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The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis

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  • Seena Fazel
  • Vivek Khosla
  • Helen Doll
  • John Geddes

Abstract

Background: There are well over a million homeless people in Western Europe and North America, but reliable estimates of the prevalence of major mental disorders among this population are lacking. We undertook a systematic review of surveys of such disorders in homeless people. Methods and Findings: We searched for surveys of the prevalence of psychotic illness, major depression, alcohol and drug dependence, and personality disorder that were based on interviews of samples of unselected homeless people. We searched bibliographic indexes, scanned reference lists, and corresponded with authors. We explored potential sources of any observed heterogeneity in the estimates by meta-regression analysis, including geographical region, sample size, and diagnostic method. Twenty-nine eligible surveys provided estimates obtained from 5,684 homeless individuals from seven countries. Substantial heterogeneity was observed in prevalence estimates for mental disorders among the studies (all Cochran's χ2 significant at p 85%). The most common mental disorders were alcohol dependence, which ranged from 8.1% to 58.5%, and drug dependence, which ranged from 4.5% to 54.2%. For psychotic illness, the prevalence ranged from 2.8% to 42.3%, with similar findings for major depression. The prevalence of alcohol dependence was found to have increased over recent decades. Conclusions: Homeless people in Western countries are substantially more likely to have alcohol and drug dependence than the age-matched general population in those countries, and the prevalences of psychotic illnesses and personality disorders are higher. Models of psychiatric and social care that can best meet these mental health needs requires further investigation. Seena Fazel and colleagues show, through a systematic review and meta-regression analysis, that homeless people in Western countries have a higher prevalence of alcohol and drug dependence and mental disorders. :

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  • Seena Fazel & Vivek Khosla & Helen Doll & John Geddes, 2008. "The Prevalence of Mental Disorders among the Homeless in Western Countries: Systematic Review and Meta-Regression Analysis," PLOS Medicine, Public Library of Science, vol. 5(12), pages 1-1, December.
    • Handle: RePEc:plo:pmed00:0050225
    DOI: 10.1371/journal.pmed.0050225
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    References listed on IDEAS

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    1. Bassuk, E.L. & Rubin, L. & Lauriat, A.S., 1986. "Characteristics of sheltered homeless families," American Journal of Public Health, American Public Health Association, vol. 76(9), pages 1097-1101.
    2. Sukanta Saha & David Chant & Joy Welham & John McGrath, 2005. "A Systematic Review of the Prevalence of Schizophrenia," PLOS Medicine, Public Library of Science, vol. 2(5), pages 1-1, May.
    3. Fischer, P.J. & Shapiro, S. & Breakey, W.R. & Anthony, J.C. & Kramer, M., 1986. "Mental health and social characteristics of the homeless: A survey of mission users," American Journal of Public Health, American Public Health Association, vol. 76(5), pages 519-524.
    4. North, C.S. & Eyrich, K.M. & Pollio, D.E. & Spitznagel, E.L., 2004. "Are Rates of Psychiatric Disorders in the Homeless Population Changing?," American Journal of Public Health, American Public Health Association, vol. 94(1), pages 103-108.
    5. Barrow, S.M. & Herman, D.B. & Córdova, P. & Struening, E.L., 1999. "Mortality among homeless shelter residents in New York City," American Journal of Public Health, American Public Health Association, vol. 89(4), pages 529-534.
    6. Farrell, Susan & Manning, Willard G. & Finch, Michael D., 2003. "Alcohol dependence and the price of alcoholic beverages," Journal of Health Economics, Elsevier, vol. 22(1), pages 117-147, January.
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    1. Joya G Chrystal & Dawn L Glover & Alexander S Young & Fiona Whelan & Erika L Austin & Nancy K Johnson & David E Pollio & Cheryl L Holt & Erin Stringfellow & Adam J Gordon & Theresa A Kim & Shanette G , 2015. "Experience of Primary Care among Homeless Individuals with Mental Health Conditions," PLOS ONE, Public Library of Science, vol. 10(2), pages 1-14, February.

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