Substance Use
Unmet Subsistence Needs, Substance Use Patterns and Mental Health Among Women Experiencing Homelessness: A Longitudinal Analysis Anna Krasnova* Anna Krasnova Krasnova Krasnova Krasnova Krasnova UCSF Benioff Homelessness and Housing Initiative
Women who experience homelessness and unstable housing (WHUH) disproportionately experience mental health challenges and substance use, including methamphetamine use. Most women who use methamphetamine engage in polysubstance use, but the effects of substance combinations on mental health are poorly understood. We examined how sociodemographic factors and polysubstance use are associated with mental health among WHUH from San Francisco community venues in 2016-2019 and followed monthly for 6 months. Substance use was assessed via self-report and toxicology. Overall mental health status was assessed using the SF-12 Mental Health Component Summary (MCS-12) score, which ranges from 0-100; a 3-5 point difference is considered clinically meaningful. We used longitudinal mixed effects models and LASSO regression to identify the substances and related combinations most strongly associated with overall mental health. We adjusted for social and structural factors, HIV status, and menopause status. Among 245 WHUH (median age 53.2 years, IQR: 45.3-59.2), 39.3% were Black; MCS-12 scores averaged 40.2 at baseline (general population average=50). Substances used during follow-up included tobacco (82.9%), opioids (62.8%), crack/cocaine (69.7%), methamphetamine (47.0%), cannabis (75.6%), and alcohol (74.8%); 83.3% reported polysubstance use. Factors with the most influence on MCS-12 scores included: having ≥1 unmet subsistence need (housing/food/clothing) was associated with -3.6 points (CI: -5.3, -1.9), and methamphetamine use -2.4 points (CI: -4.1, -0.7). Polysubstance use was not significantly associated with MCS-12 scores. Beyond unmet subsistence needs, methamphetamine use stands out from other substances as a particularly strong contributor to poor overall mental health among WHUH. This highlights the need to address methamphetamine use alongside services that support social determinants of health and unmet subsistence needs to maximize mental health outcomes for WHUH.