Koegel P, Sullivan G, Burnam A, Morton S C, Wenzel S
RAND, Santa Monica, CA 90401, USA.
Med Care. 1999 Mar;37(3):306-17. doi: 10.1097/00005650-199903000-00010.
Even though psychiatric disorders are disproportionately present among the homeless, little is known about the extent to which homeless people receive treatment for those problems or the factors that are associated with receiving treatment. This article examines utilization and predictors of mental health and substance abuse treatment among a community-based probability sample of homeless adults.
The data analyzed here were collected through face-to-face interviews with 1,563 homeless individuals. Bivariate analyses examined differences between homeless men and women in (1) the prevalence of major mental illnesses and substance dependence and (2) utilization of inpatient and outpatient treatment services for those with specific diagnoses. Logistic regression analyses identified predictors of mental health treatment among those with chronic mental illness and substance abuse treatment among those with recent substance dependence.
Two-thirds of these homeless adults met criteria for chronic substance dependence, whereas 22% met criteria for chronic mental illness, with substantial overlap between those two disorders: 77% of those with chronic mental illness were also chronic substance abusers. Only one-fifth of each of those two groups reported receiving treatment for those disorders within the last 60 days. Mental health service utilization was predicted largely by factors related to need (eg, diagnosis, acknowledgment of a mental health problem), whereas substance abuse service utilization was predicted by myriad additional factors, reflecting, in part, critical differences in the organization and financing of these systems of care.
More attention must be directed at how to better deliver appropriate mental health and substance abuse services to homeless adults.
尽管精神疾病在无家可归者中极为普遍，但对于无家可归者针对这些问题接受治疗的程度以及与接受治疗相关的因素，我们却知之甚少。本文考察了一个基于社区的无家可归成年概率样本中精神健康和药物滥用治疗的利用情况及预测因素。
此处分析的数据是通过对1563名无家可归者进行面对面访谈收集而来的。双变量分析考察了无家可归男性和女性在以下两方面的差异：（1）重度精神疾病和药物依赖的患病率；（2）针对特定诊断患者的住院和门诊治疗服务的利用情况。逻辑回归分析确定了慢性精神疾病患者中接受精神健康治疗的预测因素以及近期药物依赖患者中接受药物滥用治疗的预测因素。
这些无家可归成年人中有三分之二符合慢性药物依赖标准，而22%符合慢性精神疾病标准，这两种疾病之间存在大量重叠：77%的慢性精神疾病患者也是慢性药物滥用者。在这两组人群中，每组只有五分之一的人报告在过去60天内针对这些疾病接受过治疗。精神健康服务的利用情况在很大程度上由与需求相关的因素预测（例如诊断、对精神健康问题的认知），而药物滥用服务的利用情况则由众多其他因素预测，这在一定程度上反映了这些护理系统在组织和资金方面的关键差异。
必须更加关注如何更好地为无家可归成年人提供适当的精神健康和药物滥用服务。
