McGuire James F, Rosenheck Robert A
Northeast Program Evaluation Center, Department of Veterans Affairs West Los Angeles Healthcare Center, Building 500, Room 6651, 11301 Wilshire Boulevard, Los Angeles, California 90073, USA.
Psychiatr Serv. 2004 Jan;55(1):42-8. doi: 10.1176/appi.ps.55.1.42.
This study examined the clinical problems and treatment outcomes of homeless people with severe mental illness and a history of incarceration.
Between May 1994 and June 1998, a total of 5,774 people entered assertive community treatment case management services in the Access to Community Care and Effective Services and Supports (ACCESS) demonstration program at 18 sites in nine states. This study used data from reassessments at 12 months after program entry. Analysis of variance was used to compare baseline status and 12-month outcomes for clients with a lifetime incarceration history of less than six months, of six months or more, and no incarceration history. The outcomes assessed were housing status, employment status, psychiatric problems, alcohol problems, drug problems, and criminal justice involvement.
Two-thirds of the ACCESS clients had a history of incarceration, with about one-third having less than six months of incarceration and about one-third having six months or more of incarceration. Clients with a long-term incarceration history had higher psychiatric symptom scores, higher drug use and alcohol use scores, and higher levels of dual diagnosis than those with a short-term incarceration history or those with no history of incarceration. The same order of differences was found on measures of childhood abuse, family-of-origin stability, and childhood conduct disorder. Clients with an incarceration history of six months or more reported higher levels of long-term homelessness than the group without an incarceration history. The group with an incarceration history of less than six months showed less improvement at the 12-month follow-up evaluation than the group with no incarceration history on only one outcome measure, psychiatric problems. The group with an incarceration history of six months or more had poorer outcomes than the group with no incarceration history on only two of six outcomes, psychiatric problems and number of days in jail.
This study found that among homeless clients with severe mental illness, clients with a history of incarceration have more serious problems and show somewhat less improvement in some community adjustment domains.
本研究调查了患有严重精神疾病且有监禁史的无家可归者的临床问题及治疗结果。
1994年5月至1998年6月期间，共有5774人在9个州18个地点的“获得社区护理及有效服务与支持”（ACCESS）示范项目中接受了积极社区治疗病例管理服务。本研究使用了项目入组12个月后重新评估的数据。方差分析用于比较终生监禁史少于6个月、6个月或更长时间以及无监禁史的客户的基线状态和12个月的结果。评估的结果包括住房状况、就业状况、精神问题、酒精问题、药物问题以及刑事司法参与情况。
ACCESS项目中的三分之二客户有监禁史，其中约三分之一的监禁时间少于6个月，约三分之一的监禁时间为6个月或更长。与短期监禁史或无监禁史的客户相比，长期监禁史的客户有更高的精神症状评分、更高的药物使用和酒精使用评分，以及更高的双重诊断水平。在童年虐待、原生家庭稳定性和童年品行障碍的测量中也发现了相同的差异顺序。监禁史为6个月或更长时间的客户报告的长期无家可归水平高于无监禁史的群体。在12个月的随访评估中，监禁史少于6个月的群体在仅一项结果指标（精神问题）上的改善程度低于无监禁史的群体。在六项结果中的两项（精神问题和入狱天数）上，监禁史为6个月或更长时间的群体的结果比无监禁史的群体更差。
本研究发现，在患有严重精神疾病的无家可归客户中，有监禁史的客户存在更严重的问题，并且在某些社区适应领域的改善程度略低。
