North C S, Smith E M, Pollio D E, Spitznagel E L
Department of Psychiatry, School of Medicine, Washington University, St. Louis, Missouri 63110, USA.
Ann Clin Psychiatry. 1996 Sep;8(3):117-28. doi: 10.3109/10401239609147749.
The question has been raised whether it is useful or meaningful to dichotomize the homeless population by mental illness - i.e., to consider the mentally ill homeless as distinct from other homeless people. The current article presents evidence from a single data set to address this question empirically. Data from a randomly sampled population of 900 homeless men and women systemically interviewed using the Diagnostic Interview Schedule were examined to determine associations of mental illness with the problems of homelessness, controlling for the presence of substance abuse in the analyses. Although a few clinically meaningful associations with mental illness were found that might suggest directions for appropriate interventions, mental illness did not differentiate individuals in many important demographic and biographic respects. Individual diagnoses did not perform much better in differentiating the homeless by mental illness. Schizophrenia and bipolar mania showed a few significant associations not identified by the "major mental illness" construct. Major depression, constituting the majority of nonsubstance Axis I disorder in the homeless, provided no association beyond that obtained with the "major mental illness" category. The data provide little support for conceptualizing homeless subgroups or homelessness in general on the basis of mental illness alone. To do so also risks neglecting the emotional distress of the majority without major mental illness and the other problems that homeless persons share regardless of psychiatric illness. While serious mental illness is overrepresented among the homeless, it represents just one of many important vulnerability factors for homelessness. Substance abuse is far more prevalent than other Axis I disorders. Media images equating homelessness with major mental illness unnecessarily stigmatize homeless people and encourage oversimplified and narrowly conceived psychiatric interventions. While continuing attention is needed on improving identification and management of serious mental illness among the homeless, this must be accomplished within the broader context of social and economic aspects of homelessness.
是否按照精神疾病对无家可归人群进行二分法划分——即将患有精神疾病的无家可归者与其他无家可归者区分开来——这一问题已经被提出来了。当前这篇文章呈现了来自单一数据集的证据，以便从实证角度解决这个问题。对通过使用诊断性访谈表进行系统访谈的900名无家可归男女的随机抽样人群的数据进行了检查，以确定精神疾病与无家可归问题之间的关联，并在分析中控制药物滥用的存在情况。尽管发现了一些与精神疾病具有临床意义的关联，这些关联可能为适当的干预措施指明方向，但在许多重要的人口统计学和传记学方面，精神疾病并不能区分个体。个体诊断在按照精神疾病区分无家可归者方面表现也并不更好。精神分裂症和双相躁狂症显示出一些“主要精神疾病”概念未识别出的显著关联。重度抑郁症在无家可归者中构成了非物质性轴I障碍的大多数，但除了“主要精神疾病”类别所获得的关联之外，没有提供其他关联。这些数据几乎没有支持仅基于精神疾病来对无家可归亚群体或总体无家可归状态进行概念化。这样做还可能会忽视没有严重精神疾病的大多数人的情绪困扰以及无家可归者无论是否患有精神疾病都共同面临的其他问题。虽然严重精神疾病在无家可归者中占比过高，但它只是导致无家可归的众多重要脆弱因素之一。药物滥用比其他轴I障碍更为普遍。将无家可归与严重精神疾病等同起来的媒体形象不必要地给无家可归者贴上了污名，并鼓励了过于简单和狭隘的精神病学干预措施。虽然需要持续关注改善对无家可归者中严重精神疾病的识别和管理，但这必须在无家可归问题的更广泛社会和经济背景下完成。
