Mental health and social characteristics of the homeless: a survey of mission users.
Abstract
Selected mental health and social characteristics of 51 homeless persons drawn as a probability sample from missions are compared to those of 1,338 men aged 18-64 years living in households from the NIMH Epidemiologic Catchment Area survey conducted in Eastern Baltimore. Differences between the two groups were small with respect to age, race, education, and military service but the differences in mental health status, utilization patterns, and social dysfunction were large. About one-third of the homeless scored high on the General Health Questionnaire which measures distress. A similar proportion had a current psychiatric disorder as ascertained by the Diagnostic Interview Schedule (DIS), with the homeless exhibiting higher prevalence rates in every DIS/DSM III diagnostic category compared to domiciled men. Homeless persons reported higher rates of hospitalization than household men for both mental (33 per cent vs 5 per cent) and physical (20 per cent vs 10 per cent) problems but a lower proportion received ambulatory care (41 per cent vs 50 per cent). Social dysfunction among the homeless was indicated by fewer social contacts and higher rates of arrests as adults than domiciled men (58 per cent vs 24 per cent), including multiple arrests (38 per cent vs 9 per cent) and felony convictions (16 per cent vs 5 per cent). Implications of these findings are discussed in terms of research and health policy.
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Psychotic illness was reported in 28 surveys with a random effects pooled prevalence of 12.7% (95% CI 10.2%-15.2%).
“Psychotic illness was reported in 28 surveys with a random effects pooled prevalence of 12.7% (95% CI 10.2%–15.2%) [6–10,38–56,60,61].”
From The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis (2008) · cites this paper as [6]
Diagnoses of psychosis in homeless individuals range from 2% to 31% in prior surveys.
“Diagnoses of psychosis range from 2% [6] to 31% [7], depression from 4% [8] to 41% [9], and personality disorder from 3% [9] to 71% [10].”
From The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis (2008) · cites this paper as [6]
We identified 14 surveys that reported personality disorder diagnoses in 2,413 homeless persons.
“We identified 14 surveys that reported personality disorder diagnoses in 2,413 homeless persons (Figure 4) [6–10,38,39,41,48,51,54,55,61].”
From The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis (2008) · cites this paper as [6]
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“Diagnoses of psychosis range from 2% [6] to 31% [7], depression from 4% [8] to 41% [9], and personality disorder from 3% [9] to 71% [10].”
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“The betterdesigned investigations utilized standardized diagnostic instruments such as the Diagnostic Interview Schedule (3, 20, 21, 23, 40, 41), Composite International Diagnostic Interview (24, 34), the Structured Clinical Interview for DSM-III-R (6, 42) or DSM-IV (7), the Psychiatric Diagnostic Interview (43), the…”
MethodStructural Determinants of Homelessness in the United States
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“Rather, most empirical studies of the homeless estimate the size of the homeless population or describe the demographic and personal characteristics of homeless individuals and their living conditions (Ball and Havassy, 1984; Bassuk, 1984, 1986; Burt and Cohen, 1989; Fischer et al., 1986; Lee, 1989a, 1989b; Rossi et a…”
BackgroundMethodology for Obtaining a Representative Sample of Homeless Persons
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“Several studies of antisocial personality disorder (ASPD) have estimated rates between 10% and 40% [6] [7] [8] [9] [10] [11] [12] [13], and this prevalence exceeds all Axis I disorders except substance abuse.”
BackgroundAttkisson, C. C., Cook, J. Α., Karno, M. P., Lehman, A. F., McGlashan, T. H., Meltzer, H. Y., O'Connor, M., Richardson, D., Rosenblatt, A., Wells, K., et al. (1992) · Schizophrenia Bulletin · doi:10.1093/schbul/18.4.561 · Cited by 133 · see citing works
“Studies have used diverse measures and definitions of mental illness (Santiago et al, 1988), as well as samples from highly diverse populations (compare, eg, Fischer et al, 1984; Lipton et al, 1986; and Vergare and Acre 1986).”
MethodDrug use disorders and treatment contact among homeless adults in Alameda County, California.
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“Used sedatives 0 (0) 4 (2) 2 (2) Used barbiturates 5 (2) 0 (0) 2 (2) Used any drug 59 (26) 43 (24) 50 (50)”
BackgroundInfluentialDistinguishing homelessness from poverty: a comparative study.
Toro, P., Bellavia, C. W., Daeschler, C. V., Owens, B., Wall, D., Passero, J. M., & Thomas, D. M. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.63.2.280 · Cited by 131 · see citing works
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“Neither men nor women were as disaffiliated as one might expect from other published reports (Bassuk, Rubin, & Lauriat 1984; Fischer, Shapiro, Breakey, Anthony & Kramer 1986; Bassuk & Rosenberg 1988; Fischer & Breakey 1986; Milburn & D'Ercole 1991).”
ResultWhen social support fails: The homeless
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“The DIS has been widely used in recent studies of homeless adults (e.g., Fischer, Shapiro, Breakey, Anthony, & Kramer, 1986; Fournier, Mercier, Raynault, Ohayon, & Caulet, 1993; Koegel, Burnam, & Farr, 1988; North & Smith, 1993; Roberston et al., 1997; Toro et al., 1995, 1997).”
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“Many studies have examined contacts with family and/or friends by describing the social support networks of homeless adults (Bruni and Sosin, 1997; Fischer et al., 1986; Grigsby et al., 1990; Schutt et al., 1994; Sosin et al., 1993; Stahler et al., 1995).”
BackgroundHomelessness: What is a psychologist to do?
Shinn, M. (1992) · American Journal of Community Psychology · doi:10.1007/bf00942179 · Cited by 98 · see citing works
“For example, several studies found differences between homeless and housed respondents with respect to social networks (Bassuk & Rosenberg, 1988; Fischer, Shapiro, Breakey, Anthony, & Kramer, 1986; Passero, Zax, & Zozus, 1991; Sosin et al., 1988; Wood, Valdez, Hayashi, & Shen, 1990), but others did not (Goodman, 1991;…”
ResultHospitalization in an Urban Homeless Population: The Honolulu Urban Homeless Project
Martell, J. V., Seitz, R. S., Harada, J. K., Kobayashi, J., Sasaki, V. K., & Wong, C. (1992) · Annals of Internal Medicine · doi:10.7326/0003-4819-116-4-299 · Cited by 94 · see citing works
“5 (0) Filipino 34(2) 9(3) 87(11) Other 71(4) 11(3) 85 (10) HIV risk present 232 (13) 59 (19) NA HIV-positive 25(1) 10(3) NA”
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“1 42 Since the 1990s epidemiologic studies of homeless people have demonstrated that about onehalf of people who are sleeping on the streets or in shelters have a history of incarceration (1,2) and that rates of multiple arrests are four times higher for homeless men than for domiciled men (3).”
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The prevalence of psychiatric disorders and use of care by homeless people in Paris
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Street Crime Victimization Among Homeless Adults: A Review of the Literature
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BackgroundMethodSocial and physical health of homeless adults previously treated for mental health problems.
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Self-citationCriminal activity among the homeless: a study of arrests in Baltimore.
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Self-citationPredicting Health Services Utilization Among Homeless Adults: A Prospective Analysis
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Cognitive Dysfunction in Homeless Adults: A Systematic Review
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Risks Associated with Long-Term Homelessness among Women: Battery, Rape, and HIV Infection
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Exposure to project-based Housing First is associated with reduced jail time and bookings
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Residential patterns in older homeless adults: Results of a cluster analysis
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“Similar to other studies of older homeless adults, we found a higher rate of chronic illness (Hahn et al., 2006), cognitive impairments (Buhrich et al., 2000; Fischer et al., 1986), and a lower rate of active illicit drug use than younger samples (Gelberg et al., 1990).”
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Dental health of homeless adults.
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A Quantitative Review of Cognitive Functioning in Homeless Adults
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A Systematic Study of Mental Illness, Substance Abuse, and Treatment in 600 Homeless Men
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“However, despite their poorer health status and considerable need for medical care, homeless persons underuse outpatient medical services [9,10] and rely to a greater extent on emergency department visits [11,12] and costly inpatient hospitalizations [13,14], often for preventable medical problems [15].”
BackgroundChallenges for psychiatry in serving homeless people with psychiatric disorders.
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Homelessness Is Traumatic: Abuse, Victimization, and Trauma Histories of Homeless Men
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Psychometric Properties of the Dutch Version of the Self-Sufficiency Matrix (SSM-D)
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“Apart from physical and (severe) mental health issues (Fischer et al. 1986; Phelan et al. 2001), problems T.”
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“Individuals who are homeless for longer durations are more likely to have concurrent substance use and mental disorders (Fischer et al, 1986 ; Kuhn & Culhane, 1998 ) which, in turn, complicate the housing and the recovery needs of individuals (Edens, Mares, Tsai, & Rosenheck, 2011 ; Kertesz, Crouch, Milby, Cusimano, &…”
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Correlates of codisorders in homeless and never homeless indigent schizophrenic men
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A decade of research and services for homeless mentally ill persons. Where do we stand
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“The homeless subgroup has been characterized by social isolation and diminished social support networks (Fisher, Shapiro, Breakey, Anthony, & Kramer, 1984), residential instability, and the significant prevalence of concomitant substance abuse problems (Morrissey & Dennis, 1986).”
BackgroundA systematic study of mental health services utilization by homeless men and women
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“A number of other investigators have reported similar observations (Breakey et al. 1989; Fischer and Breakey 1986; Fischer et al. 1986; Drake et al. 1991; Bassuk et al. 1984).”
BackgroundResultProblems in the Assessment of Mental Illness among the Homeless Empirical Approach
Koegel, P., & Burnam, M. (1992) · doi:10.1007/978-1-4899-0679-3_7 · Cited by 51
Perceived unmet need and barriers to care amongst street‐involved people who use illicit drugs
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A systematic review of cognition in homeless children and adolescents.
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Mental illness in a representative sample of homeless men in Munich, Germany
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“Specifically, Hausman and Hammen (1993) discuss the “double crisis” of family homelessness.”
BackgroundNo Place Called Home: Life Quality and Purpose of Homeless Youths
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“This argument is consistent with reports that social disaffiliation and development of poor coping strategies may precede homelessness (e.g., Fischer, Shapiro, Breakey, Anthony, & Kramer, 1986; Fors & Rojek, 1991).”
ResultA Model of Homeless Migration: Homeless Men in Skid Row, Los Angeles
Rahimian, A., Wolch, J., & Koegel, P. (1992) · Environment and Planning · doi:10.1068/a241317 · Cited by 47
Preferences for sites of care among urban homeless and housed poor adults
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Linn, L., Gelberg, L., & Leake, B. (1990) · Hospital & community psychiatry · doi:10.1176/ps.41.3.306 · Cited by 44 · see citing works
Reardon, M. L., Burns, A. B., Preist, R., Sachs-Ericsson, N., & Lang, A. R. (2003) · Substance Use & Misuse · doi:10.1081/ja-120017387 · Cited by 43 · see citing works
“…prevalence rates are highly consistent with studies that have compared rates of the currently homeless to those of the general population sample (Fischer et al., 1986), suggesting that despite having escaped homelessness, these FH individuals still experience substantially elevated rates of…”
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Homeless mentally disordered offenders and violent crimes
Martell, D. A. (1991) · Law and Human Behavior · doi:10.1007/bf02074075 · Cited by 42 · see citing works
“A number of studies have attempted to determine what proportion of the homeless are mentally disordered (Arce & Vergare, 1984; Fischer, Shapiro, Breakey, Anthony, & Kramer, 1986; NYS Office of Mental Health, 1982; Rossi, Wright, Fisher, & Willis, 1987).”
BackgroundStress, social support, and outcomes in two probability samples of homeless adults
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The Service Hub Concept in Human Services Planning
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A Comparison of Clinical and Structured Interview Diagnoses in a Homeless Mental Health Clinic
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“Questions have been raised about potential lack of sensitivity of the DIS to psychiatric disorders such as schizophrenia and depression in homeless populations ( Fischer, Shapiro, Breakey, Anthony, & Kramer, 1986; Breakey, et al. 1989; Fischer, 1989).”
BackgroundIndicators of Chronic Homelessness Among Veterans
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Diblasio, F. A., & Belcher, J. R. (1995) · American Journal of Orthopsychiatry · doi:10.1037/h0079596 · Cited by 35
- Authors
- Fischer, P. J., Shapiro, S., Breakey, W. R., Anthony, J. C., & Kramer, M.
- Affiliations
- Johns Hopkins University (US)
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 1986-05
- Volume
- 76
- Issue
- 5
- Pages
- 519-524
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- OpenAlex
- W1993664362
- Cited by
- 259
- References
- 32
- Citations by year
- 2024: 1 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 2 · 2019: 4 · 2018: 2 · 2017: 1 · 2016: 6 · 2015: 8 · 2014: 2 · 2013: 9 · 2012: 7
- FWCI
- 45.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (3u01mh033883-05s3, 3u01mh033870-05s1)
- National Institute of Mental Health (U01 MH-33883, U01 MH34224, U01 MH 33870)
- Topics
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- homelessness, mental health, mental illness, social dysfunction, homeless men, psychiatric hospitalization, ambulatory care utilization, arrests, social contact, General Health Questionnaire, Diagnostic Interview Schedule, Baltimore
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Catchment Area, Health, Crime, Employment, Epidemiologic Methods, Family, Female, Ill-Housed Persons, Hospitalization, Humans, Male, Marriage, Maryland, Mental Health Services, Middle Aged, Psychosocial Deprivation, Surveys and Questionnaires, Social Isolation
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