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Compromised mental health and mental illness can be both a risk for and an outcome of homelessness, the report points out.

"It's probably not as simple as it's always one pathway or another — it's probably a bit of both," Zelmer told CMAJ in an interview.

"In some cases it may well be that a severe mental illness leads to loss of employment and that's the trigger factor for ending up being homeless. But we also know that homeless youth tend to report much higher stress levels than other youth, and that's one of the risk factors for mental illness."

Poverty, inadequate income and spending an excessive amount of one's income on shelter are all risk factors for mental illness, Zelmer says.

In addition, "we do know that some types of mental illness are more common among people who have lower incomes," she added.

People living on the street are much more likely to report mental illnesses, including schizophrenia and depression, and that is reflected in their use of health services, she says. They are also less likely to report healthy coping strategies, another risk factor for mental illness.

Several studies cited in the report identify higher stress and substance abuse among street youth compared with the general population, as well as higher incidence of self-harm and suicide attempts.

One national survey, for the Public Health Agency of Canada, reported 2% of males and 6% of females aged 15–25 attempted suicide in Canada.

A 2006 British Columbia survey, however, indicates 15% of males and 30% of females living on the street or identifying as "marginalized" had attempted suicide at least once in the previous year.

http://www.cmaj.ca/cgi/content/full/177/9/1015