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This project builds upon initial proof of concept work examining the optimal set of supports for youth who have recently exited homelessness - an intervention comprised of mental health and peer supports alongside transitional case management. This collaborative model will be tested as a proof-of-concept in Thunder Bay with Indigenous youth and a trial will be conducted in Toronto to optimize and determine the effectiveness of the existing model of support.
In response to the challenges outlined above, and with the support of a grant from the Ontario Ministry of Child and Youth Services, the investigators developed and tested a tertiary prevention strategy called the Housing Outreach Program Collaborative (HOP-C) which launched in the summer of 2015. In this approach the investigators focused on collaborations and interventions that have the greatest potential to be effective with this population. The investigators brought together partners from a number of sectors in the GTA and have tested a 3-pronged set of supports (intervention described in detail in the methods):
This initiative has proven feasible and is demonstrating good outcomes - with excellent youth engagement, reports of lower social isolation, improved mental health, and engagement with resources, and spin-off benefits of closer collaboration between organizations. The investigators successfully met the target of youth engagement, with a total of 31 youth participating, minimal attrition (n=2), and the investigators observed no indications that HOP-C resulted in risk of any form, both with respect to the intervention itself and the mixed methods research methodology. This promising feasibility work formed the foundation from which the investigators were successful in obtaining a grant from the Local Poverty Reduction Fund to support the study described in this proposal.
Current Project Determine through a randomized trial in Toronto if the positive outcomes the investigators are observing are due solely or primarily to transitional case management and if the additional peer and mental health components are necessary.
Engaging in intensive, tertiary prevention shows clear promise in disrupting a cycle of poverty and marginalization at a critical time - if proven and scaled a key driver of chronic homelessness would be addressed.
Research Questions The objective of this two-part project is to examine the effectiveness and transferability of the Housing Outreach Program-Collaboration (HOP-C) transitional intervention. HOP-C has proven to be feasible with promising outcomes in the Toronto proof-of-concept work currently underway.
1. Are the benefits of the complex HOP-C intervention with all components in place greater than transitional case management in isolation?
• It is hypothesized that the full model will provide benefit in domains of housing stability, mental health, and quality of life that are significantly greater than case management alone.
The investigators have data in hand from their recent national work in the area which provides data on 'treatment as usual' or the outcomes that attend typically available supports. The proposed trial will unpack benefit and be essential in economic and viability arguments to be made going forward.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Transitional Case Management Only | Active Comparator | Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth. |
|
| Full HOP-C Service | Experimental | Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| HOP-C | Behavioral | Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. |
| Measure | Description | Time Frame |
|---|---|---|
| Housing | Participants coded in a binary manner as having gained or sustained housing (binary positive) or lost (binary negative) based on assessment of the participant's trajectory from baseline to 6 months. | Change from Baseline to 6 months |
| Employment/Education | Participants coded in a binary manner as having gained or sustained education or employment (binary positive) or lost (binary negative) based on assessment of the participant's trajectory from baseline to 6 months. | Change from baseline to 6 months |
| Mental Health | Participants coded in a binary manner as having gained or sustained mental health status without crises (binary positive) or experienced a crises that impacted major life domains (binary negative) based on assessment of the participant's trajectory from baseline to 6 months. | Change from baseline to 6 months |
| Housing Security Scale | The Housing Security Scale contains 12 items on a 5 point likert scale (Frederick et al., 2014). Scores range from "strongly disagree" (minimum = 1) to "strongly agree" (maximum = 5). Higher scores indicate better outcomes. Mean item range is 1-5 with pre-post difference reported. | Change from Baseline to 6 months |
| Housing Security Scale (Subjective Housing Stability Subscale) | The Housing Security Scale contains a 4 item subscale that measures subjective housing satisfaction and perception of housing stability (Frederick et al., 2014). Scores range from "strongly disagree" (minimum = 1) to "strongly agree" (maximum = 5). Higher scores indicate better outcomes with a mean range of 1-5 with pre-post change reported. | Change from Baseline to 6 months |
| Measure | Description | Time Frame |
|---|---|---|
| Mental Health Continuum - Short Form | Mental Health Continuum - Short Form assess mental health and addictions by measuring emotional, psychological and social well-being. It contains 14 items on a 6 point scale ranging from at minimum "never" (0) to, at maximum, "every day" (5). Higher scores indicate better outcomes. Range is 0-5 (means) with pre-post differences reported. | Change from baseline to 6 month |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Sean A Kidd, Phd | Centre for Addiction and Mental Health | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Centre for Addiction and Mental Health | Toronto | Ontario | M5T 1R8 | Canada |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20494240 | Background | Altena AM, Brilleslijper-Kater SN, Wolf JL. Effective interventions for homeless youth: a systematic review. Am J Prev Med. 2010 Jun;38(6):637-45. doi: 10.1016/j.amepre.2010.02.017. | |
| 16060731 | Background | Barber CC, Fonagy P, Fultz J, Simulinas M, Yates M. Homeless near a thousand homes: outcomes of homeless youth in a crisis shelter. Am J Orthopsychiatry. 2005 Jul;75(3):347-55. doi: 10.1037/0002-9432.75.3.347. |
| Label | URL |
|---|---|
| Information about research at the Centre for Addiction and Mental Health, Canada's largest mental health and addictions teaching hospital. | View source |
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| ID | Title | Description |
|---|---|---|
| FG000 | Transitional Case Management Only | Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth. Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. |
| FG001 | Full HOP-C Service | Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
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| ID | Title | Description |
|---|---|---|
| BG000 | Transitional Case Management Only | Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Mean |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Housing | Participants coded in a binary manner as having gained or sustained housing (binary positive) or lost (binary negative) based on assessment of the participant's trajectory from baseline to 6 months. | Posted | Count of Participants | Participants | No | Change from Baseline to 6 months |
|
6 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Transitional Case Management Only | Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth. Transitional Case Management Only: Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. |
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Variability in youth service need resulting in variable effectiveness of treatment. In attempt to normalize the control group, it became less generalizable. RCT challenges with engagement and trust.
| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Sean Kidd | Centre for Addiction and Mental Health | 416-535-8501 | 36295 | sean.kidd@camh.ca |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | May 30, 2018 | May 29, 2020 | Prot_SAP_000.pdf |
| ICF | No | No | Yes | Informed Consent Form | May 29, 2018 | May 29, 2020 | ICF_001.pdf |
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|
| Transitional Case Management Only | Behavioral | Participants in this arm will be provided with a transition-focused community support worker who will assist in areas ranging from general support and encouragement to assistance in navigating relevant systems. They will have weekly contacts with participants by phone, informal contact via text and email, and at least twice per month will visit the participant where they are residing. It is expected that all participants will engage a community support worker. The transitional case manager hired into this role will be highly experienced in case management for youth. |
|
| Cognitive and Affective Mindfulness Scale | Cognitive and Affective Mindfulness Scale Revised was used to measure mindfulness and has demonstrated acceptable reliability (Feldman, Hayes, Kumar, Greeson, & Laurenceau, 2007). It contains 10 items. The minimum score is "rarely/Not at all" (1) and the maximum score is "almost always" (4). Higher scores indicate better outcomes with a mean item range from 1-4 with pre-post mean change reported. | Change from baseline to 6 months |
| Community Integration Scale | Behavioural and psychological aspects of community integration was examined using Community Integration Scale The scale contains 7 dichotomous questions with higher scores indicating greater community integration (better outcomes). Mean item range is 0-1 with mean change reported. | Change from baseline to 6 months |
| Community Integration Measure | Behavioural and psychological aspects of community integration were examined using the Community Integration Measure. The measure contains 6 items scored on a 5 point scale ranging from, at minimum, "always disagree" (1) to, at maximum, "always agree" (5). Higher scores indicating better outcomes with an item mean range from 1-5 with mean pre-post differences reported. | Change from baseline to 6 months |
| Resilience Scale | Resilience will be measured using the 10-item Resilience Scale. Each item score ranges from, at minimum, "Not true at all" (0) to, at maximum, "True nearly all the time" (4) with higher scores indicating better outcomes. Mean item range is from 0-4 with pre-post change in means reported. | Change from baseline to 6 months |
| Adults Hope Scale | Adult Hope Scale, a cognitive measure of hope, was employed. This self-report questionnaire contains 8 questions that are each scored on an 8 point Likert scale with scores ranging from "Definitely False" to "Definitely True". Higher scores indicate better outcomes. Mean item range is minimum 1 to maximum 8 with pre-post mean differences reported. | Change from baseline to 6 months |
| GAIN Short Screener (CAMH Modified) | Mental health (and addictions) was measured using the Global Assessment of Individual Needs Short Screener, which includes 22 items scored on a 5 point scale ranging from "never" (0) as the minimum score and "past month" (4) as the maximum score. Higher scores indicate worse outcomes. Mean item range is 0-4 with pre-post mean change reported. | Change from baseline to 6 months |
| Medical Outcomes Study (MOS) Social Support Survey | We used a modified version of the Medical Outcomes Study Social Support Survey to measure social support. It is a 15-item 5-point Likert-type scale. The maximum score is "all of the time" (5) and the minimum score is "none of the time" (1). Higher score indicates better outcome. Item mean range is 1-5 with pre-post mean difference reported. | Change from baseline to 6 month |
| World Health Organization Quality of Life Scale - BREF | The brief World Health Organization Quality of Life Scale - BREF contains 26 items, each scored from 1 to 5 with various labels for each score (e.g. 1= "very poor" for item 1 and 1= "very dissatisfied" for item 2). Higher scores indicate better outcomes with a mean item range of 1-5 with pre-post mean change reported. | Change from baseline to 6 months |
| Background | Boyatzis, R. E. (1998). Transforming Qualitative Information: Thematic Analysis and code Development. Thousand Oaks, California: Sage. |
| 12703651 | Background | Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003 Apr;84(4):822-48. doi: 10.1037/0022-3514.84.4.822. |
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| Background | Karabanow J. (2004). Being Young and Homeless: Understanding how youth enter and exit street life. New York, NY. Peter Lang Publishing INC. |
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| Background | Karabanow, J. (2008). Getting off the Street: Exploring Young People's Street Exits. American Behavioral Scientist, 51, 772-788. |
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| 15245623 | Background | Kidd SA, Scrimenti K. Evaluating child and youth homelessness. Eval Rev. 2004 Aug;28(4):325-41. doi: 10.1177/0193841X04264820. |
| Background | Kidd, S.A. (2006). Factors precipitating suicidality among homeless youth: A quantitative follow-up. Youth & Society, 37, 393-422. |
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| Background | Linehan, M. (2014). DBT Skills Training Manual Second Edition. New York: The Guilford Press. |
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| Background | Public Health Agency of Canada. (2006). Street Youth in Canada. www.publichealth.gc.ca/sti |
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| Background | Wagnild G.M. The Resilience Scale user's guide for the US English version of the Resilience Scale and the 14- Item Resilience Scale (RS-14). Worden, MT: The Resilience Center. 2010. |
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| 32309974 | Derived | Kidd SA, Vitopoulos N, Frederick T, Leon S, Wang W, Mushquash C, McKenzie K. Trialing the feasibility of a critical time intervention for youth transitioning out of homelessness. Am J Orthopsychiatry. 2020;90(5):535-545. doi: 10.1037/ort0000454. Epub 2020 Apr 20. |
| BG001 | Full HOP-C Service | HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. |
| BG002 | Total | Total of all reporting groups |
| years |
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| Sex/Gender, Customized | Count of Participants | Participants |
|
| Race/Ethnicity, Customized | Count of Participants | Participants |
|
| Sexual Orientation | Count of Participants | Participants |
|
| Highest Education | Count of Participants | Participants |
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| Homelessness - Lifetime Length | Count of Participants | Participants |
|
| NEET - Not in Employment, Education or Training | Count of Participants | Participants |
|
| OG001 | Full HOP-C Service | HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. |
|
|
|
| Primary | Employment/Education | Participants coded in a binary manner as having gained or sustained education or employment (binary positive) or lost (binary negative) based on assessment of the participant's trajectory from baseline to 6 months. | Posted | Count of Participants | Participants | No | Change from baseline to 6 months |
|
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|
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| Primary | Mental Health | Participants coded in a binary manner as having gained or sustained mental health status without crises (binary positive) or experienced a crises that impacted major life domains (binary negative) based on assessment of the participant's trajectory from baseline to 6 months. | Posted | Count of Participants | Participants | No | Change from baseline to 6 months |
|
|
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| Primary | Housing Security Scale | The Housing Security Scale contains 12 items on a 5 point likert scale (Frederick et al., 2014). Scores range from "strongly disagree" (minimum = 1) to "strongly agree" (maximum = 5). Higher scores indicate better outcomes. Mean item range is 1-5 with pre-post difference reported. | Posted | Mean | Standard Error | score on a scale | Change from Baseline to 6 months |
|
|
|
|
| Primary | Housing Security Scale (Subjective Housing Stability Subscale) | The Housing Security Scale contains a 4 item subscale that measures subjective housing satisfaction and perception of housing stability (Frederick et al., 2014). Scores range from "strongly disagree" (minimum = 1) to "strongly agree" (maximum = 5). Higher scores indicate better outcomes with a mean range of 1-5 with pre-post change reported. | Posted | Mean | Standard Error | score on a scale | Change from Baseline to 6 months |
|
|
|
|
| Secondary | Mental Health Continuum - Short Form | Mental Health Continuum - Short Form assess mental health and addictions by measuring emotional, psychological and social well-being. It contains 14 items on a 6 point scale ranging from at minimum "never" (0) to, at maximum, "every day" (5). Higher scores indicate better outcomes. Range is 0-5 (means) with pre-post differences reported. | Posted | Mean | Standard Error | score on a scale | Change from baseline to 6 month |
|
|
|
|
| Secondary | Cognitive and Affective Mindfulness Scale | Cognitive and Affective Mindfulness Scale Revised was used to measure mindfulness and has demonstrated acceptable reliability (Feldman, Hayes, Kumar, Greeson, & Laurenceau, 2007). It contains 10 items. The minimum score is "rarely/Not at all" (1) and the maximum score is "almost always" (4). Higher scores indicate better outcomes with a mean item range from 1-4 with pre-post mean change reported. | Posted | Mean | Standard Error | score on a scale | Change from baseline to 6 months |
|
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|
|
| Secondary | Community Integration Scale | Behavioural and psychological aspects of community integration was examined using Community Integration Scale The scale contains 7 dichotomous questions with higher scores indicating greater community integration (better outcomes). Mean item range is 0-1 with mean change reported. | Posted | Mean | Standard Error | score on a scale | Change from baseline to 6 months |
|
|
|
|
| Secondary | Community Integration Measure | Behavioural and psychological aspects of community integration were examined using the Community Integration Measure. The measure contains 6 items scored on a 5 point scale ranging from, at minimum, "always disagree" (1) to, at maximum, "always agree" (5). Higher scores indicating better outcomes with an item mean range from 1-5 with mean pre-post differences reported. | Posted | Mean | Standard Error | score on a scale | Change from baseline to 6 months |
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| Secondary | Resilience Scale | Resilience will be measured using the 10-item Resilience Scale. Each item score ranges from, at minimum, "Not true at all" (0) to, at maximum, "True nearly all the time" (4) with higher scores indicating better outcomes. Mean item range is from 0-4 with pre-post change in means reported. | Posted | Mean | Standard Error | score on a scale | Change from baseline to 6 months |
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| Secondary | Adults Hope Scale | Adult Hope Scale, a cognitive measure of hope, was employed. This self-report questionnaire contains 8 questions that are each scored on an 8 point Likert scale with scores ranging from "Definitely False" to "Definitely True". Higher scores indicate better outcomes. Mean item range is minimum 1 to maximum 8 with pre-post mean differences reported. | Posted | Mean | Standard Error | score on a scale | Change from baseline to 6 months |
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| Secondary | GAIN Short Screener (CAMH Modified) | Mental health (and addictions) was measured using the Global Assessment of Individual Needs Short Screener, which includes 22 items scored on a 5 point scale ranging from "never" (0) as the minimum score and "past month" (4) as the maximum score. Higher scores indicate worse outcomes. Mean item range is 0-4 with pre-post mean change reported. | Posted | Mean | Standard Error | score on a scale | Change from baseline to 6 months |
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| Secondary | Medical Outcomes Study (MOS) Social Support Survey | We used a modified version of the Medical Outcomes Study Social Support Survey to measure social support. It is a 15-item 5-point Likert-type scale. The maximum score is "all of the time" (5) and the minimum score is "none of the time" (1). Higher score indicates better outcome. Item mean range is 1-5 with pre-post mean difference reported. | Posted | Mean | Standard Error | score on a scale | Change from baseline to 6 month |
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| Secondary | World Health Organization Quality of Life Scale - BREF | The brief World Health Organization Quality of Life Scale - BREF contains 26 items, each scored from 1 to 5 with various labels for each score (e.g. 1= "very poor" for item 1 and 1= "very dissatisfied" for item 2). Higher scores indicate better outcomes with a mean item range of 1-5 with pre-post mean change reported. | Posted | Mean | Standard Error | score on a scale | Change from baseline to 6 months |
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|
|
| 0 |
| 31 |
| 0 |
| 31 |
| 0 |
| 31 |
| EG001 | Full HOP-C Service | Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. HOP-C: Service provision will be provided by Loft and Covenant House for the transitional case management component, the peer component will be supported through Sketch Arts, and the mental health component will be provided by a post-doctoral fellow clinical psychologist and a mindfulness therapist from the Centre for Mindfulness Studies, supervised by Dr. Sean Kidd. | 0 | 34 | 0 | 34 | 0 | 34 |
Not provided
Not provided
Not provided
| Regression, Linear |
| 0.200 |
| Odds Ratio (OR) |
| 2.30 |
| Standard Error of the Mean |
| 0.64 |
| 2-Sided |
| Other |
| Regression, Logistic |
| 0.134 |
| Odds Ratio (OR) |
| 3.63 |
| Standard Error of the Mean |
| 0.85 |
| 2-Sided |
| Other |
Unadjusted
| Other |
Unadjusted.
| Other |
Unadjusted.
| Other |
Unadjusted.
| Other |
Unadjusted.
| Other |
Unadjusted.
| Other |
Unadjusted.
| Other |
Unadjusted.
| Other |
| Substance Use |
|
| 0.177 |
Unadjusted. |
| Other |
| Externalizing | Regression, Linear | 0.325 | Unadjusted. | Other |
| Externalizing | Regression, Linear | 0.227 | Unadjusted. | Other |
| Substance Use | Regression, Linear | 0.106 | Unadjusted. | Other |
| Substance Use | Regression, Linear | 0.058 | Unadjusted. | Other |
| Affectionate Supports |
|
| 0.382 |
Unadjusted. |
| Other |
| Tangible Supports | Regression, Linear | 0.680 | Unadjusted. | Other |
| Tangible Supports | Regression, Linear | 0.988 | Unadjusted. | Other |
| Affectionate | Regression, Linear | 0.701 | Unadjusted. | Other |
| Affectionate | Regression, Linear | 0.154 | Unadjusted. | Other |
| Social |
|
| Environment |
|
| 0.150 |
Unadjusted. |
| Other |
| Psychological | Regression, Linear | 0.789 | Unadjusted. | Other |
| Psychological | Regression, Linear | 0.811 | Unadjusted. | Other |
| Social | Regression, Linear | 0.726 | Unadjusted. | Other |
| Social | Regression, Linear | 0.795 | Unadjusted. | Other |
| Environment | Regression, Linear | 0.837 | Unadjusted. | Other |
| Environment | Regression, Linear | 0.048 | Unadjusted. | Other |