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Cited by 77Homelessness and Social IssuesMental Health Treatment and AccessPsychiatric care and mental health services

The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index; none of the 48 sources its claims cite is checked for support yet.

Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia

Open access
Fekadu, Abebaw, Hanlon, Charlotte, Gebre-Eyesus, Emebet, Agedew, Melkamu, Solomon, Haddis, Teferra, Solomon, Gebre-Eyesus, Tsehaysina, Baheretibeb, Yonas, Medhin, Girmay, Shibre, Teshome, Workneh, Abraham, Tegegn, Teketel, Ketema, Alehegn, Timms, Philip, Thornicroft, Graham, Prince, Martin·2014·BMC Medicine
DOI 10.1186/s12916-014-0138-xPMC PMC4147171
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Abstract

BACKGROUND: The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia. METHODS: A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule. RESULTS: We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness. CONCLUSION: Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In a cross-sectional survey of 217 street homeless adults in Addis Ababa, Ethiopia, about 90% had some form of mental or alcohol use disorder, with 41.0% meeting criteria for psychosis. People with psychosis had extensive unmet needs and a very high treatment gap, with only about 10% ever having received treatment.

Key findings

  • Among 217 street homeless adults, 41.0% (89/217) had psychosis; most of those with psychosis had schizophrenia (88%, 79/89).
  • About 90% had some form of mental or alcohol use disorder; 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month.
  • Homeless people with psychosis had extensive unmet needs, with 80% to 100% reporting unmet needs across 26 domains; nearly 30% had physical disability, and only 10.0% of those with psychosis had ever received treatment for their illness.
  • Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness.

Methods

  • Cross-sectional community-based study of street homeless adults in four districts of Addis Ababa; homelessness was defined as rooflessness, and eligibility required at least 24 hours on the street prior to assessment.
  • Double-stage sampling: trained community nurses screened for potential psychosis and administered standardized measures of mental distress (K10), suicidality, and alcohol use disorder (AUDIT); psychiatric nurses then conducted confirmatory psychosis assessments using SCAN/PSQ items and administered a locally adapted 26-item Camberwell Assessment of Needs Short Appraisal Schedule (CANSAS).
  • Analyses were primarily descriptive, reporting frequencies and percentages; comparative analysis examined factors associated with chronicity of homelessness and compared those with and without psychosis, using complete case analysis for missing data.

Limitations

  • The paper states that missing information was a major problem, with missing values in some domains sometimes up to 33%, and that more mobile and recently homeless people were difficult to evaluate.
  • The paper states that it did not examine unmet needs among homeless people without psychosis, intentionally focusing on the more severely mentally ill population.
  • Evident from the text: the cross-sectional design cannot establish causation, and the two-stage evaluation may have screened out some individuals with psychosis, potentially underestimating prevalence; AUDIT was also noted as not validated in the Ethiopian setting.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12916-014-0138-x

Cites

43 of 43 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 48 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Alcohol use disorder was positively associated with chronicity of homelessness among street homeless people in Addis Ababa.

    “Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness.”
    Quote in the paperNot a substantial claim
  • Findingown data

    60.0% of assessed street homeless adults in Addis Ababa had hazardous or dependent alcohol use.

    “We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month.”
    Quote in the paperNot a substantial claim
  • Findingown data

    About 90% of assessed street homeless adults in Addis Ababa had experienced some form of mental or alcohol use disorder.

    “We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month.”
    Quote in the paperNot a substantial claim
  • Findingown data

    About nine in ten street homeless individuals in Addis Ababa had some form of mental or alcohol use disorder.

    “About nine in ten individuals had some form of mental or alcohol use disorder”
    • Also stated in: § Prevalence of mental disorders · plain
      “Considering milder mental distress and alcohol use disorders in addition to psychosis, about 90% of street homeless adults had some form of current mental disorder.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Only 10.0% of those with psychosis had ever received treatment for their illness.

    “Only 10.0% of those with psychosis had ever received treatment for their illness.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim. 37
  • The quote only partly states this claim. 2
  • It may state two separate claims as one. 19

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    Among those with psychosis, 9.0% (8) had nonorganic psychotic disorders.

    “the rest had either nonorganic psychotic disorders (9.0%; n = 8)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    Among those with psychosis, 2.2% (2) had psychosis related to bipolar disorder.

    “or psychosis related to bipolar disorder (2.2%; n = 2)”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    41.8% of the sample reported a persistent wish to die in the past month.

    “A high proportion of the sample reported having a persistent wish to die (41.8%)”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Most participants with psychotic disorder were chronically homeless, with over two-thirds having been homeless for 2 years or longer.

    “Most participants with psychotic disorder were chronically homeless, with over two-thirds having been homeless for 2 years or longer; just 16.7% were homeless for less than 6 months (Table 4).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingnone given

    Many had co-morbid untreated physical illness or physical disability, and had not accessed care.

    “Many had co-morbid untreated physical illness or physical disability, and had not accessed care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    8 of the 15 patients with disability had significant physical impairments.

    “8 of these 15 patients had significant physical impairments (visual and sensory impairment and impaired mobility).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Six individuals reported a history of sexual abuse, of which three were women.

    “Six individuals reported a history of sexual abuse, of which three were women.”
    • Also stated in: § Prevalence of mental disorders · plain
      “3/6 women (50%) who responded reported sexual abuse.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    About 19% (11/58) reported a history of imprisonment since becoming homeless.

    “About 19% (11/58) reported a history of imprisonment since becoming homeless.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    Mental illness and treatment seeking for mental illness were cited as the main reason for homelessness in only five cases (8%).

    “Mental illness and treatment seeking for mental illness were cited as the main reason for homelessness in only five cases (8%)”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    Physical health needs were unmet in 84% of people with psychosis.

    “Physical health needs were unmet in 84%.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    Self-injurious behaviour was noted in about 10% of participants.

    “Self-injurious behaviour was noted in about 10% of participants.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Findingnone given

    Most of the participants were not originally from Addis Ababa, but had migrated in after becoming homeless.

    “Most of the participants were not originally from Addis Ababa, but had migrated in after becoming homeless.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In China, in a 10-year prospective study of people with schizophrenia, 7.8% of the sample had experienced homelessness at least once.

    “In China, in a 10-year prospective study of people with schizophrenia, 7.8% of the sample had experienced homelessness at least once [28].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] Ran MS, Chan CLW, Chen EYH, Xiang MZ, Caine ED, Conwell Y: Homelessness among patients with schizophrenia in rural China: a 10-year cohort study. Acta Psychiatr Scand. 2006, 114: 118-123. 10.1111/j.1600-0447.2006.00746.x. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In high income countries, 25% to 50% of the homeless population are reported to have some form of mental disorder.

    “Generally, 25% to 50% of the homeless population are reported to have some form of mental disorder [11–14] in high income countries.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [11] Scott J: Homelessness and mental illness. Br J Psychiatry. 1993, 162: 314-324. 10.1192/bjp.162.3.314. source
    • cites [12] Breakey WR, Fischer PJ, Kramer M: Health and mental health problems of homeless men and women living in Baltimore. JAMA. 1989, 262: 1352-1357. 10.1001/jama.1989.03430100086034. source
    • cites [13] Gelberg L, Linn LS: Demographic differences in health status of homeless adults. J Gen Intern Med. 1992, 7: 601-608. 10.1007/BF02599198. source
    • cites [14] Koegel P, Burnam MA: Alcoholism among homeless adults in the inner city of Los Angeles. Arch Gen Psychiatry. 1988, 45: 1011-1018. 10.1001/archpsyc.1988.01800350045007. source

  • It may state two separate claims as one.

    Premisecitation

    Both the 10-item and 6-item versions of the K10 were validated in Ethiopia, with the 10-item version showing superior validity.

    “Both the 10-item and 6-item versions (K10 and K6) were validated in Ethiopia, with the 10-item version showing superior validity [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Tesfaye M, Hanlon C, Alem A: Detecting postnatal common mental disorders in Addis Ababa: Ethiopia: validation of the Edinburgh Postnatal Depression Scale and Kessler Scales. J Affect Disord. 2010, 122: 102-108. 10.1016/j.jad.2009.06.020. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The K10 is a widely used tool to assess mental distress in the preceding one month.

    “The K10 is a widely used tool to assess mental distress in the preceding one month [33].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Kessler RC, Andrews G, C LJ, Hiripi E, Mroczek DK: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002, 32: 959-976. 10.1017/S0033291702006074. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In high income countries, about 60% of those who are street homeless are reported to have some form of mental disorder.

    “This rises to about 60% among those who are street homeless.”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [11] Scott J: Homelessness and mental illness. Br J Psychiatry. 1993, 162: 314-324. 10.1192/bjp.162.3.314. source
    • cites [12] Breakey WR, Fischer PJ, Kramer M: Health and mental health problems of homeless men and women living in Baltimore. JAMA. 1989, 262: 1352-1357. 10.1001/jama.1989.03430100086034. source
    • cites [13] Gelberg L, Linn LS: Demographic differences in health status of homeless adults. J Gen Intern Med. 1992, 7: 601-608. 10.1007/BF02599198. source
    • cites [14] Koegel P, Burnam MA: Alcoholism among homeless adults in the inner city of Los Angeles. Arch Gen Psychiatry. 1988, 45: 1011-1018. 10.1001/archpsyc.1988.01800350045007. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Mental disorder among homeless people in high income countries is associated with increased vulnerability, including violent victimisation and criminality.

    “2) increased vulnerability of the homeless person, including violent victimisation [20] and criminality [21–23];”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [20] Walsh E, Moran P, Scott C, McKenzie K, Burns T, Creed F, Tyrer P, Murray RM, Fahy T: Prevalence of violent victimisation in severe mental illness. Br J Psychiatry. 2003, 183: 233-238. 10.1192/bjp.183.3.233. source
    • cites [21] Brennan P, Mednick S, Hodgins S: Major mental disorders and criminal violence in a Danish birth cohort. Arch Gen Psychiatry. 2000, 57: 494-500. 10.1001/archpsyc.57.5.494. source
    • cites [22] Fazel S, Grann M: The population impact of severe mental illness on violent crime. Am J Psychiatry. 2006, 163: 1397-1403. 10.1176/appi.ajp.163.8.1397. source
    • cites [23] Gelberg L, Linn LS, Leake BD: Mental health, alcohol and drug use, and criminal history among homeless adults. Am J Psychiatry. 1988, 145: 191-196. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    A community-based study of people with schizophrenia reported a prevalence of 7% homelessness in Ethiopia.

    “A community-based study of people with schizophrenia reported a prevalence of 7% homelessness in Ethiopia [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Kebede D, Alem A, Shibre T, Negash A, Fekadu A, Fekadu D, Deyassa N, Jacobsson L, Kullgren G: Onset and clinical course of schizophrenia in Butajira-Ethiopia–a community-based study. Soc Psychiatry Psychiatr Epidemiol. 2003, 38: 625-631. 10.1007/s00127-003-0678-4. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    Data were double-entered using Epidata and exported to SPSS for analysis.

    “Data were double-entered using Epidata, v 3.1 (The EpiData Association, Odense, Denmark) and exported to the IBM SPSS, v 20 (IBM Corp., NY) for analysis.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    When family ties have failed, there are no structured programmes or appropriate welfare systems to support homeless people with mental disorders in low income countries, thus increasing their vulnerability.

    “Furthermore, when family ties have failed, there are no structured programmes or appropriate welfare systems to support homeless people with mental disorders in low income countries, thus increasing their vulnerability [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Gureje O, Bamidele R: Thirteen-year social outcome among Nigerian outpatients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 1999, 34: 147-151. 10.1007/s001270050126. source

  • Probably not a substantial claim.

    Study design and conductnone given

    Community workers were trained to recognise manifestations of mental disorders and distinguish severe mental disorders in homeless people from behaviours that may develop in chronic homelessness.

    “The community workers were first trained to recognise the manifestations of mental disorders, and how to distinguish severe mental disorders in homeless people from behaviours that may develop in the context of chronic homelessness.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In a 13-year retrospective study of people with schizophrenia in Nigeria, a history of homelessness was found in 4% of the sample.

    “In a 13-year retrospective study of people with schizophrenia in Nigeria, a history of homelessness was found in 4% of the sample [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Gureje O, Bamidele R: Thirteen-year social outcome among Nigerian outpatients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 1999, 34: 147-151. 10.1007/s001270050126. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductreasoning

    The CANSAS was adapted based on expert consensus meetings and discussions with developers, with items modified, four items added, total increased from 22 to 26, and final version approved by developers.

    “The CANSAS was adapted based on a series of expert consensus meetings and discussions with the developers of the original CANSAS.”
    • Also stated in: § Assessment for psychotic disorders · plain
      “Thus the total number of specific needs assessed was increased from 22 to 26.”
    • Also stated in: § Assessment for psychotic disorders · plain
      “The final version of the adapted CANSAS was approved by the developers of the original CANSAS.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Thornicroft G, Beck T, Knapp M, Knudsen HC, Schene A, Tansella M, Vázquez-Barquero JL: International Outcome Measures in Mental Health: Quality of Life, Needs, Service Satisfaction, Costs and Impact on Carers. 2006, Gaskell, London

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Mental disorder among homeless people in high income countries is associated with increased risk of mortality from general medical causes, suicide, and drug-related causes.

    “The consequences of mental disorder among homeless people in high income countries are: 1) an increased risk of mortality from general medical causes, suicide [16–18] and drug-related causes [19];”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [16] Babidge NC, Buhrich N, Butler T: Mortality among homeless people with schizophrenia in Sydney, Australia: a ten year follow-up. Acta Psychiatr Scand. 2001, 103: 105-110. 10.1034/j.1600-0447.2001.00192.x. source
    • cites [17] Hwang SW: Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000, 283: 2152-2157. 10.1001/jama.283.16.2152. source
    • cites [18] Prigerson HG, Desai RA, Liu-Mares W, Rosenheck RA: Suicidal ideation and suicide attempts in homeless mentally ill persons: age-specific risks of substance abuse. Soc Psychiatry Psychiatr Epidemiol. 2003, 38: 213-219. 10.1007/s00127-003-0621-8. source
    • cites [19] Barrow SM, Herman DB, Cordova P, Struening EL: Mortality among homeless shelter residents in New York City. Am J Public Health. 1999, 89: 529-534. 10.2105/AJPH.89.4.529. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    Complete case analysis was used to deal with missing data in the few comparisons conducted.

    “We used complete case analysis to deal with missing data in the few comparisons we conducted.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    In a meta-analysis of 29 studies conducted from 1979 to 2005, the commonest disorders among the homeless population were alcohol dependence, drug dependence and psychotic disorders, with random effects pooled prevalence estimates of 37.9%, 24.4%, and 12.7%, respectively.

    “In a meta-analysis of 29 studies conducted from 1979 to 2005, the commonest disorders found among the homeless population were alcohol dependence, drug dependence and psychotic disorders, with random effects pooled prevalence estimates of 37.9%, 24.4%, and 12.7%, respectively [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] Fazel S, Khosla V, Doll H, Geddes J: The prevalence of mental disorders among the homeless in Western countries: Systematic review and meta-regression analysis. PLoS Med. 2008, 5: e225-10.1371/journal.pmed.0050225. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Mental disorder among homeless people in high income countries is associated with increased likelihood that the person spends longer periods as homeless.

    “and 3) increased likelihood that the person spends longer periods as homeless [24].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [24] Morse G, Shields NM, Hanneke CR, McCall GJ, Calsyn RJ, Nelson B: St. Louis’s homeless: Mental health needs, services, and policy implications. Psychosoc Rehabil J. 1986, 9: 39-50. 10.1037/h0099150. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    People with depression (with psychosis) had a higher rate of suicide attempt than those with schizophrenia, although the latter had made more dangerous attempts.

    “It has been reported that people with depression (with psychosis) had a higher rate of suicide attempt than those with schizophrenia, although the latter had made more dangerous attempts [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Radomsky ED, Haas GL, Mann JJ, Sweeney JA: Suicidal behavior in patients with schizophrenia and other psychotic disorders. Am J Psychiatry. 1999, 156: 1590-1595. source

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Interpretationreasoning

    Once immediate mental health needs are met, homeless people with mental illness will be better positioned to benefit from social and economic interventions occurring as part of wider community development.

    “Once immediate mental health needs are met, homeless people with mental illness will be better positioned to benefit from the social and economic interventions occurring as part of the wider community development.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationcitation

    The higher rate of suicide attempts among those with non-psychotic disorders may be a reflection of that trend.

    “Thus, the higher rate of suicide attempts among those with non-psychotic disorders may be a reflection of that trend.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Radomsky ED, Haas GL, Mann JJ, Sweeney JA: Suicidal behavior in patients with schizophrenia and other psychotic disorders. Am J Psychiatry. 1999, 156: 1590-1595. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Premisenone given

    Although it is often believed that traditional communities in low income countries are tolerant of mental illness, there are no concrete data supporting this belief.

    “Although it is often believed that traditional communities in low income countries are tolerant of mental illness, there are no concrete data supporting this belief.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    A study of homeless shelter users from Rio de Janeiro, Brazil, reported the 12-month prevalence of any mental disorder and major mental disorders to be 49% and 19%, respectively.

    “A study of homeless shelter users from Rio de Janeiro, Brazil [44], reported the 12-month prevalence of any mental disorder and major mental disorders to be 49% and 19%, respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Lovisi GM, Mann AH, Coutinho E, Morgado AF: Mental illness in an adult sample admitted to public hostels in the Rio de Janeiro metropolitan area. Braz Soc Psychiatry Psychiatr Epidemiol. 2003, 38: 496-501.

  • It may state two separate claims as one.

    Interpretationown data

    Although economic reasons seemed to play a major role in the causation of homelessness within the sample, there are indications that mental illness may be an important factor in the causation and maintenance of homelessness in many homeless people with psychoses.

    “Although economic reasons seemed to play a major role in the causation of homelessness within our sample, there are indications that mental illness may be an important factor in the causation and maintenance of homelessness in many homeless people with psychoses.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationreasoning

    This migration may have been triggered by the loss of traditional family networks and support from the community.

    “This migration may have been triggered by the loss of traditional family networks and support from the community.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    An excerpt from a focus group discussion expresses the fear of traditional rural communities.

    “An excerpt from a focus group discussion expresses the fear of traditional rural communities: ‘Mad people…would run to the town…(they) are better tolerated in town. People in town are not afraid that these people would burn their houses. They would not chase them away like we do, that is why they run to town’ [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Shibre T, Teferra S, Morgan C, Alem A: Exploring the apparent absence of psychosis amongst the Borana pastoralist community of Southern Ethiopia. A mixed method follow-up study. World Psychiatry. 2010, 9: 98-102. source

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.

    Interpretationreasoning

    All these findings represent a substantial level of neglect of the street homeless population, particularly those with mental illness.

    “All these findings represent a substantial level of neglect of the street homeless population, particularly those with mental illness.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Study design and conductreasoning

    The two-stage evaluation may screen out some individuals with psychosis, and the study might have underestimated the prevalence of psychosis.

    “In conjunction with the two-stage evaluation, which may screen out some individuals with psychosis, we might have underestimated the prevalence of psychosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    The lack of treatment and other support services is likely to increase the incidence and prevalence of homelessness among the mentally ill.

    “The lack of treatment and other support services is likely to increase the incidence and prevalence of homelessness among the mentally ill.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    A large-scale multi-country study of homelessness involving eight low and middle income countries identified two main related reasons for homelessness: poverty and failure of the housing supply system.

    “A large-scale multi-country study of homelessness involving eight low and middle income countries (Peru, South Africa, Zimbabwe, Ghana, India, Bangladesh, Indonesia and China) identified two main related reasons for homelessness [5]: poverty and failure of the housing supply system.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] The Nature and Extent of Homelessness in Developing Countries. 2003, CARDO, University of Newcastle upon Tyne, New Castle

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductreasoning

    The study attempted to minimize the impact of missing data by focusing analyses and presentation on relevant descriptive data rather than investigating complex associations.

    “We attempted to minimize the impact of missing data by focusing the analyses and the presentation on relevant descriptive data rather than investigating complex associations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.

    Interpretationreasoning

    Governmental plans to scale up mental health care for the general population may improve treatment receipt and potentially prevent the onset of homelessness among the mentally ill.

    “Thus, governmental plans to scale up mental health care for the general population may improve treatment receipt and, potentially, prevent the onset of homelessness among the mentally ill.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationnone given

    The stress of homelessness and access to substances of abuse can increase the risk of mental illness, although this is difficult to establish.

    “It is also worth noting that the stress of homelessness and access to substances of abuse can increase the risk of mental illness, although this is difficult to establish.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    The sample was chronically homeless, a factor known to be associated with increased psychiatric morbidity.

    “Additionally the sample was chronically homeless, a factor known to be associated with increased psychiatric morbidity [45].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Phelan JC, Link BG: Who are ‘the homeless’? Reconsidering the composition and stability of the homeless population. Am J Public Health. 1999, 89: 1334-1338. 10.2105/AJPH.89.9.1334. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In studies investigating those who are newly homeless, even higher rates of mental disorder have been documented.

    “However, in studies investigating those who are newly homeless, even higher rates of mental disorder have been documented [46,47].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [46] Bresnahan M, Collins PY, Susser E: Mental illness in an adult sample admitted to public hostels in the Rio de Janeiro metropolitan area, Brazil: On Lovisi et al. Soc Psychiatry Psychiatr Epidemiol. 2003, 38: 499-501. 10.1007/s00127-003-0667-7. source
    • cites [47] Susser E, Moore R, Link BG: Risk factors Homelessness. Epidemiol Rev. 1993, 15: 545-555. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In reports from high income countries, the prevalence of mental disorder is around 60% in the street homeless.

    “In reports from high income countries, the prevalence of mental disorder is around 60% in the street homeless [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Scott J: Homelessness and mental illness. Br J Psychiatry. 1993, 162: 314-324. 10.1192/bjp.162.3.314. source

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Premisecitation

    The 'low-cost, no-care solution' is not a good intervention model to follow for low income countries.

    “Part of the lesson from the work that has been performed in high income countries is that the ‘low-cost, no-care solution’ [2] is not a good intervention model to follow for low income countries.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Timms P: Homelessness and Mental Illness: A Brief History. Homelessness and Mental Health. Edited by: Bhurga D. 1996, Cambridge University Press, Cambridge, 11-25. 10.1017/CBO9780511526732.003. source

  • It may state two separate claims as one.

    Interpretationreasoning

    Under-reporting and ability to access alcoholic drinks among those with psychosis may be important factors in the finding of lower alcohol dependence.

    “Both under-reporting and the ability to access alcoholic drinks among those with psychosis in our homeless sample may also be important factors in the finding of lower alcohol dependence among our sample.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationreasoning

    If the assumption is correct, mental illness may have made some contribution to the homelessness of over half of the cases (n = 33/61).

    “If this assumption is correct, mental illness may have made some contribution to the homelessness of over half of the cases (n = 33/61).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Mental illness is likely to have been relevant to the homelessness of those reporting family disagreements and those who claimed not to know the reason for their homelessness.
49 of 49

  • The paper relies on this without support.

    The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems.

    “The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems.”

  • The paper relies on this without support.

    In Addis Ababa, the number of homeless individuals is around 50,000 (city administration estimate).

    “In Addis Ababa, for example, the city administration estimates the number of homeless individuals to be around 50,000.”

  • The paper relies on this without support.

    Homeless people with mental illness are likely to have complex physical, social and psychological needs requiring complex interventions.

    “Homeless people with mental illness are likely to have complex physical, social and psychological needs requiring complex interventions.”

  • The paper relies on this without support.

    Those with psychosis are the most vulnerable and least likely to benefit from decentralized services or programmes aimed at addressing the needs of homeless people.

    “Secondly, those with psychosis are the most vulnerable and least likely to benefit from decentralized services or programmes that are aimed at addressing the needs of homeless people.”

  • The paper relies on this without support.

    There are no studies looking explicitly at the prevalence of mental disorders among the street homeless, the needs of this group and potential solutions, or barriers to improving their care in low income countries.

    “To our knowledge, there are no studies looking explicitly at the prevalence of mental disorders among the street homeless, the needs of this group and potential solutions, or barriers to improving their care in low income countries.”

  • The paper relies on this without support.

    Community nurses' screening based on behavioural manifestations can identify potential psychosis among street homeless people.

    “The community nurses based their assessment of psychosis on the behavioural manifestations of psychosis among the street homeless.”

  • The authors state this as an assumption.

    Mental illness is likely to have been relevant to the homelessness of those reporting family disagreements and those who claimed not to know the reason for their homelessness.

    “mental illness is likely to have been relevant to the homelessness of those reporting family disagreements, and for those who claimed not to know the reason for their homelessness.”
    “If this assumption is correct, mental illness may have made some contribution to the homelessness of over half of the cases (n = 33/61).”

  • The paper relies on this without support.

    The study is the first in Africa, or any other low income country, to determine the prevalence of mental disorders among street homeless people or to estimate the unmet needs of street homeless people with psychosis.

    “To our knowledge, this is the first study in Africa, or any other low income country, attempting to determine the prevalence of mental disorders among street homeless people, or to estimate the unmet needs of street homeless people with psychosis.”

  • The paper relies on this without support.

    Homeless individuals with mental illness are excluded from the activities of the Addis Ababa City Administration to rehabilitate the homeless.

    “Moreover, homeless individuals with mental illness are excluded from the activities of the Addis Ababa City Administration to rehabilitate the homeless.”

  • The paper relies on this without support.

    The focus of the rehabilitation by the city administration is primarily development of economic capacity, and those with mental illness have not been able to benefit from these initiatives.

    “The focus of the rehabilitation by the city administration is primarily development of economic capacity, and those with mental illness have not been able to benefit from these initiatives.”

  • The paper relies on this without support.

    There has been very little interest from international organizations to support homeless mentally ill individuals to date.

    “It is of note that there has been very little interest from international organizations to support homeless mentally ill individuals to date.”

  • The paper relies on this without support.

    There is a lack of an organized social welfare system in Ethiopia.

    “This finding was anticipated from the outset given the lack of an organized social welfare system in Ethiopia.”
12 of 12

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Methadone replacement treatment for opioid dependence reduces use of heroin and maintains engagement with addiction treatment.

    “Methadone replacement treatment for opioid dependence reduces use of heroin and maintains engagement with addiction treatment. 40”

    From The Hotel Study—Clinical and Health Service Effectiveness in a Cohort of Homeless or Marginally Housed Persons (2017) · cites this paper as [40]

    The Results and Conclusions discuss mental and alcohol use disorders among street homeless people in Addis Ababa, but do not address methadone treatment, heroin use, or retention in addiction treatment. Searches for methadone replacement treatment and opioid dependence found no passage addressing the claimed effects. Page numbers are unavailable in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Psychosis duration counts disagree between Tables 3 and 4

    Major

    For people with psychosis who had been homeless for more than five years, Table 3 reports 45 (40.2%), while Table 4 reports 40 (54.8%). The discrepancy changes the apparent comparison between the psychosis and non-psychosis groups.

  • Table 3 reverses the reported age pattern for psychosis

    Minor

    The text says participants with psychosis were older, but Table 3 places 55.3% of the non-psychosis group and only 22.9% of the psychosis group at age 35 or above.

  • AUDIT respondent totals differ between text and Table 2

    Minor

    The results text says 181 people responded to the AUDIT questions, whereas Table 2 gives 188 as the denominator for alcohol-use categories.

  • Place-to-return responses exceed their stated denominator

    Minor

    Table 4 lists 33 respondents with no place to return to and 27 with a place, totaling 60 rather than the stated 57. The printed percentages also correspond to a denominator of 60.

    Reported 57 · recomputed 60

  • Table 1 misstates the percentage without children

    Minor

    Of the 49 respondents, 39 without children is 79.6%, not 89.9%.

    Reported 89.9 · recomputed 79.591837

5 of 5

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. Paul GO: Observations on the Subject of Lunatic Asylums. 1812, Private publication, Gloucester
  2. Ocobock P: Introduction. Vagrancy and Homelessness in Global and Historical Perspective. Edited by: Beier AL, Ocobock P. 2008, Ohio University Press, USA, 1-34. 1
  3. An Urbanising World: Global Report on Human Settlements. 1996, Oxford University Press, Oxford
  4. mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Program (mhGAP). 2010, WHO Press, Geneva
  5. Fekadu A, Alem A, Hanlon C: Alcohol and drug abuse in Ethiopia: past, present and future. Afr J Drug Alcohol Stud. 2007, 6: 39-53.

Cited by

Sorted by citations

Related

Metadata

Authors
Fekadu, A., Hanlon, C., Gebre-Eyesus, E., Agedew, M., Solomon, H., Teferra, S., Gebre-Eyesus, T., Baheretibeb, Y., Medhin, G., Shibre, T., Workneh, A., Tegegn, T., Ketema, A., Timms, P., Thornicroft, G., & Prince, M.
Affiliations
  • King's College London (GB)
  • Amanuel Mental Specialized Hospital (ET)
  • Addis Ababa University (ET)
  • St. Paul's Hospital Millennium Medical College (ET)
  • University of Toronto (CA)
  • South London and Maudsley NHS Foundation Trust (GB)
Corresponding author
Fekadu, Abebaw
ORCID
Venue
BMC Medicine
Publisher
Springer Science and Business Media LLC
Published
2014-08-20
Volume
12
Issue
1
Pages
138-138
ISSN
1741-7015 (ISSN-L)
DOI
10.1186/s12916-014-0138-x
PMC
PMC4147171
OpenAlex
W2163576960
Semantic Scholar
837cc65f80f95a3964876bcf42dd24fca8d67e1d
Cited by
76
References
42
Citations by year
2026: 5 · 2025: 7 · 2024: 6 · 2023: 18 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 6 · 2018: 7 · 2017: 3 · 2016: 7 · 2014: 1
FWCI
6.64
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by)
  • TSpace (University of Toronto) (submittedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
Funders
National Institute for Health and Care Research (NF-SI-0611-10053)
Topics
  • Social Sciences › Sociology and Political Science › Homelessness and Social Issues
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
street homelessness, mental illness, psychosis, unmet needs, psychological distress, suicidality, alcoholism, chronic homelessness, physical disability, access to mental health care, Addis Ababa
MeSH terms
Adult, Aged, Alcoholism, Mental Disorders, Cross-Sectional Studies, Ethiopia, Female, Ill-Housed Persons, Humans, Male, Middle Aged, Suicide, Prevalence, Cost of Illness

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

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