This study examined the relationship between different forms of childhood violence (emotional, physical, and sexual) and these same forms of violence in adulthood, using a crosssectional baseline survey of 298 homeless and unstably housed women in San Francisco, California. We also examined other related factors, including mental illnesses diagnosis, sex exchange, jail time, HIV status, and sociodemographic information. Regression analysis indicated that although several of these factors were associated with experiences of violence as an adult, specific types of child violence (e.g., sexual violence) predicted instances of that same type of violence as an adult but not necessarily other types. Thus, risk of adult violence among low-income women may be better predicted and addressed through histories of same-type childhood violence, despite years of intervening exposures and stressors.

Background

Stress associated with minority statuses has been linked to mental health disorders. However, research conducted exclusively among impoverished women, a population known to be at risk for poor health owing to overlapping risks, is sparse. We sought to determine if homeless and unstably housed sexual minority (i.e., nonheterosexual) women were at greater psychiatric risk than their heterosexual counterparts. We also sought to determine if racial/ethnic minority and human immunodeficiency virus status contributed to psychiatric risks.

Methods

Homeless/unstably housed women living in San Francisco between 2008 and 2010 were followed biannually over 3 years. Generalized estimating equation analysis identified significant correlates of any substance use, mood, or anxiety disorder, as well as the total number of psychiatric disorders.

Results

Among 300 women, 24% reported nonheterosexual identity at the first study visit. Consistent with minority stress theory, lesbian and bisexual identity were associated with higher levels of mental health comorbidity, and bisexual identity was related to greater rates of substance use disorders and mood disorders. Unique to this study, we found that identity assessed 1 or 2 years prior does not predict current substance disorders, but current identity does. In addition, women who were infected with the human immunodeficiency virus also had higher rates of mental health comorbidity and substance use disorders. Contrary to psychosocial stress theory, racial/ethnic minority status was associated with reduced odds of substance use disorder in this population. Recent homelessness was related to greater risk of anxiety disorder.

Conclusions

Best research and health care practices should include the assessment of sexual orientation and housing status when addressing risks for mental health and substance disorders among low-income women.

In the present research, we examined the effects of childhood experiences of racism-both directly and vicariously experienced when directed at family members or close others-on postpartum depressive symptoms one month after the birth of a child. The sample included 1,349 African American women, who were predominantly low-income. Data were collected by an NIH network in five different regions of the United States using community-based participatory research methods. Participants completed interview measures of childhood experiences of racism, current everyday experiences of discrimination, and postpartum depressive symptoms at one month after birth. We also assessed adult everyday experiences of discrimination as a potential mediator of the association between childhood racism and depressive symptoms. Direct and vicarious childhood racism experiences were each independently associated with greater postpartum depressive symptoms. Furthermore, when adult everyday experiences of racism were included in the models, the effects of childhood racism were no longer significant, suggesting mediation. Consistent with this hypothesis, associations between both childhood direct and indirect racism experiences and postpartum depressive symptoms were partially mediated by the participant's everyday experiences of racism as an adult. Our findings suggest that childhood racism experiences, even those that are observed rather than directly experienced, may have implications for future mental health.