Choice affects the health of people experiencing homelessness: the role of resignation

Aims and objectives: People experiencing homelessness (PEH) face worse physical and psychosocial health problems than the general population. Several studies have shown that perceived choice in PEH affects self-reported well-being and the mediation role of mastery. Nevertheless, the processes underlying these effects are not completely understood. The research aims to evaluate whether the level of perceived choice and the frequency of use of homeless services has an impact on self-rated health of peopleexperiencing homelessness (PEH). The mediating role of resignation (characterized by feelings of unworthiness, helplessness, alienation, and depression) is also explored. Methods: Data were collected using self-reported questionnaires. 43 people living on the street or shelters in Milan (Italy) were included in the sample, (self-identified as male = 83.7%; mean age = 52.7 years old; SD = 12.2). Participants answered measures of choice, use of services, resignation, and perceived health. Results: A higher level of choice perceived by PEH was associated with a lower sense of resignation, while the frequency of service use was not significantly related with resignation. The feeling of resignation, in turn, was negatively associated with the level of general health: the lower the level of resignation experienced, the greater the PEH’s health. Results showed a positive indirect association between choice and health, supporting the mediating role of resignation. Conclusions and implications: Our findings contribute to explain why certain service features, regardless of the type of service, can help improve PEH's health. Promoting the level of choice within the service can decrease the feelings of alienation, depression, unworthiness, and helplessness experienced by PEH. Given that perception of choice is associated with increased sense of control and autonomy and a reduced sense of resignation, a transition is desirable on a service-level from primary needs resolution to personcentered and choice-oriented approaches.