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
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
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DOI：
10.1176/appi.ajp.162.2.370
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发表时间：
2005-02-01
影响因子：
17.7
通讯作者：
Jeste, DV
中科院分区：
文献类型：
--
作者：
Folsom, DP;Hawthorne, W;Jeste, DV
目的：作者研究了在一个大型公共精神卫生系统中接受严重精神疾病治疗的所有患者在一年内无家可归的患病率和风险因素。无家可归者的公共精神卫生服务的使用也examined.Method：该研究包括10,340人治疗精神分裂症，双相情感障碍，或抑郁症在圣地亚哥县成人精神卫生服务超过1年的时间（1999 - 2000年）。使用了调整潜在混杂变量的分析方法。多变量logistic回归分析用于计算与无家可归相关因素的比值比，包括年龄，性别，种族，物质使用障碍，医疗补助保险，精神病诊断和功能水平。同样，比值比计算利用精神卫生服务的无家可归者与非无家可归patients.Results：无家可归的患病率为15%。无家可归与男性性别，非裔美国人种族，物质使用障碍的存在，缺乏医疗补助，精神分裂症或双相情感障碍的诊断以及功能较差有关。拉丁裔和亚裔美国人无家可归的可能性较小。无家可归的患者使用更多的住院和紧急类型的服务和较少的门诊型service.Conclusions：无家可归是一个严重的问题，严重的精神疾病患者。需要在这一人群中研究针对潜在可改变因素（如物质使用障碍和缺乏医疗补助）的干预措施。
Objective: 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.Method: 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.Results: 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.Conclusions: 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.