Child Development, May/June 2000, Volume 71, Number 3, Pages 721���732 Depressive Symptoms and Co-occurring Depressive Symptoms, Substance Abuse, and Conduct Problems among Runaway and Homeless Adolescents Les B. Whitbeck, Danny R. Hoyt, and Wa-Ning Bao This study examines factors that contribute to depressive symptoms and to co-occurring depression, substance abuse, and conduct problems among 602 runaway and homeless adolescents. The respondents were inter- viewed in shelters, drop-in centers, and directly on the streets in four Midwestern states (Missouri, Iowa, Ne- braska, and Kansas). Results indicate that although family-of-origin factors contribute to depressive symptoms and comorbidity among runaway and homeless adolescents, experiences and behaviors when the adolescents are on their own also have powerful effects. The authors discuss the findings from a life-course perspective fo- cusing on mechanisms through which street experiences accentuate or amplify already high levels of psycho- logical distress and behavioral problems among this population of young people. INTRODUCTION Major advances have been made over the past two decades in our understanding of the prevalence of ad- olescent depressive symptoms and the factors associ- ated with it. We know very little, however, about depression and co-occurring disorders among home- less and runaway adolescents. Although these young people experience multiple risks for depressive symp- toms, the relative impact of risks originating in the families from which they leave and the experiences they have when on their own has never been exam- ined. In this study we investigate the effects of family and street experiences on depressive symptoms and the co-occurrence of depressive symptoms, substance abuse, and conduct problems. Depressive symptoms in adolescents. Although no na- tional epidemiological studies have focused specifi- cally on adolescents, numerous smaller community samples have provided estimates of the prevalence of depressed mood that average 20%���35% of boys and 25%���40% of girls (Peterson et al., 1993). Peterson and colleagues reported a median rate of 35% of ado- lescents exceeding clinical cut-off scores on measures of depressive symptoms on the basis of a review of 14 studies. Profiles of young people at risk for depressive symptoms indicate that having a depressed parent (Downey & Coyne, 1990 Whitbeck et al., 1992), reject- ing or emotionally unavailable parents (Burge & Hammen, 1991), and living in families with high levels of marital or family conflict (Burbach & Borduin, 1986 Carlton-Ford, Paikoff, & Brooks-Gunn, 1991 Forehand et al., 1988) increase risk for depressive symptoms. Children, particularly girls, whose parents are divorced are at greater risk (Feldman, Rubinstein, & Rubin, 1988 Wallerstein & Corbin, 1991) as are children in lower socioeconomic environments (Garrison, Schluc- ter, Schoenbach, & Kaplan, 1989) and children in eco- nomically distressed families (Conger et al., 1992, 1993). Children with histories of maltreatment and phys- ical and/or sexual abuse are at particular risk for de- pressive symptoms (Downey & Walker, 1992 Finkel- hor, 1984). Young people with depressive symptoms report more negative life events in their own lives and in those of family members (Compas, Howell, Phares, Williams, & Ledeaux, 1989 Ge, Lorenz, Conger, Elder, & Simons, 1994) and more daily stressors (Wagner, Compas, & Howell, 1988). They also report lower lev- els of social support available to help them cope with stressful events (Armsden, McCauley, Greenbur, Burke, & Mitchell, 1990 Daniels & Moos, 1990). De- pressed adolescents often view themselves as unpop- ular with peers and as having poorer relationships with peers (Jacobsen, Lahey, & Strauss, 1983). Risk factors among homeless and runaway adoles- cents. Runaway and homeless adolescents fall into nearly all of the risk categories enumerated in the ad- olescent depression literature. Recent work has shown convincingly that runaways experience high rates of family disorganization, ineffective parenting, and physical and/or sexual abuse. Homeless adoles- cents score higher than housed adolescents on mea- sures of parental deprivation (Schweitzer, Hier, & Terry, 1994). Control group studies have indicated that homeless adolescents report higher levels of pa- rental marital problems and lower levels of parental care and acceptance than adolescents who live at �� 2000 by the Society for Research in Child Development, Inc. All rights reserved. 0009-3920/2000/7103-0018

722 Child Development home (Daddis, Braddock, Cuers, Elliott, & Kelly, 1993). Using multiple reporter data from runaway ad- olescents and their caregivers, Whitbeck and col- leagues found that when compared with nonrun- away adolescents and their parents, both runaway adolescents and their caregivers scored lower on measures of parental warmth and supportiveness and parental monitoring and higher on measures of parental rejection (Whitbeck, Hoyt, & Ackley, 1997a). A substantial proportion of runaways leaves fam- ily situations that pose serious risks. Although rates of adolescent reports of abusive family backgrounds vary widely across studies, all indicate severe risk for physical and sexual abuse. Janus, Burgess, and Mc- Cormack (1987) found that 71.5% of the male run- aways they interviewed reported physical abuse and 38.2% reported sexual abuse in their families. Silbert and Pines��� (1981) study of juvenile and adult street prostitutes indicated that 60% had family histories of sexual abuse. In the Kurtz, Kurtz, and Jarvis (1991) report based on shelter intake records of 2,019 run- aways from eight southeastern states, 28% of the runaways identified themselves as having been sexu- ally or physically abused. About 30% of Kufeldt and Nimmo���s (1987) sample of 474 runaways reported physical abuse. Bridge, Inc. in Boston (Saltonstall, 1984) have reported a 65% physical abuse rate. Only 5% of their sample (p. 78) ���clearly stated there was no abuse in their homes.��� A Los Angeles County shel- ter/drop-in center study (Pennbridge, Yates, David, & McKenzie, 1990) reported a 47% abuse/neglect rate. Using the Conflict Tactics Scale (Straus & Gelles, 1990), Whitbeck and Simons (1993) found physical abuse rates ranging from 80% for slapping to 48% for being ���beat up��� for a sample of 150 street youth in Des Moines, IA. Thirty-seven percent of the young women reported forced sexual activity by an adult caregiver. According to the National Network of Run- away and Youth Services, 70% of adolescents in shel- ters have been physically or sexually abused, or both (Kennedy, 1991). Homeless and runaway adolescents have few so- cial resources, low levels of social support, and high levels of daily stressors associated with being on their own (Whitbeck, Hoyt, & Ackley, 1997b) or coping with life in a homeless and runaway youth center. Running away is in itself a major source of stress for young people. Leaving even a disorganized family and losing familiar routines of school and home is ex- tremely disruptive for young lives. Time spent on the streets or shelters presents novel situations that are associated with vulnerability, unfamiliar and threat- ening surroundings, hunger, and new, often unpre- dictable associates. The emotional consequences of homelessness. Good- man and colleagues use trauma theory to explain the psychological stress experienced by adults who be- come homeless (Goodman, Saxe, & Harvey, 1991). They suggest that experiencing homelessness is traumatic for adults in three ways. First, the process of becom- ing homeless may produce symptoms of psychological distress. Becoming homeless means the loss of familiar routines day-to-day contacts with friends, relatives, and neighbors and loss of a safe and private space. Second, the condition of homelessness is incredibly stressful. A heightened sense of vulnerability, hyper- vigilance, anxiety, and fear may be adaptive to street life but stress producing nonetheless. Third, if the in- dividual is already experiencing psychological distress when he or she becomes homeless, the experience will almost certainly exacerbate existing symptoms. If these processes are expected to produce traumatic stress for adults, the effects should be much greater for young people who need and expect adult care. Studies of psychological distress among homeless youth, however, are remarkably silent regarding the effects of street life on the emotional well-being of these young people. Instead, they tend to dwell on pathological influences before running away. Even some of the best diagnostic assessments of street youth do not take street victimization and the trauma of being homeless into consideration. In the studies that choose to document it, evidence of the hazards of street life is plentiful. Such evidence shows that con- stant anxiety and fear are associated with precocious independence. For example, more than 50% of Kipke���s sample of Hollywood street youth feared being shot or stabbed and almost 50% feared being sexually as- saulted or beaten up (Kipke, Simon, Montgomery, Unger, & Iverson, 1997). Fifty-one percent reported that they had been beaten up since being on the streets, 45% had been chased, and 26% had been shot at. Nineteen percent had been stabbed while living on the streets, 15% sexually assaulted, and 7% wounded by gunfire. Rotheram-Borus and associates (Rotheram-Borus, Rosario, & Koopman, 1991) re- ported that in a New York sample of runaways, 20% were physically assaulted, 20% sexually assaulted, and 20% robbed in the three months before seeking shelter. Whitbeck and Simons (1993) in a Des Moines sample of homeless adolescents and adults reported that one-half of the adolescent males had been beaten up on the streets, 57% had been threatened with a weapon, and 42% actually assaulted with a weapon. One-third of the adolescent females had been beaten up, one-third had been threatened with a weapon, and almost one-fourth had been assaulted with a weapon.