Missed opportunities: childhood learning disabilities as early indicators of risk among homeless adults with mental illness in Vancouver, British Columbia

Objectives: It is well documented that early-learning problems and poor academic achievement adversely impact child development and a wide range of adult outcomes; however, these indicators have received scant attention among homeless adults. This study examines self-reported learning disabilities (LD) in childhood as predictors of duration of homelessness, mental and substance use disorders, physical health, and service utilisation in a sample of homeless adults with current mental illness. Design: This study was conducted using the baseline sample from a randomised controlled trial (RCT). Setting: Participants were sampled from the community in Vancouver, British Columbia. Participants: The total sample included 497 adult participants who met criteria for absolute homelessness or precarious housing and a current mental disorder based on a structured diagnostic interview. Learning disabilities in childhood were assessed by asking adult participants whether they thought they had an LD in childhood and if anyone had told them they had an LD. Only participants who responded positively to both questions (n=133) were included in the analyses. Outcome measures: Primary outcomes include current mental disorders, substance use disorders, physical health, service utilisation and duration of homelessness. Results: In multivariable regression models, self-reported LD during childhood independently predicted self-reported educational attainment and lifetime duration of homelessness as well as a range of mental health, physical health and substance use problems, but did not predict reported health or justice service utilisation. Conclusions: Childhood learning problems are overrepresented among homeless adults with complex comorbidities and long histories of homelessness. Our findings are consistent with a growing body of literature indicating that adverse childhood events are potent risk factors for a number of adult health and psychiatric problems, including substance abuse. Trials registration number: This trial has been registered with the International Standard Randomised Control Trial Number Register and assigned ISRCTN42520374.