Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Kildegaardsvej 28, Build. 15, 4th floor, DK-2900, Hellerup, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Urban Health. 2019 Oct;96(5):741-750. doi: 10.1007/s11524-019-00377-x.
Homelessness remains a societal problem. Compiled evidence of predictors for becoming homeless and exiting homelessness might be used to inform policy-makers and practitioners in their work to reduce homeless-related problems. We examined individual-level predictors for becoming homeless and exiting homelessness by searching PubMed, EMBASE, PsycINFO, and Web of Science up to January 2018. Becoming homeless and exiting homelessness were the outcomes. Observational studies with comparison groups from high-income countries were included. The Newcastle Ottawa Quality Assessment Scale was used for bias assessment. Random effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). We included 116 independent studies of risk factors for becoming homeless and 18 for exiting homelessness. We found evidence of adverse life events as risk factors for homelessness, e.g., physical abuse (OR 2.9, 95% CI 1.8-4.4) and foster care experiences (3.7, 1.9-7.3). History of incarceration (3.6, 1.3-10.4), suicide attempt (3.6, 2.1-6.3), and psychiatric problems, especially drug use problems (2.9, 1.5-5.1), were associated with increased risk of homelessness. The heterogeneity was substantial in most analyses (I > 90%). Female sex (1.5, 1.1-1.9; I = 69%) and having a partner (1.7, 1.3-2.1; I = 40%) predicted higher chances whereas relationship problems (0.6, 0.5-0.8), psychotic disorders (0.4, 0.2-0.8; I = 0%), and drug use problems (0.7, 0.6-0.9; I = 0%) reduced the chances for exiting homelessness. In conclusion, sociodemographic factors, adverse life events, criminal behaviour, and psychiatric problems were individual-level predictors for becoming homeless and/or exiting homelessness. Focus on individual-level vulnerabilities and early intervention is needed. PROSPERO registration number: CRD42014013119 .
homelessness remains a societal problem. Compiled evidence of predictors for becoming homeless and exiting homelessness might be used to inform policy-makers and practitioners in their work to reduce homeless-related problems. We examined individual-level predictors for becoming homeless and exiting homelessness by searching PubMed, EMBASE, PsycINFO, and Web of Science up to January 2018. Becoming homeless and exiting homelessness were the outcomes. Observational studies with comparison groups from high-income countries were included. The Newcastle Ottawa Quality Assessment Scale was used for bias assessment. Random effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). We included 116 independent studies of risk factors for becoming homeless and 18 for exiting homelessness. We found evidence of adverse life events as risk factors for homelessness, e.g., physical abuse (OR 2.9, 95% CI 1.8-4.4) and foster care experiences (3.7, 1.9-7.3). History of incarceration (3.6, 1.3-10.4), suicide attempt (3.6, 2.1-6.3), and psychiatric problems, especially drug use problems (2.9, 1.5-5.1), were associated with increased risk of homelessness. The heterogeneity was substantial in most analyses (I > 90%). Female sex (1.5, 1.1-1.9; I = 69%) and having a partner (1.7, 1.3-2.1; I = 40%) predicted higher chances whereas relationship problems (0.6, 0.5-0.8), psychotic disorders (0.4, 0.2-0.8; I = 0%), and drug use problems (0.7, 0.6-0.9; I = 0%) reduced the chances for exiting homelessness. In conclusion, sociodemographic factors, adverse life events, criminal behaviour, and psychiatric problems were individual-level predictors for becoming homeless and/or exiting homelessness. Focus on individual-level vulnerabilities and early intervention is needed. PROSPERO registration number: CRD42014013119.
无家可归仍是一个社会问题。编制的有关成为无家可归者和摆脱无家可归状态的预测因素的证据，可以为决策者和实践者提供信息，帮助他们减少与无家可归相关的问题。我们通过检索 PubMed、EMBASE、PsycINFO 和 Web of Science，查找截至 2018 年 1 月的有关成为无家可归者和摆脱无家可归状态的预测因素的证据。成为无家可归者和摆脱无家可归状态是结果。纳入了来自高收入国家的有对照组的观察性研究。纽卡斯尔-渥太华质量评估量表用于偏倚评估。采用随机效应模型计算汇总优势比（OR）及其 95%置信区间（CI）。我们纳入了 116 项关于成为无家可归者的风险因素的独立研究和 18 项关于摆脱无家可归状态的风险因素的研究。我们发现，生活事件不良是导致无家可归的风险因素，例如身体虐待（OR 2.9，95%CI 1.8-4.4）和寄养经历（3.7，1.9-7.3）。入狱史（3.6，1.3-10.4）、自杀未遂（3.6，2.1-6.3）以及精神疾病，特别是药物使用问题（2.9，1.5-5.1），与无家可归的风险增加有关。大多数分析的异质性都很大（I > 90%）。女性（1.5，1.1-1.9；I = 69%）和有伴侣（1.7，1.3-2.1；I = 40%）预测的可能性较高，而人际关系问题（0.6，0.5-0.8）、精神障碍（0.4，0.2-0.8；I = 0%）和药物使用问题（0.7，0.6-0.9；I = 0%）降低了摆脱无家可归状态的可能性。总之，社会人口因素、生活事件不良、犯罪行为和精神疾病是成为无家可归者和/或摆脱无家可归状态的个体水平预测因素。需要关注个体脆弱性和早期干预。PROSPERO 注册号：CRD42014013119。
