{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T03:33:41Z","timestamp":1776310421005,"version":"3.50.1"},"reference-count":100,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,6,25]],"date-time":"2019-06-25T00:00:00Z","timestamp":1561420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psychiatric Ment Health Nurs"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Accessible summary<\/jats:title><jats:sec><jats:title>What is known on the subject?<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Understanding what strategies individuals use to cope with serious mental illness is vital for enhancing their quality of life, mental well\u2010being\u00a0and recovery, and effective use of services;<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>An episode of homelessness can be a profoundly disruptive event that often leads to chronic stress, social isolation, a negative belief about oneself\u00a0and restricted access to care, among other adverse experiences;<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec><jats:sec><jats:title>What the paper adds to existing knowledge?<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>In contrast to existing reviews of qualitative research focusing on escaping homelessness, managing problem substance use and growing resilience, the current review offers an in\u2010depth, interpretive account of coping with serious mental illness during an episode of homelessness;<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>This paper integrates evidence showing the diverse and intricate processes via which homelessness can impede an individual's ability to successfully cope with life stressors\u00a0and with chronic mental illness;<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Despite experiencing severe social disadvantage, many individuals demonstrate positive adaptation and coping, and even personal growth;<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec><jats:sec><jats:title>What are the implications for practice?<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>It is important to be aware of the many ways in which coping with serious mental illness can be influenced by adverse environmental factors such as poverty, homelessness, traumatic life experiences and institutional discrimination;<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Nursing practice should recognize that coping efforts\u00a0by individuals facing multiple forms of social disadvantage may be shaped by\u00a0acute adverse life events and\u00a0institutional interactions, as well as by the stresses and strains of living on the streets;<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Nursing practice should focus not only on reducing clients' mental illness symptoms and facilitating positive coping behaviours, but also\u00a0on helping create the conditions that aid clients in leveraging inner resources for personal growth and constructive\u00a0meaning\u2010making.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><jats:sec><jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>An evidence gap\u00a0persists concerning the impact of extreme socio\u2010structural disadvantage, such as homelessness, on the nature and effectiveness of coping with severe mental illness (SMI). While existing reviews of qualitative research into homelessness have focused on processes such as escaping homelessness and managing concurrent problem substance use, as well as on the experiences of specific vulnerable groups such\u00a0as women and youth, no analogical review has been dedicated to\u00a0understanding the management of SMI during an episode of homelessness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim\/Question<\/jats:title><jats:p>A qualitative metasynthesis of first\u2010person accounts was conducted to understand how individuals cope with SMI when experiencing homelessness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The systematic search strategy yielded 481 potentially eligible sources. Following the team\u2010based full\u2010text screening and the two\u2010tiered quality appraisal, 14 studies involving 377 participants with lived experience were synthesized following Noblit and Hare's metaethnographic method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven third\u2010order concepts were derived capturing the complex nature and processual character of coping, as well as the\u00a0web of contextual influences upon coping strategies. The resultant line\u2010of\u2010argument synthesis reveals the dialectical relationship between the two higher\u2010order constructs\u2014\u201cthe continuum of coping\u201d and \u201cthe assemblage of disadvantage.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Despite the profoundly adverse impacts of biographical and socio\u2010structural conditions, many individuals mobilized internal and external resources to enable various coping processes. Coping in the context of multiple disadvantage is not a monolith but rather a multidimensional, contingent and fluid phenomenon.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for practice<\/jats:title><jats:p>Nursing practice should espouse a humanizing, structurally competent, and strength\u2010 and meaning\u2010oriented approach in order to meet the complex and multifaceted needs of such multiply disadvantaged persons.<\/jats:p><\/jats:sec><\/jats:sec><\/jats:sec>","DOI":"10.1111\/jpm.12524","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T19:27:42Z","timestamp":1558034862000},"page":"4-24","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Coping amidst an assemblage of disadvantage: A qualitative metasynthesis of first\u2010person accounts of managing severe mental illness while homeless"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8756-6848","authenticated-orcid":false,"given":"Dimitar","family":"Karadzhov","sequence":"first","affiliation":[{"name":"Centre for Health Policy, International Public Policy Institute, School of Social Work and Social Policy University of Strathclyde Glasgow UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0655-9193","authenticated-orcid":false,"given":"Yeqing","family":"Yuan","sequence":"additional","affiliation":[{"name":"Silver School of Social Work New York University New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6239-0839","authenticated-orcid":false,"given":"Lynden","family":"Bond","sequence":"additional","affiliation":[{"name":"Silver School of Social Work New York University New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,6,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1468017313476797"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0023598"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/14992020309074630"},{"key":"e_1_2_9_5_1","volume-title":"Unraveling the mystery of health. 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