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Media Center. Multimedia Library. Connect Ask the Expert Join Us. How are homelessness and mental illness connected? Can homelessness exacerbate an existing mental illness? How does homelessness affect mental illness within families? Managing Stress Around the Holidays. Community-based mental health services play an important role. Homelessness could be drastically reduced if people with severe mental illness were able to access supportive housing as well as other necessary community supports.
They encounter more barriers to employment and tend to be in poorer health than other people experiencing homelessness. Housing outreach services that provide a safe place to live are a vital component of stabilizing the illness and helping individuals on their journey to recovery. Skip to main content. Homelessness What is homelessness? Housing First How many people are homeless in Canada? Ending Homelessness Cost Analysis. Poverty Hub. Knowledge Mobilization.
Victimization In New York, homeless men were interviewed regarding having been assaulted or injured. Twelve percent of the men were psychotic, and this group was significantly more likely than the nonpsychotic men to have been robbed, beaten, threatened with a weapon, or injured concussion or limb fractures. Those who receive social security disability checks become targets for muggers.
There is a hierarchy among the shelter clients, and the visibly mentally ill are the lowest caste, untouchables among the outcasts. Anecdotally, the stories bear out the studies. For instance, Albert Blanchard, a homeless man with a long history of schizophrenia and homelessness, was set on fire as he slept on a sidewalk in downtown Nashville. He chose to live on the streets to keep the people the voices warned him of from finding him.
Sexual assault The consequences of impaired thinking are often direr for women with untreated mental illness than they are for men. A study of the incidence of rape among women with schizophrenia reported it to be 22 percent, with two-thirds of those having been raped multiple times. A study of homeless women in Baltimore found that nearly one-third of the women had been raped Breakey, W.
A report on homeless women in San Francisco noted the women were being raped and sexually assaulted at an alarming rate, with some women being raped as many as 17 times. To protect themselves from attack, homeless women were known to wear 10 pairs of panty hose at once and bundle up in layers of clothing Cooper, C. Rape also exposes these women to deadly infection with the HIV virus that causes AIDS, especially since most of the men committing the rapes are drug addicts among whom HIV infection is common.
No study has been done to date of the HIV infection rate among homeless women who have a severe mental illness. Clinical AIDS will, therefore, become an increasing problem in the near future among the homeless psychiatrically ill. Death There is evidence that those who are homeless and suffering from a psychiatric illness have a markedly elevated death rate from a variety of causes. This is not surprising since the homeless in general have a three times higher risk of death than the general population and severely ill individuals have a 2.
As part of a study in England, for example, investigators collected data for 18 months on 48 homeless people who also had a severe mental illness.
They found that three people had died from physical causes i. Depending on whether or not the missing participants were alive, the month mortality rate was a minimum of eight percent and a maximum of 15 percent.
Homeless people with untreated brain disorders frequently suffer fatal accidents caused by their impaired thinking. A study of homeless people published in Hospital and Community Psychiatry found that 43 percent of the cases showed the marked disorganization of mental illness and poor problem-solving skills H. In an additional 30 percent, the subjects were not only disorganized but too paranoid to accept help. For example, two of the people had a place to live, but were too paranoid and fearful to stay there.
Freezing to death during bitter weather is all-too-common among the homeless in general, but especially among those with schizophrenia and manic-depressive illness. These deaths do not usually attract much attention, but on November 29, , in Washington, DC, Yetta Adams was found frozen to death on a bench across the street from the headquarters of the Department of Housing and Urban Development HUD.
Adams suffered from schizophrenia and alcoholism and was living on the streets. Cisneros, left his office to find out what had happened. Murder is the most horrific cause of increased mortality among those homeless individuals with untreated psychiatric illnesses. While no formal study has been conducted, anecdotal evidence suggests that such deaths are not rare.
In , three men and a woman, ages 19 to 22, beat a homeless man to death with baseball bats as part of a gang initiation.
Randall Townsend, 42, had a severe mental illness and was living under a bridge. One assailant hit him in the face so hard that the bat broke. The other assailants then punched and kicked him and dropped a boulder on his face. Townsend never regained consciousness and died from head injuries. In , three young men savagely beat Van Mill, a pound man with paranoid-schizophrenia who was living in a tent in Des Moines, IA, to death.
Frustration with inability to treat Most homeless individuals with severe psychiatric disorders are not being treated. Furthermore, longitudinal studies could examine mechanisms linking homelessness and mental disorders in order to develop more effective preventive measures. We are grateful to authors of included and non-included publications who provided additional details about their studies: C.
Adams, H. Salize, A. Greifenhagen, C. Vazquez, U. Beijer, C. Siegel, and G. We are also grateful to the professional translator N. Spennemann for assistance with Japanese studies.
Abstract Background Homelessness continues to be a pressing public health concern in many countries, and mental disorders in homeless persons contribute to their high rates of morbidity and mortality. Methods and findings We systematically searched for observational studies that estimated prevalence rates of mental disorders in samples of homeless individuals, using Medline, Embase, PsycInfo, and Google Scholar.
Conclusions Public health and policy interventions to improve the health of homeless persons should consider the pattern and extent of psychiatric morbidity. Author summary Why was this study done? Homelessness continues to affect a large number of people in high-income countries and is associated with an increased risk of mental disorders. To guide service development, further research, and public policy, reliable estimates on the prevalence of mental disorders among homeless individuals are needed.
Many primary investigations into rates of mental disorders have been published since a previous comprehensive quantitative synthesis in What did the researchers do and find? We performed a systematic database search, extracted data from primary reports, and assessed their risk of bias, resulting in a sample of 39 studies including information from over 8, homeless individuals in 11 countries.
We conducted random effects meta-analyses of 7 common diagnostic categories. Prevalence estimates were all increased in homeless individuals compared with those in the general population. There was substantial between-study variation in prevalence estimates, and meta-regression analyses found that sampling method, participant sex distribution, and study country explained some of the heterogeneity.
What do these findings mean? The high burden of substance use disorders and severe mental illness in homeless people represents a unique challenge to public health and policy. Future research should prioritize quantification of unmet healthcare needs, and how they can be identified and effectively treated.
Research on subgroups, including younger people and immigrant populations, is a priority for prevalence work. Introduction Homelessness is recognized by the United Nations Economic and Social Council as an issue of global importance [ 1 ]. Methods Search strategy We searched for studies that determined prevalence rates for at least 1 of the following disorders among homeless persons: 1 schizophrenia spectrum disorders, 2 major depressive disorder, 3 bipolar disorder, 4 alcohol use disorders, 5 drug use disorders, 6 personality disorders, and 7 any current mental disorder Axis I disorders in the Diagnostic and Statistical Manual of Mental Disorders [DSM] multiaxial system [ 30 ].
Eligibility criteria and study selection Inclusion criteria were as follows: 1 homelessness status of study participants was validated by an operationalized definition or a sampling method that specifically targeted homeless population; 2 standardized criteria for the psychiatric disorders specified above, based on the International Classification of Diseases ICD or DSM, were applied; 3 psychiatric diagnoses were made by clinical examination or interviews using validated semi-structured diagnostic instruments; 4 for any psychiatric disorders except for personality disorders where lifetime rates were used , prevalence rates were reported within 12 months; and 5 study location was a high-income country according to the classification of the World Bank [ 33 ].
Data collection and quality assessment Information from included surveys was extracted on study location, year of diagnostic assessment, operational definition of homelessness status, sampling method, diagnostic procedures, diagnostic criteria, professional qualification of interviewers, response rate, dropout rate, number of participants by sex, sample mean age, current accommodation of participants, sample mean duration of homelessness, and number of participants diagnosed with schizophrenia spectrum disorders, major depressive disorder, bipolar disorder, alcohol- and drug-related disorders, personality disorders, and any primary diagnosis of a mental disorder apart from personality and developmental disorders i.
Results Description of included studies The systematic literature search returned 5, distinct records, of which full texts were assessed see S3 Table for reasons for exclusion. Download: PPT. Any current mental disorders There were 8 surveys reporting on homeless people having at least 1 diagnosis of a current mental disorder [ 28 , 51 , 54 , 62 , 71 — 73 , 81 ], with a random effects pooled prevalence estimated at Fig 2.
Forest plot of prevalence estimates of any current mental disorder. Table 1. Study-level factors associated with between-study heterogeneity in multivariable meta-regression. Schizophrenia spectrum disorders There were 35 surveys reporting on any schizophrenia spectrum disorder [ 28 , 29 , 49 , 51 — 58 , 60 — 74 , 76 — 78 , 80 — 85 ], and the random effects prevalence was Fig 3. Forest plot of prevalence estimates of schizophrenia spectrum disorders.
Major depression We identified 18 studies reporting prevalence estimates on major depressive disorder [ 28 , 49 , 52 , 55 , 57 — 60 , 62 , 63 , 65 , 67 , 71 , 77 , 80 , 81 , 84 , 85 ], with a random effects pooled prevalence of Fig 4. Forest plot of prevalence estimates of major depression. Bipolar disorder Fourteen surveys with prevalence estimates on bipolar disorder were identified [ 28 , 49 , 55 , 57 — 59 , 62 , 63 , 65 , 67 , 71 , 77 , 84 , 85 ].
Fig 5. Forest plot of prevalence estimates of bipolar disorder. Alcohol use disorders Estimates on alcohol use disorders could be extracted from 29 surveys [ 28 , 29 , 51 — 66 , 68 , 71 — 73 , 76 , 77 , 79 — 81 , 84 , 85 ]. Fig 6. Forest plot of prevalence estimates of alcohol use disorders.
Drug use disorders We identified 23 surveys reporting prevalence estimates on drug use disorders [ 28 , 29 , 52 , 53 , 55 — 65 , 71 , 73 , 76 , 79 , 80 , 82 , 84 , 85 ] Fig 7.
Fig 7. Forest plot of prevalence estimates of drug use disorders. Personality disorders Fourteen studies reported prevalence estimates on lifetime personality disorders [ 28 , 51 — 53 , 62 , 64 , 67 , 75 — 77 , 80 , 82 , 84 , 85 ], with a random effects pooled prevalence of Discussion This systematic review and meta-analysis of the prevalence of mental illness among homeless people in high-income countries included 39 studies comprising a total of 8, participants.
Supporting information. S1 Table. Database search strings. S2 Table. S3 Table. Studies excluded at full-text screening, with reasons.
S4 Table. Study characteristics. S5 Table. JBI checklist for prevalence studies. S6 Table. Risk of bias tool. S7 Table. Data basis for meta-analyses and meta-regression analyses. S8 Table. Univariable regression models.
S9 Table. Results of single factor meta-regression models for affective disorders pooled. S10 Table. Results of multiple factor meta-regression for affective disorders pooled. S1 Text. Affective disorders. Results of meta-analysis and meta-regression analysis. Acknowledgments We are grateful to authors of included and non-included publications who provided additional details about their studies: C. References 1. United Nations Commission for Social Development. Affordable housing and social protection systems for all to address homelessness.
Report of the Secretary-General. Directorate of Employment, Labour and Social Affairs. Tsai J. J Public Health Oxf. Part 1: point-in-time estimates of homelessness. Willliams SP, Bryant K. Sexually transmitted infection prevalence among homeless adults in the United States: a systematic literature review. Sex Transm Dis. Traumatic brain injury among people who are homeless: a systematic review.
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Am J Public Health. View Article Google Scholar Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis.
Lancet Infect Dis. Mortality among homeless adults in Boston: shifts in causes of death over a year period. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: a longitudinal, community-based study in Vancouver, Canada.
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