-19 pandemic among women experiencing homelessness and unstable housing (HUH). Extrapolating from the available evidence,2,3 there are approximately 440 000 women experiencing HUH in the US.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: May 5, 2021.

Published: July 14, 2021. doi:10.1001/jamanetworkopen.2021.17035

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Riley ED et al. JAMA Network Open.

Corresponding Author: Elise D. Riley, PhD, MPH, Department of Medicine, University of California, San Francisco, 1001 Potrero Ave, Mailbox 0874, San Francisco, CA 94143-0874 (elise.riley@ucsf.edu).

Author Contributions: Dr Riley and Ms Dilworth had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Riley, Weiser.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Riley.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Dilworth, Neilands.

Obtained funding: Riley.

Administrative, technical, or material support: Riley, Dilworth, Satre.

Supervision: Riley, Mangurian.

Conflict of Interest Disclosures: Dr Silverberg reported receiving grants from Gilead Sciences, Inc outside the submitted work. Dr Neilands reported receiving grants from the National Institutes of Health (NIH) as coinvestigator outside the submitted work. Dr Mangurian reported receiving grants from the NIH, Genentech, Weston Havens, Doris Duke Charitable Foundation, and the California Health Care Foundation outside the submitted work. Dr Weiser reported receiving grants from the NIH, SF Hearts Foundation, Kaiser Community Benefits, and TDRP outside the submitted work. No other disclosures were reported.

Funding/Support: This research was supported by RGPO Emergency COVID-19 Research Seed Funding provided by the California HIV/AIDS Research Program of the University of California (grant R00RG3097 to Dr Riley) and the NIH (grants R01 DA037012, R01 DA049648, and K24 DA039780 to Dr Riley). Dr Satre was also supported by the Dolby Family Center for Mood Disorders at the University of California, San Francisco.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Meeting Presentation: Portions of this article were presented at the 2021 International Women’s and Children’s Health and Gender (InWomen’s) Group Conference (breakout session 5); June 18, 2021; https://web.cvent.com/event/b4bae4b4-896d-4125-b512-bfbb0b8f37f0/websitePage:adc4407a-ff86-4457-a889-84f3d36ae609.

Additional Contributions: Carl Braun, BS, Aron O’Donnell, BS, and Lizet Campos, BS (all from University of California, San Francisco), assisted with data collection. Elizabeth Chur, BA (freelance editor), provided editing assistance. All acknowledged individuals received compensation for their contributions and agreed to be named here.

References
1.
Ettman  CK , Abdalla  SM , Cohen  GH , Sampson  L , Vivier  PM , Galea  S .  Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic.   JAMA Netw Open. 2020;3(9):e2019686. doi:10.1001/jamanetworkopen.2020.19686PubMedGoogle Scholar
2.
Henry  M , deSousa  T , Roddey  C , Swati  G , Bednar  TJ . The 2020 Annual Homeless Assessment Report (AHAR) to Congress. The U.S. Department of Housing and Urban Development; Office of Community Planning and Development. Published January 2021. Accessed June 8, 2021. https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf
3.
Riley  ED , Cohen  J , Knight  KR , Decker  A , Marson  K , Shumway  M .  Recent violence in a community-based sample of homeless and unstably housed women with high levels of psychiatric comorbidity.   Am J Public Health. 2014;104(9):1657-1663. doi:10.2105/AJPH.2014.301958PubMedGoogle ScholarCrossref
4.
Kroenke  K , Spitzer  RL , Williams  JB .  The PHQ-9: validity of a brief depression severity measure.   J Gen Intern Med. 2001;16(9):606-613. doi:10.1046/j.1525-1497.2001.016009606.xPubMedGoogle ScholarCrossref
5.
Spitzer  RL , Kroenke  K , Williams  JB , Löwe  B .  A brief measure for assessing generalized anxiety disorder: the GAD-7.   Arch Intern Med. 2006;166(10):1092-1097. doi:10.1001/archinte.166.10.1092PubMedGoogle ScholarCrossref
6.
Riley  ED , Delucchi  K , Rubin  S , Weiser  SD , Vijayaraghavan  M , Tsoh  J . Informing tobacco cessation interventions for homeless and unstably housed women. Society for Research on Nicotine and Tobacco annual meeting; poster 86, poster session 4. Published February 28, 2020. Accessed June 8, 2021. https://cdn.ymaws.com/www.srnt.org/resource/resmgr/conferences/2020_annual_meeting/SRNT20_Abstracts_NEW_0227202.pdf
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