MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
PLoS One. 2023 Feb 10;18(2):e0277074. doi: 10.1371/journal.pone.0277074. eCollection 2023.
There is scant research on the effectiveness of permanent supportive housing for homeless women with mental illness. This study examines the effectiveness of Housing First with an unprecedentedly large sample of homeless women from five Canadian cities, and explore baseline risk factors that predict social, health and well-being outcomes over a 24 month-period.
The At Home/Chez Soi multi-site randomized controlled Housing First trial recruited over 600 women between October 2009 and July 2011. This is a post-hoc subgroup exploratory analysis of self-identified women with at least one follow-up interview who were randomized to Housing First (HF) (n = 374) or treatment-as-usual (TAU) (n = 279) and had at least one follow-up interview. Linear mixed models and generalized estimating equations were used after multiple imputation was applied to address missing data.
At the end of follow-up, the mean percentage of days spent stably housed was higher for women in the intervention 74.8% (95%CI = 71.7%-77.8%) compared with women in the treatment-as-usual group, 37.9% (95%CI = 34.4%-41.3%), p<0.001. With few exceptions, social and mental health outcomes were similar for both groups at 6-, 12-, 18- and 24-months post-enrollment. Suicidality was a consistent predictor of increased mental health symptoms (beta = 2.85, 95% CI 1.59-4.11, p<0.001), decreased quality of life (beta = -3.99, 95% CI -6.49 to -1.49, p<0.001), decreased community functioning (beta = -1.16, 95% CI -2.10 to -0.22, p = 0.015) and more emergency department visits (rate ratio = 1.44, 95% CI 1.10-1.87, p<0.001) over the study period. Lower education was a predictor of lower community functioning (beta = -1.32, 95% CI -2.27 to -0.37, p = 0.006) and higher substance use problems (rate ratio = 1.27, 95% CI 1.06-1.52, p = 0.009) during the study.
Housing First interventions ensured that women experiencing homelessness are quickly and consistently stably housed. However, they did not differentially impact health and social measures compared to treatment as usual. Ensuring positive health and social outcomes may require greater supports at enrolment for subgroups such as those with low educational attainment, and additional attention to severity of baseline mental health challenges, such as suicidality.
International Standard Randomized Control Trial Number Register Identifier: ISRCTN42520374.
针对患有精神疾病的无家可归女性的永久性支持性住房的有效性，相关研究仍十分匮乏。本研究使用来自加拿大五个城市的大量无家可归女性样本，检验了“先住后付（Housing First）”模式的有效性，并探讨了在 24 个月的随访期间，预测社会、健康和幸福感的基线风险因素。
“安家/在家（At Home/Chez Soi）”多地点随机对照 Housing First 试验于 2009 年 10 月至 2011 年 7 月期间招募了 600 多名女性。本研究是对自我认定的至少有一次随访访谈且随机分配到 Housing First（HF）（n=374）或常规治疗（TAU）（n=279）并至少有一次随访访谈的女性进行的事后亚组探索性分析。采用线性混合模型和广义估计方程，在进行多次插补以解决缺失数据后，对结果进行分析。
随访结束时，干预组中稳定住房的天数比例高于对照组，干预组中女性的稳定住房天数比例为 74.8%（95%CI=71.7%-77.8%），而对照组中女性的稳定住房天数比例为 37.9%（95%CI=34.4%-41.3%），p<0.001。除了少数例外，在 6、12、18 和 24 个月的随访中，两组的社会和心理健康结果相似。自杀意念是心理健康症状增加的一致预测因素（β=2.85，95%CI 1.59-4.11，p<0.001），生活质量下降（β=-3.99，95%CI-6.49 至-1.49，p<0.001），社区功能下降（β=-1.16，95%CI-2.10 至-0.22，p=0.015）和更多的急诊就诊（率比=1.44，95%CI 1.10-1.87，p<0.001）。受教育程度较低是社区功能下降的预测因素（β=-1.32，95%CI-2.27 至-0.37，p=0.006）和物质使用问题增加的预测因素（率比=1.27，95%CI 1.06-1.52，p=0.009）。
Housing First 干预措施确保了无家可归的女性能够迅速、持续地稳定住房。然而，与常规治疗相比，它们并没有对健康和社会措施产生不同的影响。为了确保亚组（如教育程度较低的人群）的健康和社会结果良好，可能需要在入组时提供更大的支持，同时还需要更多地关注基线心理健康挑战的严重程度，如自杀意念。
国际标准随机对照试验注册号：ISRCTN42520374。
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