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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    • "Además, en los últimos años (2005-2012) la población sin hogar se ha incrementado en España un 132%, falleciendo en nuestro país una persona sin hogar cada cinco días (INE, 2012). Se asocian a una baja calidad de vida y altas tasas de enfermedad física y psíquica (Folsom et al., 2005; Sullivan, Burman, Koegel y Hollenberg, 2000), sufren un evidente deterioro mental fruto de su estancia en la calle (Csémy, Vágnerová y Marek, 2011; Muñoz, Vázquez, Panadero y Vázquez, 2003; Salavera, Puyuelo y Orejudo, 2009; Solliday-McRoy, Campbell, Melchert , Young y Cisler, 2004) y se consideran el nivel máximo de exclusión social que se produce en una sociedad moderna (Combaluzier y Pedinielli, 2003; Vágnerová, Csémy y Marek, 2012). La adherencia a tratamientos psicosociales en esta población es muy baja, convirtiéndose en muchas ocasiones en actuaciones puntuales sobre las necesidades más básicas (comida , alojamiento y ropa). "

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