North C S, Thompson S J, Pollio D E, Ricci D A, Smith E M
Washington University, Department of Social Work, St. Louis, MO 63110, USA.
Soc Psychiatry Psychiatr Epidemiol. 1997 May;32(4):236-40. doi: 10.1007/BF00788244.
This study compared demographic and diagnostic characteristics of a sample of homeless outpatient mental health clinic attenders with a domiciled comparison group from the same clinic. Data on demographic variables and DSM-III-R psychiatric diagnoses were collected over a two-year period on a consecutive sample of 166 homeless and 117 nonhomeless clinic attenders. Data on demographics and psychiatric diagnoses of the homeless clinic attenders were further compared with data collected systematically from 900 homeless individuals in the same city. In the clinic, homeless subjects were more often members of ethnic minorities, and homeless women were significantly younger and better educated than their nonhomeless counterparts. Rates of schizophrenia, bipolar disorder, and somatization disorder were not significantly different between homeless and nonhomeless groups. Major depression was about four times as prevalent in nonhomeless men as in homeless men. Homeless men were significantly more likely than nonhomeless men to qualify for a diagnosis of alcohol use disorder, and homeless women were more likely than other women to qualify for a diagnosis of drug use disorder. Both homeless men and women were significantly more likely than their domiciled counterparts to meet criteria for antisocial personality disorder. Personality disorder other than antisocial was more prevalent in nonhomeless men than in homeless men. Combined rates of personality disorder were significantly higher among homeless than nonhomeless women, but not men. Homeless clinic attenders were demographically and diagnostically very similar to a general homeless population in the same city. The only diagnosis that was more prevalent in the homeless clinic than in the homeless community was antisocial personality disorder. We concluded that because of difference in diagnostic prevalence, homeless and nonhomeless individuals in mental health clinics need to be considered independently. Clinicians treating homeless outpatients may benefit from having special facility in diagnosis and management of antisocial personality disorder and substance abuse, along with expertise in other psychiatric disorders in this population.
本研究比较了一家无家可归者门诊心理健康诊所就诊者样本与来自同一家诊所的有住所对照群体的人口统计学和诊断特征。在两年时间里，对166名无家可归的诊所就诊者和117名非无家可归的诊所就诊者的连续样本收集了人口统计学变量和DSM-III-R精神疾病诊断数据。还将无家可归的诊所就诊者的人口统计学和精神疾病诊断数据与从同一城市900名无家可归者中系统收集的数据进行了进一步比较。在诊所中，无家可归者更常是少数族裔成员，无家可归的女性比有住所的女性明显更年轻且受教育程度更高。无家可归者和有住所者群体之间精神分裂症、双相情感障碍和躯体化障碍的发病率没有显著差异。重度抑郁症在非无家可归男性中的患病率约为无家可归男性的四倍。无家可归男性比非无家可归男性更有可能符合酒精使用障碍的诊断标准，无家可归女性比其他女性更有可能符合药物使用障碍的诊断标准。无家可归的男性和女性比有住所的同龄人更有可能符合反社会人格障碍的标准。除反社会型人格障碍外的其他人格障碍在非无家可归男性中比在无家可归男性中更普遍。人格障碍的合并发病率在无家可归女性中显著高于有住所女性，但在男性中并非如此。无家可归的诊所就诊者在人口统计学和诊断方面与同一城市的一般无家可归人群非常相似。在无家可归者诊所中比在无家可归社区中更普遍的唯一诊断是反社会人格障碍。我们得出结论，由于诊断患病率的差异，心理健康诊所中的无家可归者和有住所者需要独立考虑。治疗无家可归门诊患者的临床医生可能会受益于在反社会人格障碍和物质滥用的诊断和管理方面拥有特殊设施，以及在该人群其他精神疾病方面的专业知识。
