Chondraki P, Madianos M, Papadimitriou G N
Eginitio Hospital.
Psychiatriki. 2012 Oct-Dec;23(4):334-43.
Most research on the homeless is coming from the US, where the prevalence of mental disorders concerning this population was pointed out. The surveys for the homeless in European countries focus on the mental state and community care of the homeless very early, since the 1980's. Homelessness is gradually developing in these countries, while in the countries of North America the phenomenon is much older. The prevalence of mental disorders in European countries is higher in the homeless population, with rates of 58% -100% compared with the general population. In countries like Germany, Spain, Holland, France, Switzerland, where the phenomenon of homelessness has been studied, one of the most striking features was the high prevalence of substance abuse disorders, emotional disorders, while small percentages were reported for psychotic disorders. The prevalence of alcohol abuse was very high in Germany, perhaps because it is easily accessible and less expensive than in other countries. Limited use by homeless of relevant health services was also very common in this country. The same observation was also recorded in Spain, France and the Netherlands. High rates in these countries was reported for comorbidity, most often concerning the combination of substance abuse disorder and emotional disorders. Another interesting finding in the European countries is the high prevalence of depressive and anxiety disorders and the low prevalence of schizophrenia and antisocial personality disorder. The low prevalence of schizophrenia and antisocial personality disorder is in contrast with studies from North America according to some authors who compared their samples with samples of homeless people in Los Angeles. The level of abuse of illegal substances was also found high in countries such as England. In Spain affective disorders was reported to be very high among the homeless population. The homeless population faces many complex mental health problems compared with those of the general population. What is a source of concern is that these problems are not adequately faced either by mental health services and rehabilitation programs, or the social services for the homeless. It is recommended that these services have to achieve integration in therapeutic and organizational level, in order to better meet the needs of this complex and heterogeneous population.
大多数关于无家可归者的研究来自美国,该国指出了这一人群中精神障碍的患病率。自20世纪80年代以来,欧洲国家对无家可归者的调查很早就聚焦于他们的精神状态和社区护理。在这些国家,无家可归现象正逐渐显现,而在北美国家,这一现象出现的时间要早得多。欧洲国家无家可归者中精神障碍的患病率更高,与普通人群相比,患病率在58%至100%之间。在德国、西班牙、荷兰、法国、瑞士等对无家可归现象进行过研究的国家,最显著的特征之一是物质使用障碍、情感障碍的高患病率,而精神病性障碍的报告比例较小。德国酒精滥用的患病率非常高,可能是因为酒精容易获得且比其他国家便宜。在该国,无家可归者对相关医疗服务的利用率有限也很常见。西班牙、法国和荷兰也有同样的观察结果。这些国家共病率很高,最常见的是物质使用障碍和情感障碍的合并。欧洲国家另一个有趣的发现是抑郁和焦虑障碍的高患病率以及精神分裂症和反社会人格障碍的低患病率。一些作者将他们的样本与洛杉矶无家可归者的样本进行比较,他们认为精神分裂症和反社会人格障碍的低患病率与北美的研究结果形成对比。在英国等国家,非法物质的滥用水平也很高。据报道,西班牙无家可归者中情感障碍的患病率非常高。与普通人群相比,无家可归者面临许多复杂的心理健康问题。令人担忧的是,心理健康服务和康复项目以及为无家可归者提供的社会服务都没有充分应对这些问题。建议这些服务在治疗和组织层面实现整合,以便更好地满足这一复杂且异质人群的需求。