Housing instability and homelessness among rural schizophrenic patients.
Housing instability and homelessness among rural schizophrenic patients.
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农村精神分裂症患者的住房不稳定和无家可归。
DOI：
10.1176/ajp.148.3.330
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Clark,TA
中科院分区：
文献类型：
--
作者：
Drake,RE;Wallach,MA;Teague,GB;Freeman,DH;Paskus,TS;Clark,TA
目的调查农村精神分裂症患者的住房不稳定性，并与以往城市精神分裂症患者的研究结果进行比较。方法对75例在农村精神卫生中心接受治疗的精神分裂症或分裂情感性障碍患者进行研究访谈，并由其临床病例经理进行评分。结果在75例患者中，19例(25%)的住房状况被他们的病例管理者描述为不稳定。对于大多数人来说，住房不稳定意味着居住安排的微妙，而不是字面上的无家可归。不遵守药物治疗、饮酒和阴性症状可以解释不稳定住房的30%的差异。在随访期间，与生活状况稳定的患者相比，住房不稳定的患者并不更有可能再次住院，但更有可能入狱，明显更有可能无家可归。结论在作者先前对城市精神病患者的研究中，住房不稳定的患者在随访期间比农村住房不稳定的患者更有可能无家可归、高度症状和再次住院。农村地区的较好结果似乎与住房替代办法的更多可获得性和密集的病例管理有关。对于在这两个环境中住房不稳定的患者，应该果断地解决不遵守药物和药物滥用以及住房安排的问题。
ObjectiveThe authors examined housing instability among treated schizophrenic patients in a rural area and compared the findings with those from their previous study of urban patients.MethodSeventy-five patients with schizophrenia or schizoaffective disorder who were treated in a rural mental health center were assessed with research interviews and ratings by their clinical case managers. The patients were followed for 1 year to identify episodes of psychiatric hospitalization, incarceration, and literal homelessness.ResultsOf the 75 patients, 19 (25%) had housing situations characterized as unstable by their case managers. For the majority, housing instability signified tenuousness of living arrangements rather than literal homelessness. Noncompliance with medications, alcohol use, and negative symptoms accounted for 30% of the variance in unstable housing. During follow-up, the unstably housed patients, compared to those in stable living situations, were no more likely to be rehospitalized but were somewhat more likely to be jailed and significantly more likely to be literally homeless.ConclusionsIn the authors' previous study of urban psychiatric patients, unstably housed patients were more likely to be literally homeless, highly symptomatic, and rehospitalized during follow-up than the rural patients with unstable housing. Better outcomes in the rural area appeared to be related to the greater availability of housing alternatives and to intensive case management. For patients with unstable housing in both settings, noncompliance with medications and substance abuse, as well as housing arrangements, should be assertively addressed.