Ferris J. Ritchey

Social assets and mental distress among the homeless: exploring the roles of social support and other forms of social capital on depression.

This paper explores the role of social capital in mediating the effects of stressors on depression among a disadvantaged population. Utilizing a survey of 155 homeless people in a mid-sized southern U.S. city, the authors address the relevance of social capital for quality of life. The paper provides a critical test of whether social support and other forms of social capital matter when monetary and human capital is extremely limited. Under these resource-restricted circumstances does social capital add to our understanding of the distress process or does it merely restate the well established relationship between social support and quality of life outcomes? Various forms of social capital are measured: religious social capital, group participation, social trust, and bridging social capital along with a commonly used measure of social support -- perceived strong tie support. Findings suggest that social capital matters for even the most resource poor populations. In addition, social capital variables add significantly to the variance explained in depressive symptomatology over and above that traditionally explained by perceived social support.

A comparison of homeless, community-wide, and selected distressed samples on the CES-Depression Scale.

Center for Epidemiological Studies (CES) Depression Scale results for surveys of homeless, community-wide and selected distressed samples are compared. Nearly four times the percentage of homeless fit the criterion for clinical caseness (a score of 16+) compared to the general population (74 to 19 percent). None of the distressed samples exhibited a higher rate except psychiatric patients diagnosed as acutely depressive. High rates of depression have implications for social policies directed toward homelessness.

Just Thinking about It Social Capital and Suicide Ideation among Homeless Persons

Suicide ideation is a sensitive indicator of personal well-being. While ideation occurs in roughly 3 percent of the US population annually, in this study rates are 10 times higher. This article explores the role of social capital in mediating negative life circumstances on ideation for a sample of 161 homeless adults in a mid-sized Southern US metropolitan area. Our results imply that social capital does not function the same way for homeless persons as it does for the general population. This finding supports growing evidence that social capitals much touted benefits for personal well-being may not apply to disadvantaged populations.

Life Chances and Choices: Assessing Quality of Life among the Homeless

A Weberian lifestyles approach is employed to examine differences in quality of life among the homeless. Using a systematic random sample of 161 homeless people in a mid-sized, Southern metropolitan area, the study focuses on the impact of life chances and social choices on aspects of quality of life in this severely challenged population. Regression results show that a number of life chance and social choice variables affect general and domain-specific well-being. While chances and choices both contribute to these aspects of quality of life, there is only modest evidence of a mediating effect. With the exception of depressive symptoms, life chances appear to play a more important role in quality of life differences than life choices. The specific life chance and choice factors influencing aspects of quality of life vary with each separate well-being outcome. The implications of these findings for general sociology and homeless social policy are explored.

Criminal victimization among the homeless

Our study examines the prevalence and consequences of criminal victimization in a quota sample of homeless adults. This already besieged population experienced considerably higher rates of victimization than the general population and those in poverty. A majority of homeless victims could not identify their offender and were the victims of a violent crime. Although we found clear differences between the homeless and the comparison populations in the victimization episode, our results also suggest significant differences between homeless victims and homeless nonvictims. Victims had higher incomes and a greater fear of the streets, were more depressed, had a history of mental hospitalization, and experienced more physical symptoms. Finally, victimization was not a significant predictor of homeless persons depression and mastery in our sample, unlike the cases of other, more specific samples and the general population. We argue that homelessness may be such an overwhelming life circumstance that single life...

Perceptual correlates of physician referral to physical therapists: Implications for role expansion

From an interprofessional role boundary maintenance perspective, this paper traces the historical development of physical therapy relative to physicians. Then, using survey data of 206 physicians in a metropolitan area of the United States, two hypotheses are tested regarding the prospects of physical therapy expanding its role to include highly autonomous skills. The first, from a set of structural-functionalist assumptions about role differentiation, posits that role expansion will precede status enhancement. The other, from conflict-theory assumptions about status politics, posits the opposite. A panel of physical therapists rated 24 procedures as requiring high, moderate and low skills. There was no significant difference in frequency of physician referral for the three levels; referral was associated with patient needs rather than physicians perceptions of practitioner competency and status. The structural-functional hypothesis was supported, and two policy implications are noted: (1) an expanding physical therapy role is not likely to stimulate turf battles with physicians, and (2) currently, greater professional autonomy is likely to be acquired by physical therapists making physicians aware of the extent of therapists capabilities (role expansion), rather than through legislating more stringent curricular and license standards (status enhancement). The study is preliminary due to a small response rate.

A SCALE TO ASSESS ATTITUDES TOWARD EUTHANASIA

The topic of euthanasia has been a matter of public debate for several decades. Although empirical research should inform policy, scale measurement is lacking. After analyzing shortcomings of previous work, we offer a systematically designed scale to measure attitudes toward euthanasia. We attempt to encompass previously unspecified dimensions of the phenomenon that are central to the euthanasia debate. The results of our pretest show that our attitude towards euthanasia (ATE) scale is both reliable and valid. We delineate active and passive euthanasia, no chance for recovery and severe pain, and patients autonomy and doctors authority. We argue that isolating these factors provides a more robust scale capable of better analyzing sample variance. Internal consistency is established with Cronbachs alpha = .871. Construct external consistency is established by correlating the scale with other predictors such as race and spirituality.

Rising Inability to Obtain Needed Health Care Among Homeless Persons in Birmingham, Alabama (1995–2005)

BackgroundHomeless persons depend disproportionately on the health-care safety net for medical services. National reports identify financial strains to this safety net. Whether this has affected homeless persons is unknown.ObjectivesWe quantified changes in the proportion of homeless persons reporting unmet need for health care in Birmingham, Alabama, comparing two periods, 1995 and 2005. We assessed whether a period effect was independent of characteristics of persons surveyed.DesignAnalysis of two surveys conducted with identical methods among representative samples of homeless persons in 1995 (nu2009=u2009161) and 2005 (nu2009=u2009161).MeasurementsReport of unmet need (inability to obtain care when needed) was the dependent variable. Two survey periods (1995 and 2005) were compared, with multivariable adjustment for sociodemographic and health characteristics. Reasons for unmet need were determined among the subset of persons reporting unmet need.ResultsUnmet need for health care was more common in 2005 (54%) than in 1995 (32%) (pu2009<u20090.0001), especially for non-Blacks (64%) and females (65%). Adjusting for individual characteristics, a survey year of 2005 independently predicted unmet need (odds ratio 2.68, 95% CI 1.49–4.83). Among persons reporting unmet need (87 of 161 in 2005; 52 of 161 in 1995), financial barriers were more commonly cited in 2005 (67% of 87) than in 1995 (42% of 52) (pu2009=u20090.01).ConclusionA rise in unmet health-care needs was reported among Birmingham’s homeless from 1995 to 2005. This period effect was independent of population characteristics and may implicate a local safety net inadequacy. Additional data are needed to determine if this represents a national trend.

THE MYTH OF THE MIGRANT HOMELESS: AN EXPLORATION OF THE PSYCHOSOCIAL CONSEQUENCES OF MIGRATION

While migration status is frequently used to differentiate homeless subgroups, little empirical work has explored sociological distinctions between migrant and nonmigrant homeless. This article attempts to fill the gap in the literature by comprehensively examining differences in the two groups in terms of demographic characteristics, psychological and social resources, life stressors and circumstances, and psychological well-being. We use a random probability sample of 63 migrant and 98 nonmigrant homeless, distinguished by length of residence in the study city (Birmingham, Alabama). The analysis indicated that migrant and nonmigrant homeless persons share similar demographic characteristics, stressors, and levels of psychosocial resources. Multiple regression analyses revealed that although the two groups display similar levels of depressive symptomatology, the factors influencing depression appear to operate differently among migrants and nonmigrants. Although psychosocial resources are associated with lower depression for both groups, there is a significant interaction effect between migration status and mastery, with mastery being a more salient resource for the mental health of migrants. The implications of these findings for homeless service provision are discussed.

Racial Differences in Attitudes toward Euthanasia

This article examines racial differences in attitudes toward euthanasia. Many researchers assert distrust of medicine as a substantive explanation for less favorable attitudes toward euthanasia among African Americans, although quantitative measurement has been unsuccessful in showing this. In this article, spiritual meaning, perceived capacity for discrimination (distrust), individual experiences with physicians, and access to healthcare are hypothesized as intervening variables in the relationship between race and attitudes toward euthanasia. With a distinction between individual and collective experiences with discrimination we use path analysis to test previous assertions that African American distrust of medicine leads to more negative attitudes toward euthanasia. Results indicate that while African Americans exhibit higher levels of distrust of medicine, this is not related to attitudes toward euthanasia, which seem predominantly to be a spiritual matter. Our findings have implications for legislative policy, treatment interventions, doctor-patient relations, and sociological understanding of the interaction of race, spirituality, experience, and attitudes.