Prevalence and Risk Factors for Homelessness and Utilization of Mental Health Services Among 10,340 Patients With Serious Mental Illness in a Large Public Mental Health System

Department of Psychiatry, University of California, San Diego, San Diego, California, United States
American Journal of Psychiatry (Impact Factor: 12.3). 03/2005; 162(2):370-6. DOI: 10.1176/appi.ajp.162.2.370
Source: PubMed


The authors examined the prevalence of and risk factors for homelessness among all patients treated for serious mental illnesses in a large public mental health system in a 1-year period. The use of public mental health services among homeless persons was also examined.
The study included 10,340 persons treated for schizophrenia, bipolar disorder, or major depression in the San Diego County Adult Mental Health Services over a 1-year period (1999-2000). Analytic methods that adjusted for potentially confounding variables were used. Multivariate logistic regression analyses were used to calculate odds ratios for the factors associated with homelessness, including age, gender, ethnicity, substance use disorder, Medicaid insurance, psychiatric diagnosis, and level of functioning. Similarly, odds ratios were computed for utilization of mental health services by homeless versus not-homeless patients.
The prevalence of homelessness was 15%. Homelessness was associated with male gender, African American ethnicity, presence of a substance use disorder, lack of Medicaid, a diagnosis of schizophrenia or bipolar disorder, and poorer functioning. Latinos and Asian Americans were less likely to be homeless. Homeless patients used more inpatient and emergency-type services and fewer outpatient-type services.
Homelessness is a serious problem among patients with severe mental illness. Interventions focusing on potentially modifiable factors such as substance use disorders and a lack of Medicaid need to be studied in this population.

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Available from: Shahrokh Golshan, Oct 17, 2014
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    • "Bipolar depression is of particular interest in homeless populations because individuals with bipolar disorder have higher rates of homelessness , compared to those with unipolar depression (Folsom et al., 2005). Similarly, patients who had a history of homelessness have increased odds of being assessed for bipolar symptoms (Kilbourne et al., 2010). "
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    ABSTRACT: Homeless individuals are an extremely vulnerable and underserved population characterized by overlapping problems of mental illness and substance use. Given the fact that mood disorders are frequently associated with substance use disorders, we wanted to further highlight the role of excitement in substance abuse. Patterns of substance abuse among homeless suffering from unipolar and bipolar depression were compared. The "self-medication hypothesis" which would predict no-differences in substance preference by unipolar (UP) and bipolar (BP) depressed homeless was tested. Homeless individuals from the Vancouver At Home/Chez Soi study were selected for lifetime UP and lifetime BP depression and patterns of substances abused in the previous 12 months were identified with the Mini-International Neuropsychiatric Interview. Differences in substance use between BP-depressed homeless and UP-depressed homeless were tested using Chi-square and logistic regression techniques. No significant differences were observed between UP and BP homeless demographics. The bipolar depressed homeless (BDH) group displayed a higher percentage of Central Nervous System (CNS) Stimulants (χ 8.66, p=0.004) and Opiates (χ 6.41, p=0.013) as compared to the unipolar depressed homeless (UDH) group. CSN Stimulant was the only predictor within the BDH Group (χ(2) 8.74 df 1 p<0.003). Data collected are self-reported and no urinalyses were performed. The results support the hypothesis that beyond the self-medication hypothesis, bipolarity is strictly correlated to substance use; this correlation is also verified in a homeless population. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 02/2015; 176C. DOI:10.1016/j.jad.2015.01.059 · 3.38 Impact Factor
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    • "Furthermore, those with a mental illness are almost twice as likely as those without a mental illness (17% versus 9%) to have experiences of homelessness ( James & Glaze, 2006). Serious mental illness, especially untreated mental health disorders, substance abuse and dependency, and dual disorders are also risk factors for homelessness in community samples (Folsom et al., 2005; Greenberg & Rosenheck, 2010; Levin, Culhane, DeGenova, O'Quinn, & Bainbridge, 2009). In addition, doi: 10.1093/swr/svu014 © 2014 National Association of Social Workers economic disadvantage and persistent unemployment , lack of support from family and friends, low educational achievement, incarceration, and histories of childhood adversity have been identified as risk factors for homelessness among adults (Caton et al., 2005; Kertesz et al., 2005; McNeil et al., 2005; Reardon, Burns, Preist, Sachs-Ericsson, & Lang, 2003; Shelton, Taylor, Bonner, & van den Bree, 2009). "
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    • "There was no comparative reduction in ED presentations for THT participants in the difference - in - difference analysis . Previous studies have found that homeless patients with SPMI have higher rates of ED presentations ( Folsom et al . , 2005 ) . Rates of ED presentations were significantly higher for THT participants than controls for both the year before entry and year after exit . Although confounding due to differences between the hospital districts is possible , comparisons of the availability of primary care and community mental health services make this unlikely . Our"
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