Grotts Joseph H, Mead Meredith M, Rab Shayan, Walker Imani J, Choi Kristen R
School of Nursing, UCLA; 700 Tiverton Ave Los Angeles, CA, 90049, USA.
Gateways Hospital and Mental Health Center, 1891 Effie St Los Angeles, CA, USA.
Soc Sci Med. 2022 Oct;311:115343. doi: 10.1016/j.socscimed.2022.115343. Epub 2022 Sep 6.
The purpose of this study was to use geospatial indicators of mental health need and homelessness in Los Angeles County Service Planning Areas (SPAs) and a psychiatric sample of adults who were homeless to investigate 1) overlap between SPA level of mental health need and corresponding volume of involuntary psychiatric hospitalizations over time; 2) overlap between SPA level of unsheltered homelessness and corresponding volume of involuntary psychiatric hospitalizations over time; and 3) associations between SPA level of mental health need, SPA level of unsheltered homelessness, and initiation of a mental health conservatorship for grave disability. A sample of 373 adults who were homeless and hospitalized on an involuntary psychiatric hold from 2016 to 2018 were linked to data from the Greater Los Angeles Homeless Count on unsheltered homelessness and from the California Health Interview Survey on need for mental health services and suicidality, using admission zip codes to link variables at the SPA level. Geospatial mapping and bivariate tests were used to examine geographic overlap of SPA mental health need and unsheltered homelessness with volume of involuntary psychiatric admissions over the study period. Multiple logistic regression modeling was used to examine associations of SPA mental health need and unsheltered homelessness with conservatorship initiation. The volume of patients admitted from SPAs with higher levels of mental illness need grew from 2016 to 2018 (Tau = 0.27, P < 0.001; Tau = 0.40, P < 0.001), but there were fewer patients admitted from SPAs with higher levels of unsheltered homelessness over the same years (Tau of -0.33, P < 0.001). Being admitted from SPAs with the highest levels of unsheltered homelessness was associated with higher odds of conservatorship initiation (OR = 1.73, 95% CI = 1.82-16.74). Results suggest a need for targeted mental health and housing services to reach areas of highest need in Los Angeles County.
本研究的目的是利用洛杉矶县服务规划区（SPA）心理健康需求和无家可归状况的地理空间指标，以及无家可归成年精神病患者样本，来调查：1）随着时间推移，SPA心理健康需求水平与相应的非自愿精神病住院量之间的重叠情况；2）随着时间推移，SPA无庇护无家可归水平与相应的非自愿精神病住院量之间的重叠情况；3）SPA心理健康需求水平、SPA无庇护无家可归水平与因严重残疾启动心理健康监护之间的关联。2016年至2018年期间因非自愿精神病住院的373名无家可归成年患者样本，通过入院邮政编码将其与大洛杉矶无家可归者统计中关于无庇护无家可归的数据以及加州健康访谈调查中关于心理健康服务需求和自杀倾向的数据相链接，以在SPA层面链接变量。利用地理空间映射和双变量检验来检查研究期间SPA心理健康需求和无庇护无家可归状况与非自愿精神病入院量的地理重叠情况。采用多元逻辑回归模型来检查SPA心理健康需求和无庇护无家可归状况与监护启动之间的关联。2016年至2018年期间，来自心理健康需求水平较高的SPA的入院患者数量有所增加（Tau = 0.27，P < 0.001；Tau = 0.40，P < 0.001），但同期来自无庇护无家可归水平较高的SPA的入院患者数量较少（Tau为 -0.33，P < 0.001）。来自无庇护无家可归水平最高的SPA的患者被启动监护的几率更高（OR = 1.73，95% CI = 1.82 - 16.74）。结果表明，需要提供有针对性的心理健康和住房服务，以覆盖洛杉矶县需求最高的地区。
