Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness

Abstract

Traditionally, intrapersonal characteristics (distress tolerance) and interpersonal characteristics (social support) have been studied separately rather than simultaneously. In the current study, we address this gap by simultaneously examining these characteristics as potential indirect associations linking established urban stress–depression and urban stress–Post-Traumatic Stress Disorder (PTSD) relationships. Adults experiencing homelessness were recruited from six homeless shelters in Oklahoma City (n = 567). Participants self-reported urban life stress (Urban Life Stress Scale), distress tolerance (Distress Tolerance Scale), social support (Interpersonal Support Evaluation List 12), major depressive disorder (Patient Health Questionnaire-8), and PTSD symptoms (Primary Care Post-Traumatic Stress Disorder screener). Covariate-adjusted structural equation models indicated a significant indirect effect of distress tolerance on the urban stress–depression (b = 0.101, 95% CI = 0.061, 0.147) and urban stress–PTSD (b = 0.065, 95% CI = 0.023, 0.112) relationships. Additionally, a significant indirect effect of social support on the urban stress–depression (b = 0.091, 95% CI = 0.053, 0.133) and urban stress-PTSD relationships (b = 0.043, 95% CI = 0.006, 0.082) was evident. Further, both the urban stress–depression (b = 0.022, 95% CI = 0.011, 0.037) and urban stress–PTSD relationships (b = 0.014, 95% CI = 0.005, 0.026) were associated indirectly through social support to distress tolerance. Interventions that aim to increase social support may also increase distress tolerance skills and indirectly reduce depressive and PTSD symptoms in the context of urban stress among adults experiencing homelessness.