Spirituality and mental health among homeless mothers.

Author:Hodge, David R.
Position:Report
 
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Mothers are one of the fastest growing segments of the homeless population in the United States. Although mental health problems often contribute to homelessness, little is known about the factors that affect mothers' mental health. To help identify protective factors, this longitudinal study examined the relationship between spirituality and mental health among a sample of homeless women with children (N = 222). A growth curve analysis was conducted to examine relationships over a 15-month time span. Forgiveness, congregational problems, negative religious coping, and spiritual meaning all variously predicted mental health outcomes. The implications of these findings are discussed as they intersect practice with homeless mothers.

KEY WORDS: homelessness; mental health; mothers; religion; spirituality

Over the course of the past few decades, homelessness has emerged as a significant social issue (Fertig & Reingold, 2008). Obtaining accurate estimates of the number of homeless individuals is difficult because of the use of different definitions of homelessness and problems counting the homeless (Rollins, Saris, & Johnston-Robledo, 2001). For instance, according to the U.S. Department of Housing and Urban Development's latest Annual Homeless Assessment Report (2010), an estimated 643,067 people lived on the streets or in shelters on a single night, and 1.56 million people used an emergency shelter or a transitional housing program over the course of a 12-month period. Although estimates vary, general agreement exists that the number of homeless people in the United States has increased dramatically since the late 1970s (Wachholz, 2005).

In addition to growing in size, the composition of the homeless population has changed substantially over the past few decades (Averitt, 2003; T. N. Richards, Garland, Bumphus, & Thompson, 2010). Families with children have emerged as a major component of the homeless population (Meadows-Oliver, 2003; Paquette & Bassuk, 2009; Weinreb, Nicholson, Anthes, & Williams, 2007). The majority of homeless families are headed by single mothers (Goldberg, 1999). Indeed, according to some commentators, women are the fastest growing segment of the homeless population in the United States (Arangua, Andersen, & Gelberg, 2006).

The causes underlying the changing composition of the homeless population are not fully understood (Lehmann, Kass, Drake, & Nichols, 2007). The increase in the number of homeless families is not limited to the United States, but extends to Canada (Schiff, 2007), the United Kingdom (Tischler & Vostanis, 2007), and perhaps other countries as well (Daiski, 2007). Although a small but growing body of research on homeless mothers exists, this area of inquiry is still in its infancy (Cosgrove & Flynn, 2005; Gelberg, Browner, Lejano, & Arangua, 2004; Stainbrook & Homik, 2006).

One relatively established contributor to homelessness among mothers is mental health status (Arangua et al., 2006; Fertig & Reingold, 2008; Lee & Oyserman, 2009; Tischler, Rademeyer, & Vostanis, 2007; Williams & Hall, 2009; Zlomick, Tam, & Bradley, 2007). The relationship between mental health and homelessness is complex. Poor psychological health can be both an antecedent to, and a consequence of, homelessness (Philippot, Lecocq, Sempoux, Nachtergael, & Galand, 2007). In terms of the former, the onset of a mental disorder can, for example, lead to deteriorating social and economic conditions that eventually result in homelessness (Weinreb et al., 2007).

Many events unrelated to the onset of a mental disorder can result in women becoming homeless, including domestic violence, unaffordable rents, divorce or separation, condemned housing, loss of employment, and so on (Meadows-Oliver, 2003; Rollins et al., 2001; Tischler et al., 2007). On becoming homeless, mothers often report experiencing deep senses of loss, stress, or depression (Meadows-Oliver, 2003). Negative life events, cumulating with the loss of their homes and their struggle to adapt to a homeless lifestyle while parenting children, can overwhelm mothers, resulting in increased depression, anxiety, and other mental health problems (Banyard & Graham-Bermann, 1998; Tischler et al., 2007). In turn, the onset of various forms of psychological distress caused by becoming homeless can hinder women's ability to exit homelessness, causing a downward spiral (Daiski, 2007).

Although it is generally accepted that homelessness is stressful and the mental health of homeless mothers is often poor, relatively little is known about the factors that affect the mental health of these women (Tischler et al., 2007). Given the stigma homeless mothers often face, it is particularly important to focus on the strengths or protective factors that help mothers deal with mental health problems (Cosgrove & Flynn, 2005; Wachholz, 2005). Protective factors can be understood as variables that facilitate positive outcomes by buffeting individuals from constructs that place them at risk (Fraser, Richman, & Galinsky, 1999; Smith, 2006). One such factor that may help engender positive mental health among homeless mothers is spirituality (Larkin, Beckos, & Martin, in press).

SPIRITUALITY AND MENTAL HEALTH

A growing body of evidence suggests that spirituality is positively associated with women's mental health (Dailey & Stewart, 2007). Similarly, reviews of the extant research on spirituality and mental health have found generally positive associations (Ano & Vasconcelles, 2005; Hackney & Sanders, 2003; H. G. Koenig, 2007; H. G. Koenig, McCullough, & Larson, 2001; Shreve-Neiger & Edelstein, 2004). Although it is important to note that the results are not unifomly positive, in aggregate, higher levels of spirituality tend to be linked to greater psychological well-being in hundreds of studies (H. G. Koenig, 2008).

This emerging body of evidence is consistent with studies exploring coping strategies among homeless women. A number of qualitative studies have found that both women (Bhui, Shanahan, & Harding, 2006; Montgomery, 1994; Washington, Moxley, Garriott, & Weinberger, 2009) and mothers (Cosgrove & Flynn, 2005; MeadowsOliver, 2003) use spirituality to cope with the stress of being homeless. For instance, a meta-synthesis of qualitative research on homeless mothers revealed that praying was among the most common strategies used to deal with the difficulties resulting from homelessness (Meadows-Oliver, 2003).

At least two longitudinal studies have explored the relationship between spirituality and mental health among homeless mothers, with, at best, mixed results. In the United Kingdom, the relationship between five different coping strategies and mental health outconres was examined (Tischler & Vostanis, 2007). Seeking spiritual support was assessed using the Family Crisis Oriented Personal Evaluation Scales. Mental health was assessed using the General Health Questionnaire at baseline (N = 72) and at four-month follow-up (n = 44). Seeking spiritual support was unrelated to mental health, both at baseline and at follow-up. In the United States, the relationship between spirituality and mental health was explored among a sample of African American (n = 88) and non-African American mothers (n = 101) in the Connecticut area (Douglas, Jimenez, Lin, & Frisman, 2008). Spirituality was measured with the Spiritual Well-being Scale, and multiple standardized batteries were used to measure 10 dimensions of mental health. Outcomes were assessed at baseline and three follow-up points over a 15-month period. Although no significant main effects emerged, a moderator analysis was significant. Among African American mothers, higher levels of spiritual wellbeing predicted lower levels of anxiety and posttraumatic stress over time.

Among the possible explanations for the largely nonsignificant findings recorded in these two studies is the operationalization of spirituality. In other words, how spirituality was operationalized may account for the failure of spirituality to predict mental health (Hackney & Sanders, 2003).

SPIRITUALITY AND RELIGION AS MULTIDIMENSIONAL CONSTRUCTS

Spirituality and religion are increasingly defined as distinct but overlapping constructs (Derezotes, 2006; Miller & Thoresen, 2003). Spirituality is commonly defined in individual, existential, or relational terms, typically incorporating some reference to the sacred or the transcendent (Hill & Pargament, 2003; Hodge, 2005). Conversely, religion tends to be conceptualized in communal, organizational, or structural terms (Canda & Furman, 2010).

As part of the process of distinguishing spirituality from religion, observers have increasingly recognized that these constructs are multidimensional (Miller & Thoresen, 2003). In other words, spirituality and religion, regardless of which is considered to be the more encompassing construct, consist of nmltiple dimensions in much the same way that mental health consists of multiple dimensions (for example, depression, anxiety) (Berry, 2005). Examples of various dimensions include forgiveness, spiritual meaning, and positive and negative approaches to spiritual coping (Idler et al., 2003).

Thus, outcomes can vary depending on how spirituality is operationalized (Hackney & Sanders, 2003). In some cases, different dimensions of spirituality can even be inversely related to mental health (Ano & Vasconcelles, 2005). Positive spiritual coping, for example, tends to be positively associated with mental health, whereas negative spiritual coping tends to be inversely associated (Ano & Vasconcelles, 2005; H. G. Koenig et al., 2001; Pargament, 2002).

Recognition of the multifaceted nature of spirituality and religion has sparked calls for the use of multidimensional measures in research exploring the relationship between spirituality and health outcomes (Berry, 2005; H. G. Koenig et al., 2001; Miller & Thoresen, 2003). Using psychometrically sound multidimensional instruments can...

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