Département d'Information Médicale, GHU Paris Psychiatrie & Neurosciences, 75014 Paris, France.
SMES, GHU Paris Psychiatrie & Neurosciences, 75014 Paris, France.
Int J Environ Res Public Health. 2020 Nov 4;17(21):8144. doi: 10.3390/ijerph17218144.
The healthcare utilization of homeless people is generally considered insufficient, and studies often suffer from methodological bias (institutionalized vs. street samples). To adapt public health policies in France, epidemiological data on this population are scarce. The objective of this study was to analyze the use of psychiatric care by homeless people with mental health problems in the Greater Paris area and to define the factors influencing this use. The data were from the SAMENTA survey performed in 2009 with a representative random street sample of 859 homeless people from the Greater Paris area. The survey studied the use of psychiatric care (lifelong use, current follow-up, discontinuation of follow-up and treatment) and factors potentially associated with this use for people with a diagnosis of a psychotic, mood or anxiety disorder, with the diagnosis established with an original survey device. Because of our complex sampling design, we describe data for only a weighted estimated prevalence, weighted estimation of the number of people in the population (N) and unweighted total subgroup studied in the survey (). Among 840 homeless people with useable data, 377 (N = 9762) had a psychiatric disorder. The use of whole-life care for these people may seem high, estimated at 68.7%, but few people were followed up for their disorders (18.2%); individuals with a psychotic disorder were more frequently followed up (36.5%) than others were ( < 0.05). Among those followed up ( = 86, N = 1760), 63.0% were taking medication. Access to care for these people seemed preserved, but the maintenance of care seemed problematic; indeed, among people with a lifelong whole use of care (= 232, N = 6705), 72.3% could be considered to have discontinued care. The factors that improved lifetime health service utilization or follow-up were socio-demographic (age < 42 years, more educated), social (with social security coverage, not living in a hotel), and medical (psychotic disorder, personality disorder, suicide risk, somatic chronic illness, perception of mental suffering). Improving the care of homeless people with psychiatric disorders requires improving access to care for those isolated from the health system (in particular those living in hotels) and to guarantee continuity of care, by adapting the organization of the care system and promoting social rehabilitation.
无家可归者的医疗利用通常被认为不足，而且研究往往受到方法学偏见的影响（机构样本与街头样本）。为了调整法国的公共卫生政策，该人群的流行病学数据非常匮乏。本研究的目的是分析巴黎地区无家可归的有心理健康问题的人对精神保健的利用情况，并确定影响这种利用的因素。数据来自于 2009 年进行的 SAMENTA 调查，该调查采用了来自巴黎地区的一个有代表性的、随机的街头无家可归者样本 859 人。该调查研究了有精神病、心境或焦虑障碍诊断的人的精神保健利用情况（终生利用、当前随访、随访中断和治疗），以及与这种利用相关的潜在因素，这些诊断是通过原始调查设备确定的。由于我们的复杂抽样设计，我们仅描述了加权估计流行率、加权估计人群中的人数（N）和调查中研究的未加权总亚组（）的数据。在 840 名有可用数据的无家可归者中，有 377 人（N = 9762）患有精神障碍。这些人终生接受护理的使用率似乎很高，估计为 68.7%，但只有少数人接受了疾病的随访（18.2%）；患有精神病的个体比其他人更常接受随访（36.5%）（<0.05）。在接受随访的人（= 86，N = 1760）中，有 63.0%的人正在服用药物。这些人获得医疗保健的机会似乎得到了保留，但护理的维持似乎存在问题；事实上，在有终生整体护理利用的人（= 232，N = 6705）中，有 72.3%的人可以被认为已经停止了护理。改善终生卫生服务利用或随访的因素包括社会人口统计学因素（年龄<42 岁，受教育程度更高）、社会因素（有社会保障覆盖，不住在旅馆里）和医疗因素（精神病、人格障碍、自杀风险、躯体慢性疾病、精神痛苦的感知）。改善有精神障碍的无家可归者的护理需要改善那些与卫生系统隔绝的人的护理机会（特别是那些住在旅馆里的人），并保证护理的连续性，这需要调整护理系统的组织，并促进社会康复。
