• Michael Liu, Cilia Mejia-Lancheros, James Lachaud, Rosane Nisenbaum, Vicky Stergiopoulos, and Stephen W Hwang.
• Harvard Medical School, Boston, Massachusetts; MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.
• Am J Prev Med. 2020 Jun 1; 58 (6): 807816807-816.

IntroductionAdverse childhood experiences are known risk factors for a range of social, economic, and health-related outcomes over the life course. Resilience is a known protective factor. This study examines the associations of adverse childhood experiences and resilience with poor mental health outcomes among homeless adults with mental illness.MethodsThis study utilized data from 565 homeless adults with mental illness participating in a Housing First intervention in Toronto (2009-2013) to evaluate their sociodemographic characteristics, adverse childhood experience exposure, resilience, and mental health outcomes. Descriptive statistics were generated, and logistic regression models were used to examine the association of total adverse childhood experience score and resilience with poor mental health outcomes. Analyses were conducted in 2019.ResultsThe average total adverse childhood experience score was 4.1 (SD=2.8) among all study participants. Individuals with a lifetime duration of homelessness exceeding 36 months (p=0.011) had higher mean scores. Total score was positively associated with several mental illness diagnoses and psychopathology severity, indicated by co-occurring mental illness diagnoses (AOR=1.23, 95% CI=1.13, 1.33) and high Colorado Symptom Index scores (AOR=1.26, 95% CI=1.14, 1.38). Resilience served as a protective factor against several individual mental illness diagnoses, co-occurring mental illness diagnoses (AOR=0.85, 95% CI=0.76, 0.95), and high Colorado Symptom Index scores (AOR=0.69, 95% CI=0.61, 0.79).ConclusionsFindings highlight the high prevalence of adverse childhood experiences and their negative impact on homeless adults with mental illness. Resilience protects against adverse childhood experience-associated poor mental health outcomes, thereby serving as a potential interventional target in homeless populations.Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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