Resilience, Loneliness, and Psychological Distress Among Homeless Youth Jeff L. Perron, Kristen Cleverley, Sean A. Kidd PII: DOI: Reference:

S0883-9417(14)00067-3 doi: 10.1016/j.apnu.2014.05.004 YAPNU 50630

To appear in:

Archives of Psychiatric Nursing

Received date: Revised date: Accepted date:

14 January 2014 7 April 2014 11 May 2014

Please cite this article as: Perron, J.L., Cleverley, K. & Kidd, S.A., Resilience, Loneliness, and Psychological Distress Among Homeless Youth, Archives of Psychiatric Nursing (2014), doi: 10.1016/j.apnu.2014.05.004

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ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 1 RUNNING HEAD: Resilience, loneliness, and psychological distress among homeless youth

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Resilience, Loneliness, and Psychological Distress Among Homeless Youth

Kristen Cleverley, Ph.D. 2

Sean A. Kidd, Ph.D.3

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Jeff L. Perron, MBA1

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Doctoral Candidate, University of Ottawa, Clinical Psychology Program 136 Jean Jacques Lussier, Vanier Hall Ottawa, Ontario K1N 6N5 Phone: 613-562-5800 x7140; Email: [email protected] 2 Director, Practice Research and Innovation, Centre for Addiction and Mental Health 1001 Queen St. W., Unit 2-1, #161 Toronto, Ontario M6J 1H1 Phone: 416-535-8501; Email: [email protected] 3 Independent Clinician Scientist & Head, Psychology Service, Centre for Addiction and Mental Health, Schizophrenia Program 1001 Queen St. W., Unit 2-1, #161 Toronto, Ontario M6J 1H1 Phone: 416-535-8501 x6295; Email: [email protected]

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 2 RUNNING HEAD: Resilience, loneliness, and psychological distress among homeless youth

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Resilience, Loneliness, and Psychological Distress Among Homeless Youth

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 3 Abstract Extant quantitative research on loneliness among homeless youth has grouped loneliness with

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other elements of psychological distress. The current study seeks to determine if loneliness has a

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different relationship with resilience than does psychological distress among street youth. Using data from 47 participants, linear regression was conducted. Results indicate that homeless youth

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experiencing higher psychological distress reported lower resilience scores. However, levels of

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resilience are not significantly associated with feelings of loneliness when psychological distress was accounted for. This study has implications for how researchers and clinicians conceptualize

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and address feelings of loneliness among homeless youth.

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Keywords: homeless youth, loneliness, resilience

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 4 Background Youth Homelessness and Resilience

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A large number of studies concerning youth homelessness have focused on better

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understanding the myriad physical and psychological threats faced by youth living on the streets (e.g. Roy et al., 2004). Far fewer studies have examined resilience – the capacity to thrive in the

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face of adversity – among this group. However, in recent years some researchers have sought to

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better understand the role and nature of resilience among homeless youth (e.g. Cleverley & Kidd, 2011; Kolar, Erickson, & Stewart, 2012; Lee, Liang, Rotheram-Borus & Milburn, 2011).

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Relative to the risk literature, however, the understanding of resilience among homeless youth remains limited. This limited understanding persists despite findings that demonstrate the

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importance of resilience to survival on the streets and the relevance of understanding resilience

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to the development of effective interventions to help youth cope on the streets (Kidd, Miner, Walker, & Davidson, 2007).

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Personal qualities associated with resilience include self-efficacy, adaptability, and

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having an action-oriented approach (Connor & Davidson, 2003). To date, most research into resilience among homeless youth has been qualitative in nature. Interviews with homeless youth have revealed several themes associated with resilience: independence and having “street smarts,” a sense of personal mastery, adaptability, and lowered reactance to the opinions and behaviours of others (Bender, Thompson, McManus, Lantry, & Flynn, 2007; Kidd & Davidson, 2007). There exist only two quantitative studies concerning resilience among homeless youth. Rew, Taylor-Seehafer, Thomas, and Yockey (2001) explored the relationships between resilience and certain risk and protective factors. They found resilience to be related to lower

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 5 loneliness and hopelessness and fewer life-threatening behaviours. Cleverley and Kidd (2011) undertook an examination of resilience, personal and street-related demographics, psychological

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distress, self-esteem, and suicidality among homeless and street-involved youth. That study

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found perceived resilience to be associated with lower psychological distress and less suicidal ideation. Taken together, these findings suggest that resilient homeless youth experience lower

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levels of psychological distress.

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Homeless Youth and Loneliness

Loneliness is the subjective state that characterizes broken relations with significant

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persons and stigmatization by larger society (Kidd, 2004; Rew et al., 2001; Rokach, 2005). Loneliness can be considered a complicated construct among homeless youth. Its role in the

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maintenance or erosion of psychological well-being among homeless youth is not clearly

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understood (Kidd & Shahar, 2008; Rew et al. 2001). Despite a homeless youth’s best efforts to seek and maintain positive relationships with peers, the lifestyle of the streets is inherently

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transient (Kidd, Miner, Walker, & Davidson, 2007). As such, even the most socially competent

the streets.

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homeless youth will find it difficult to build and maintain important supportive relationships on

Transience is not the only barrier homeless youth face in building supportive relationships. Among housed youth, seeking out close relations with peers is considered adaptive (Kim & Cicchetti, 2010). However, Ireland and Power (2004) found that when in socially hostile environments, youth tend to develop avoidant attachment styles. This is in line with narratives from homeless youth which emphasize the importance of street smarts and being careful about whom one trusts (Kidd & Davidson, 2007). As such, an avoidant approach to relationships that promotes loneliness may actually be adaptive in street contexts.

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 6 Rew et al. (2001) are the only researchers to quantitatively study, directly, the relationship between loneliness and resilience among homeless youth. Their study suggests that

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homeless youth who feel resilient also tend to feel less lonely. Others, while not evaluating the

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relationship between resilience and loneliness directly, have contributed to the current understanding of loneliness among homeless youth. They have found that in street contexts,

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loneliness is related to suicidal ideation, physical and sexual abuse, neglect, throwaway status,

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sex trade involvement, fearful and dismissive attachment, secure attachment, social involvement, and self-esteem (Kidd & Shahar, 2008). These findings help to highlight the complex nature of

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loneliness among homeless youth and suggest that it is important to understand loneliness separately from other, more intrapsychic components of psychological distress (e.g., feeling

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trapped, hopelessness, giving up, helplessness; Cleverley & Kidd, 2011).

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The Present Study

In the effort to better understand loneliness in the context of resilience and mental health

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among homeless youth, the present study examines: 1) the relationship between resilience and

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psychological distress and, 2) the relationship between resilience and loneliness. It was expected that higher psychological distress would be related with lower resilience. However, this association would not apply to loneliness. Methods Participants Participants were 47 youths (age range = 15–21 years, M = 18.2, SD = 1.7, median = 18 years). In order to be eligible to participate in the study, a youth had to (i) either have no fixed address (including: couch surfing, staying with extended family and/or friends temporarily), or (ii) be living in a shelter for homeless youth for greater than 24 hours at the time of the survey.

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 7 Consent from underage youth was accepted as these youth were considered to be emancipated and not in contact with parents and/or guardians. Recruitment took place at a shelter for

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homeless youth in Hamilton, Ontario. Youth using the shelter were recruited by front-line staff

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working at the location. Each participant provided written, informed consent and was reimbursed with a 10 dollar restaurant gift certificate.

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Participation involved two components. The first component was a semi-structured

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interview conducted by a research assistant. The interview questions focused on the participant’s pre-street and street histories and experiences with health services. In the second component, the

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research assistant provided the youth with a quantitative self-report survey which the participant completed independently with the research assistant present. The current study uses only the

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quantitative data.

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Any youth perceived to be at risk for suicidality based on question responses was debriefed and given the contact information for the mental health clinician that served the agency

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where recruitment occurred. The research team then followed-up with this staff member (a

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Psychiatric Nurse working at the shelter). The study protocol was reviewed and approved by an institutional Research Ethics Board. A small majority (30, or 64%) of the participants were female whereas 17 (or 36%) were male. The majority of participants identified as White (76%), whereas 4% identified as Black, and 9% as Native. The remainder varied or did not report race/ethnicity. On average, participants reported having 10.6 years of education. The average age at which youth reported first becoming homeless was 14 years and 45% of them reported being homeless for greater than 6 months (>6 months).

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 8 Measures The 25-item Conner-Davidson Resilience Scale (CD_RISC; Connor & Davidson, 2003)

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was used to measure resilience. Each item is answered on a five-point scale ranging from 1 (“not

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at all true”) to 5 (“true nearly all of the time”). Items include, “I am able to adapt to change,” “I have a strong sense of purpose,” and “I am not easily discouraged by failure.” All 25 items were

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summed to create a composite score of resilience with a higher score indicative of greater

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resilience (α = 0.92).

Four items from the UCLA Loneliness Scale (“I feel isolated from everyone;” “I feel that

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there is no one I can turn to;” “I feel that I am no longer close to anyone;” “I feel that no one really knows me well”) were used to measure loneliness. Russell (1996) found the four items

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used to have the highest loadings on the general loneliness factor (α = 0.88). Participants’

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average scores on these four items represented their loneliness score. ‘Psychological distress’ was measured using a composite of 4 subscales (feeling trapped,

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hopelessness, giving up, and helplessness). This composite is derived from a similar construct

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(that included the loneliness construct) which is discussed in detail in Kidd and Shahar (2008). The 10 items in the psychological distress composite had excellent reliability (α = .93). Previous qualitative (Kidd, 2004) and quantitative (Kidd, 2006) work has highlighted feeling ‘trapped’ as being closely tied to homeless youths’ suicide risk. Items measuring the trapped variable have been derived from qualitative descriptions from homeless youth regarding how they feel about their lives on the streets (e.g., “I feel like I don’t have anywhere else to turn;” Kidd, 2004). Three such items were used in the current study. Hopelessness scores were obtained by summing participant responses from three items from Beck’s Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974). The three items used have the highest correlations

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 9 with the general hopelessness factor (Aish & Wasserman, 2001). Helplessness was measured using two items: “I feel like no matter what I do, I always end up stuck in the same place and

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having the same problems,” and “I feel like I keep trying to do something to make things better

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but nothing works.” These two items were derived from the brief form of Lester’s Helplessness Scale (Lester, 2001) and have been used with this population in the past (Kidd, 2006). Giving up

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was measured using 2 items: “I feel like giving up” and “I feel like I don’t really care about

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anything anymore.” Like the feeling trapped items, the two giving up items were developed based on qualitative work with homeless youth (Kidd, 2004). All items included in the

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psychological distress composite were measured on a five-point scale ranging from the response 1 (“never”) to 5 (“always”). Across mental health domains abbreviated measures were employed

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as lengthy surveys pose a challenge in effectively engaging this population and receiving valid

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responses. Statistical Analysis

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All analyses were conducted using SPSS, Version 19 (IBM, 2010). Correlations were

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computed to study the association among loneliness, feeling trapped, hopelessness, giving up, and helplessness, and resilience. Univariate regression analysis was then conducted to determine how the independent variables (loneliness and psychological distress) were associated with resilience. Results Table 1 provides descriptive statistics and Pearson correlation coefficients for the primary dependent variable, resilience, as well as loneliness, feeling trapped, hopelessness, giving up, and helplessness. As expected, resilience was negatively correlated with each of loneliness (-.52), hopelessness (-.54), giving up (-.65), feeling trapped (-.65), and helplessness (-.44). Each of

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 10 loneliness, feeling trapped, hopelessness, giving up, and helplessness were positively correlated with each other.

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Regression analysis

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Both of the independent variables were entered simultaneously into a regression analysis to determine their association with the resilience measure (see Table 2).

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Psychological distress was significantly associated with resilience scores, B = -0.611, t

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(1, 45) = -4.345, p < 0.001. Participants with higher psychological distress reported lower resilience scores. On the other hand, loneliness was not significantly associated with resilience

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scores with psychological distress accounted for, B = -0.131, t (1, 45) = -0.934, p = .355. The regression model was evaluated for multicollinearity. Psychological distress (VIF = 1.722) and

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loneliness (VIF = 1.722) did not present multicollinearity concerns despite the high correlation

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between psychological distress and loneliness (r = 0.648, p < 0.001; O’Brien, 2007). Discussion

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This study found that loneliness is not significantly associated with resilience among

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homeless youth when psychological distress is accounted for. Our findings are not in line with those of the only other quantitative study to look directly at the link between resilience and loneliness among homeless youth conducted by Rew et al. (2001). Using a regression model that included life threatening behaviour, connectedness, hopelessness, and loneliness, Rew et al. (2001), found that loneliness was significantly associated with resilience. In a second regression model which included connectedness, hopelessness, and loneliness, Rew et al. (2001) again found loneliness to be significantly associated with resilience. Differences in results between the current study and Rew et al. (2001) could be explained by the fact that Rew et al. used the full 20-item, 4-point Likert scale version of the UCLA-R

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 11 (Russell, Peplau, & Cutrona, 1980). The current study used four items from the UCLA-R, using a 5-point Likert scale.

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It is also possible that the regression model used in the current study accounted for more

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variance attributable to the intrapsychic components of psychological distress. The current study’s psychological distress variable included feeling trapped, hopelessness, giving up, and

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helplessness. Rew et al.’s (2001) regression analyses used fewer and arguably less inclusive

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measures of psychological distress.

In line with Cleverley and Kidd (2011) we found that a composite measure of

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psychological distress predicted resilience scores. Different from Cleverley and Kidd (2011) however, was that this study used only the intrapsychic components of psychological distress in

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order to analyze loneliness (an interpersonal construct) separately.

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The hypothesis that loneliness would have a weaker relationship with resilience than general psychological distress was supported. This could be explained by the complex nature of

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loneliness and social support outlined in the introduction. In street contexts, having “close”

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relationships can on the one had provide some elements of support but on the other hand can enhance exposure to victimization and challenging relationships with other young people in significant distress (Kidd & Davidson, 2007). As such, social support through close relationships can be considered to be characterized as a “double-edged sword” for many homeless youth. Furthermore, this might suggest that processing social adversity presents the most pronounced challenge for street-involved youth, with even the most resilient struggling to develop and experience meaningful and positive connections with others. These findings must be qualified, however, by the cross-sectional nature of the study which precludes any comment about the causality of these associations.

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 12 Future research should revaluate the findings of this study so as to more clearly ascertain whether intrapsychic and interpersonal correlates of resilience should be examined in isolation

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and to better parse out the types of social supports that enhance or erode resilience in this

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population. Additionally, while the UCLA-R (Russell, 1996) would seem appropriate for examining loneliness in this population, researchers will need to decide whether to use the scale

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in its entirety (as in Rew, 2001) or to abbreviate it using items with the highest loadings on the

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general loneliness factor (as in the current study). In studies examining multiple variables with this population finding a balance between comprehensiveness and survey length is an ongoing

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challenge as with greater length the quality of responses can diminish. Limitations

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This study had several limitations. Chief among these are the small sample size and the

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fact that all participants were drawn from the same homeless youth agency. This study was also impacted by a challenge common to many homeless youth researchers conducting a longitudinal

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study: the transience of homeless youth. The study was initially designed to be longitudinal, but

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given the high rate of attrition (often due to youth moving or losing contact with shelter staff), analyses had to be undertaken in cross-sectional manner limiting inferences regarding causal and directional relationships. Implications Despite the limitations of this study, these findings have several implications. The findings suggest that even the most resilient appearing homeless youth may struggle considerably with loneliness. This is an important observation, given the indications that loneliness and social adversity are strongly linked with distress and suicidality in this and other youth populations (Kidd, 2006). It may be the case that in under-resourced service settings where

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 13 more resilient-seeming youth might be overlooked by staff attending to youth in various crises, opportunities to intervene and prevent decline may be missed. These more nuanced mental health

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considerations in a population that has extremely high rates of mental illness, particularly

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depression and trauma in association with various forms of victimization (Kidd, 2013), speak to the need to increase capacity in psychiatric nursing in community service contexts that see

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homeless and at risk youth. Given the complex overlay of mental and physical health challenges

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faced by homeless youth, nursing, as was the case in the shelter where this study was conducted,

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is a very well-matched discipline to the needs of this high risk population.

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 14 References Aish, A., & Wasserman, D. (2001). Does Beck’s Hopelessness Scale really measure several

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components? Psychological Medicine, 31, 367-372.

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Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: the Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42, 861-865.

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Bender, K., Thompson, S. J., McManus, H., Lantry, J., & Flynn, P. M. (2007). Capacity for

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survival: exploring strengths of homeless street youth. Child and Youth Care Forum, 36, 25-42.

of Adolescence, 34, 1049-1054.

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Cleverley, K., & Kidd, S. A. (2011). Resilience and suicidality among homeless youth. Journal

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Connor, K. M., & Davidson, J. (2003). Development of a new resilience scale: the Connor-

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Davidson resilience scale (CD-RISC). Depression and Anxiety, 18, 76-82.

Corporation.

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IBM Corporation. (2010). IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM

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Ireland, J. L., & Power, C. L. (2004). Attachment, emotional loneliness, and bullying behaviour: A study of adult and young offenders. Aggressive Behavior, 30, 298-312. Kidd, S. A. (2004). “The walls were closing in and we were trapped”: a qualitative analysis of street youth suicide. Youth and Society, 36, 30-55. Kidd, S. A. (2006). Factors precipitating suicidality among homeless youth: a quantitative follow-up. Youth and Society, 37, 393-422. Kidd, S. A., & Davidson, L. (2007). “You have to adapt because you have no other choice.”: the stories of strength and resilience of 208 homeless youth in New York City and Toronto. Journal of Community Psychology, 35, 219-238.

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 15 Kidd, S. A., Miner, S., Walker, D., & Davidson, L. (2007). Stories of working with homeless youth: on being “mind-boggling”. Children and Youth Services Review, 29, 16-34.

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Kidd, S. A., & Shahar, G. (2008). The relationship between social factors and suicidality among

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homeless youths. American Journal of Orthopsychiatry, 78, 163-172. Kidd, S.A. (2013). Mental illness among homeless youth: A critical review. In S. Gaetz (Eds.)

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Youth Homelessness in Canada. Toronto: Canadian Homelessness Research Network.

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Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and

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Psychiatry, 51, 706-716.

Kolar, K., Erickson, P. G., & Stewart, D. (2012). Coping strategies of street-involved youth:

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exploring contexts of resilience. Journal of youth studies, 15, 744-760.

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Lester, D. (2001). An inventory to measure helplessness, hopelessness, and haplessness. Psychological Reports, 89, 495-498.

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O’Brien, R. M. (2007). A caution regarding rules of thumb for variance inflation factors. Quality

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& Quantity, 41, 673-690. Rew, L., Taylor-Seehafer, M., Thomas, N. Y., & Yockey, R. D. (2001). Correlates of resilience in homeless adolescents. Journal of Nursing Scholarship, 33, 33-40. Rokach, A. (2005). Private lives in public places: Loneliness of the homeless. Social Indicators Research, 72, 99-114. Roy, E., Haley, N., Leclerc, P., Sochanski, B., Boudreau, J., & Boivin, J. (2004). Mortality in a cohort of street youth in Montreal. Journal of the American Medical Association, 292, 569-574. Russell, D. W. (1996). UCLA loneliness scale (Version 3): reliability, validity, and factor

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 16 structure. Journal of Personality Assessment, 66, 20-40. Russell, D., Peplau, L. A., & Cutrona, C. E. (1980). The revised UCLA Loneliness Scale:

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Concurrent and discriminant validity evidence. Journal of Personality and Social

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Psychology, 39, 472-480.

ACCEPTED MANUSCRIPT Resilience, loneliness, and psychological distress among homeless youth 17

2

3

4

--

-.52**

-.54**

--

.48**

2.Loneliness

--

6

-.70**

-.65**

-.44**

.57**

.70**

.39**

.57**

.62**

.59**

--

.73**

.57**

--

.62**

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3.Hopelessnes

5

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1.Resiliency

1

4.Giving Up

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5.Trapped

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Correlations and descriptive statistics for the study measures

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6.Helplessness

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Table 1

--

2.22

2.92

2.87

3.14

2.84

3.41

SD

.73

1.04

1.07

1.33

1.10

1.09

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**Correlation is significant at the 0.01 level (2-tailed).

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Table 2

β

t

-.465

.107

-.611

-4.345

-.093

.099

-.131

Loneliness

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Distress

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S.E.

p

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Psychological

B

.000

-.934

.355

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Predictors

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Summary of regression model results (N=47)



VIF

.50

1.722

______________________________________________________________________________

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Note: Statistics in the columns are unstandardized regression coefficients (B), associated standard errors (S.E.), standardized regression coefficients [betas](β), significant tests of each variable (t), associated p values (p), variance explained (r²), and variance inflation factor (VIF).

Resilience, loneliness, and psychological distress among homeless youth.

Extant quantitative research on loneliness among homeless youth has grouped loneliness with other elements of psychological distress. The current stud...
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