Folsom David P, Hawthorne William, Lindamer Laurie, Gilmer Todd, Bailey Anne, Golshan Shahrokh, Garcia Piedad, Unützer Jürgen, Hough Richard, Jeste Dilip V
Department of Psychiatry, University of California, San Diego, CA, USA.
Am J Psychiatry. 2005 Feb;162(2):370-6. doi: 10.1176/appi.ajp.162.2.370.
The authors examined the prevalence of and risk factors for homelessness among all patients treated for serious mental illnesses in a large public mental health system in a 1-year period. The use of public mental health services among homeless persons was also examined.
The study included 10,340 persons treated for schizophrenia, bipolar disorder, or major depression in the San Diego County Adult Mental Health Services over a 1-year period (1999-2000). Analytic methods that adjusted for potentially confounding variables were used. Multivariate logistic regression analyses were used to calculate odds ratios for the factors associated with homelessness, including age, gender, ethnicity, substance use disorder, Medicaid insurance, psychiatric diagnosis, and level of functioning. Similarly, odds ratios were computed for utilization of mental health services by homeless versus not-homeless patients.
The prevalence of homelessness was 15%. Homelessness was associated with male gender, African American ethnicity, presence of a substance use disorder, lack of Medicaid, a diagnosis of schizophrenia or bipolar disorder, and poorer functioning. Latinos and Asian Americans were less likely to be homeless. Homeless patients used more inpatient and emergency-type services and fewer outpatient-type services.
Homelessness is a serious problem among patients with severe mental illness. Interventions focusing on potentially modifiable factors such as substance use disorders and a lack of Medicaid need to be studied in this population.
作者调查了在一个大型公共精神卫生系统中，一年内接受严重精神疾病治疗的所有患者中无家可归的患病率及危险因素。还研究了无家可归者使用公共精神卫生服务的情况。
该研究纳入了1999年至2000年期间在圣地亚哥县成人精神卫生服务机构接受精神分裂症、双相情感障碍或重度抑郁症治疗的10340人。采用了对潜在混杂变量进行调整的分析方法。多变量逻辑回归分析用于计算与无家可归相关因素的比值比，这些因素包括年龄、性别、种族、物质使用障碍、医疗补助保险、精神科诊断和功能水平。同样，计算了无家可归患者与非无家可归患者使用精神卫生服务的比值比。
无家可归的患病率为15%。无家可归与男性、非裔美国人种族、存在物质使用障碍、缺乏医疗补助、精神分裂症或双相情感障碍诊断以及功能较差有关。拉丁裔和亚裔美国人无家可归的可能性较小。无家可归患者使用更多的住院和急诊类服务，而门诊类服务较少。
无家可归在严重精神疾病患者中是一个严重问题。针对物质使用障碍和缺乏医疗补助等潜在可改变因素的干预措施需要在该人群中进行研究。
