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Motivational and cognitive factors linked to community integration in homeless veterans: study 1 – individuals with psychotic disorders

Published online by Cambridge University Press:  10 June 2020

Michael F. Green Open the ORCID record for Michael F. Green [Opens in a new window] ,
Jonathan K. Wynn ,
Sonya Gabrielian ,
Gerhard Hellemann ,
William P. Horan ,
Robert S. Kern ,
Junghee Lee ,
Stephen R. Marder  and
Catherine A. Sugar
Michael F. Green*
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
Jonathan K. Wynn
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
Sonya Gabrielian
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
Gerhard Hellemann
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
William P. Horan
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA VeriSci, Durham, North Carolina, USA
Robert S. Kern
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
Junghee Lee
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
Stephen R. Marder
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
Catherine A. Sugar
Affiliation:
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA90024-1759, USA Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA VA Research and Enhancement Award Program to Enhance Community Integration in Homeless Veterans, Los Angeles, CA, USA
*
Author for correspondence: Michael F. Green, E-mail: mgreen@ucla.edu
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Abstract

Background

Little is known about the determinants of community integration (i.e. recovery) for individuals with a history of homelessness, yet such information is essential to develop targeted interventions.

Methods

We recruited homeless Veterans with a history of psychotic disorders and evaluated four domains of correlates of community integration: perception, non-social cognition, social cognition, and motivation. Baseline assessments occurred after participants were engaged in supported housing services but before they received housing, and again after 12 months. Ninety-five homeless Veterans with a history of psychosis were assessed at baseline and 53 returned after 12 months. We examined both cross-sectional and longitudinal relationships with 12-month community integration.

Results

The strongest longitudinal association was between a baseline motivational measure and social integration at 12 months. We also observed cross-sectional associations at baseline between motivational measures and community integration, including social, work, and independent living. Cross-lagged panel analyses did not suggest causal associations for the motivational measures. Correlations with perception and non-social cognition were weak. One social cognition measure showed a significant longitudinal correlation with independent living at 12 months that was significant for cross-lagged analysis, consistent with a causal relationship and potential treatment target.

Conclusions

The relatively selective associations for motivational measures differ from what is typically seen in psychosis, in which all domains are associated with community integration. These findings are presented along with a partner paper (Study 2) to compare findings from this study to an independent sample without a history of psychotic disorders to evaluate the consistency in findings regarding community integration across projects.

Keywords

Cognitioncommunity integrationhomelessnessmotivationpsychotic disordersVeterans
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 1 , January 2022 , pp. 169 - 177
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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