Kerman Nick, Sanches Marcos, Kidd Sean A, Stergiopoulos Vicky
Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
J Urban Health. 2025 Jun 9. doi: 10.1007/s11524-025-00984-x.
People experiencing homelessness have high rates of violent victimization, overdose, suicidality, and non-suicidal self-injury. These health-related critical incidents contribute to high mortality rates among homeless populations, making their prevention a critical public health goal. The objective of this study was to identify trends and correlates of physical violence, overdose, and self-injury in homeless shelters in Toronto, Canada. A retrospective study was conducted using administrative data on health-related critical incidents in Toronto's shelter system from 2012 to 2021. Log-linked negative binomial regression models were fitted to (a) predict physical violence, overdose, and self-injury incident counts during the study period by year, season, and pandemic onset, and (b) examine programmatic, environmental, and temporal correlates of these outcomes, with separate analyses performed for the pre-pandemic and pandemic periods. Shelter-based physical violence (incidence rate ratio [IRR] 1.08; 95% confidence interval [CI] 1.06-1.11), overdose (IRR 1.20; CI 1.13-1.26), and self-injury (IRR 1.16; CI 1.11-1.21) incidents increased over the study period, with the rates of the increases for violence (IRR 1.10; CI 1.00-1.20) and overdoses (IRR 1.66; CI 1.48-1.86) intensifying during the COVID-19 pandemic. Larger congregate shelters had higher rates of violence, overdose, and self-injury, whereas shelter-based hotels had lower incident rates. Critical incidents were also higher during the winter, and there was an increased rate of overdoses during cheque week. The development of smaller shelters that offer greater privacy to service users warrants further examination to advance safety in shelter settings. Increasing access to naloxone and other substance use supports, especially during check week, is also recommended for reducing drug-related harms.
无家可归者遭受暴力侵害、药物过量、自杀及非自杀性自伤的比例很高。这些与健康相关的重大事件导致无家可归人群的死亡率居高不下，因此预防这些事件成为一项关键的公共卫生目标。本研究的目的是确定加拿大多伦多无家可归者收容所中身体暴力、药物过量和自伤的趋势及相关因素。利用2012年至2021年多伦多收容系统中与健康相关重大事件的行政数据进行了一项回顾性研究。拟合对数链接负二项回归模型以：(a) 按年份、季节和疫情爆发情况预测研究期间的身体暴力、药物过量和自伤事件计数；(b) 检查这些结果的项目、环境和时间相关因素，对疫情前和疫情期间分别进行分析。在研究期间，收容所内的身体暴力事件（发病率比[IRR] 1.08；95%置信区间[CI] 1.06 - 1.11）、药物过量事件（IRR 1.20；CI 1.13 - 1.26）和自伤事件（IRR 1.16；CI 1.11 - 1.21）有所增加，在2019冠状病毒病疫情期间，暴力事件（IRR 1.10；CI 1.00 - 1.20）和药物过量事件（IRR 1.66；CI 1.48 - 1.86）的增加速度加快。规模较大的集体收容所暴力、药物过量和自伤发生率较高，而基于收容所的酒店发生率较低。冬季的重大事件也较多，在发薪周药物过量发生率增加。开发为服务使用者提供更多隐私的小型收容所值得进一步研究，以提高收容所环境的安全性。还建议增加纳洛酮及其他物质使用支持的可及性，尤其是在发薪周，以减少与药物相关的危害。
