Journal Article

Association between housing status and mental health and substance use severity among individuals with opioid use disorder and co-occurring depression and/or PTSD

Watkins, Katherine E., Meredith, Lisa S., Hunter, Sarah B., Komaromy, Miriam, McCullough, Colleen M., Hindmarch, Grace M., Mendon-Plasek, Sapna, Kelly, Lauren, Griffin, Beth Ann

2025

Overview

Background Opioid use disorder, mental health conditions, and housing instability are frequently intertwined and have a profound impact on health outcomes. While past research has focused on the opioid use and mental health of people experiencing homelessness, less is known about those experiencing housing instability. We examined the cross-sectional associations between housing status (currently unhoused, unstably housed, and stably housed) and mental health and substance use severity among primary care patients with co-occurring disorders. Methods Data are from a randomized controlled trial, Collaboration Leading to Addiction Treatment and Recovery from other Stresses, which tests the Collaborative Care Model for primary care patients with opioid use disorder and co-occurring depression and/or post-traumatic stress disorder (PTSD). We defined being unhoused as not living in stable housing in the past 3 months and being unstably housed as living in stable housing but being worried or concerned about loss of housing in the next 3 months. We assessed differences in baseline characteristics across the housing groups using ANOVA for continuous variables and chi-squared tests for categorical and binary measures. Adjusted linear regression models were used to assess associations between housing status and mental health and substance use symptom severity scores. Results Among the 797 patients randomized, 13% of the sample was currently unhoused, 24% was unstably housed, and 63% was stably housed. Individuals who were unhoused were on average younger, received less education, never married, and had not used prescribed medications for opioid use disorder (MOUD) in the past 30 days. The adjusted regression results showed that both being unhoused and being unstably housed were significantly associated with higher PTSD symptom severity, depression symptom severity, opioid use severity, and opioid overdose risk behaviors compared to being stably housed. Conclusion Primary care patients with co-occurring disorders who were either unhoused or unstably housed have worse mental health and substance use symptom severity when compared with stably housed individuals. This suggests primary care providers should screen patients with co-occurring disorders not only for being unhoused but also for unstable housing. Addressing housing instability in primary care settings could lead to improved health outcomes and reduced healthcare costs. Trial registration Clinicaltrials.gov NCT04559893, registered on January 8, 2021.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Addictions / Alcohol use / Clinical outcomes / Clinical trials / Clinics / Collaboration / Comorbidity / Depression, Mental / Disorders / Drug overdose / Drug use / Electronic health records / Family Medicine / General Practice / Health care expenditures / Health services / Health status / Homeless people / Homelessness / Homes and haunts / Housing / Housing and health / Housing stability / Integrated care / Medical personnel / Medicine / Medicine & Public Health / Mental depression / Mental disorders / Mental health / Mentally ill / Mortality / Narcotics / Opioid use disorder / Opioids / Patients / Post traumatic stress disorder / Primary care / Primary Care Medicine / Registration / Rehabilitation / Risk behavior / Risk factors / Severity / Shelters / Stability / Substance abuse treatment / Substance use disorder / Surveys / Symptoms / Trauma / Unstable housing / Variance analysis