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The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis

Author

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  • Stefan Gutwinski
  • Stefanie Schreiter
  • Karl Deutscher
  • Seena Fazel

Abstract

Background: Homelessness continues to be a pressing public health concern in many countries, and mental disorders in homeless persons contribute to their high rates of morbidity and mortality. Many primary studies have estimated prevalence rates for mental disorders in homeless individuals. We conducted a systematic review and meta-analysis of studies on the prevalence of any mental disorder and major psychiatric diagnoses in clearly defined homeless populations in any high-income country. Methods and findings: We systematically searched for observational studies that estimated prevalence rates of mental disorders in samples of homeless individuals, using Medline, Embase, PsycInfo, and Google Scholar. We updated a previous systematic review and meta-analysis conducted in 2007, and searched until 1 April 2021. Studies were included if they sampled exclusively homeless persons, diagnosed mental disorders by standardized criteria using validated methods, provided point or up to 12-month prevalence rates, and were conducted in high-income countries. We identified 39 publications with a total of 8,049 participants. Study quality was assessed using the JBI critical appraisal tool for prevalence studies and a risk of bias tool. Random effects meta-analyses of prevalence rates were conducted, and heterogeneity was assessed by meta-regression analyses. The mean prevalence of any current mental disorder was estimated at 76.2% (95% CI 64.0% to 86.6%). The most common diagnostic categories were alcohol use disorders, at 36.7% (95% CI 27.7% to 46.2%), and drug use disorders, at 21.7% (95% CI 13.1% to 31.7%), followed by schizophrenia spectrum disorders (12.4% [95% CI 9.5% to 15.7%]) and major depression (12.6% [95% CI 8.0% to 18.2%]). We found substantial heterogeneity in prevalence rates between studies, which was partially explained by sampling method, study location, and the sex distribution of participants. Limitations included lack of information on certain subpopulations (e.g., women and immigrants) and unmet healthcare needs. Conclusions: Public health and policy interventions to improve the health of homeless persons should consider the pattern and extent of psychiatric morbidity. Our findings suggest that the burden of psychiatric morbidity in homeless persons is substantial, and should lead to regular reviews of how healthcare services assess, treat, and follow up homeless people. The high burden of substance use disorders and schizophrenia spectrum disorders need particular attention in service development. This systematic review and meta-analysis have been registered with PROSPERO (CRD42018085216). Trial registration: PROSPERO CRD42018085216. In an updated systematic review and meta analysis, Stefan Gutwinski, Stefanie Schreiter, and colleagues examine the prevalence of mental disorders among individuals who are homeless in high income countries.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Stefan Gutwinski & Stefanie Schreiter & Karl Deutscher & Seena Fazel, 2021. "The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis," PLOS Medicine, Public Library of Science, vol. 18(8), pages 1-22, August.
  • Handle: RePEc:plo:pmed00:1003750
    DOI: 10.1371/journal.pmed.1003750
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    Cited by:

    1. Tobias Schiffler & Ali Kapan & Alina Gansterer & Thomas Pass & Lisa Lehner & Alejandro Gil-Salmeron & Daragh T. McDermott & Igor Grabovac, 2023. "Characteristics and Effectiveness of Co-Designed Mental Health Interventions in Primary Care for People Experiencing Homelessness: A Systematic Review," IJERPH, MDPI, vol. 20(1), pages 1-14, January.
    2. Alison L. Weightman & Mark J. Kelson & Ian Thomas & Mala K. Mann & Lydia Searchfield & Simone Willis & Ben Hannigan & Robin J. Smith & Rhiannon Cordiner, 2023. "Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta‐analysis and thematic synthesis," Campbell Systematic Reviews, John Wiley & Sons, vol. 19(2), June.
    3. Derrien, Monika M. & Bratman, Gregory N. & Cerveny, Lee K. & Levy, Chaja & Blahna, Dale J. & Frank, Paulo & Serio, Naomi, 2024. "Public nature and health for homeless populations: Professionals’ perceptions of contingent human benefits and harms," Social Science & Medicine, Elsevier, vol. 347(C).
    4. Guillaume Lio & Malek Ghazzai & Frédéric Haesebaert & Julien Dubreucq & Hélène Verdoux & Clélia Quiles & Nemat Jaafari & Isabelle Chéreau-Boudet & Emilie Legros-Lafarge & Nathalie Guillard-Bouhet & Ca, 2022. "Actionable Predictive Factors of Homelessness in a Psychiatric Population: Results from the REHABase Cohort Using a Machine Learning Approach," IJERPH, MDPI, vol. 19(19), pages 1-12, September.
    5. Alison L. Weightman & Mark J. Kelson & Ian Thomas & Mala K. Mann & Lydia Searchfield & Ben Hannigan & Robin J. Smith & Simone Willis & Rhiannon Cordiner, 2022. "PROTOCOL: Exploring the effect of case management in homelessness per components: A systematic review of effectiveness and implementation, with meta‐analysis and thematic synthesis," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(1), March.
    6. Alícia Parés-Bayerri & Fran Calvo & Sílvia Font-Mayolas & Sonia Panadero & José Juan Vázquez, 2023. "Differences in Drug Use among Persons Experiencing Homelessness According to Gender and Nationality," IJERPH, MDPI, vol. 20(5), pages 1-16, February.
    7. Heather Aydin-Ghormoz & Temilayo Adeyeye & Neil Muscatiello & Seema Nayak & Sanghamitra Savadatti & Tabassum Z. Insaf, 2022. "Identifying Risk Factors for Hospitalization with Behavioral Health Disorders and Concurrent Temperature-Related Illness in New York State," IJERPH, MDPI, vol. 19(24), pages 1-15, December.
    8. Maria Jennifer Estrella & Bonnie Kirsh & Pia Kontos & Alisa Grigorovich & Angela Colantonio & Vincy Chan & Emily Joan Nalder, 2021. "Critical Characteristics of Housing and Housing Supports for Individuals with Concurrent Traumatic Brain Injury and Mental Health and/or Substance Use Challenges: A Qualitative Study," IJERPH, MDPI, vol. 18(22), pages 1-19, November.

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