Ducq H, Guesdon I, Roelandt J L
Clinique J. Bosch, EPSM Lille-Métropole, Armentières.
Encephale. 1997 Nov-Dec;23(6):420-30.
Because the visibility of homeless persons congregating in urban areas has increased since the 1980's, the relationship between homelessness and mental illness has caused more and more concern. A multitude of epidemiological surveys have been organized in Great Britain, Australia, Canada, and mainly in United States, and have attempted to evaluate scientifically the psychiatric morbidity of this population. This literature review reveals disparity of epidemiological methods in assessing the type and extent of mental illness among homeless adults. The lack of consensual definition of homelessness, the choice of different settings in which the research is organized (street, health centres, shelters), and the use of diverse instruments of psychiatric evaluation (diagnosis by clinician, by scale or by structured diagnostic interview) lead to a great disparity of the results. Thus, 1/3 of the homeless adults had prior history of psychiatric hospitalisation. Rates of psychosis range to 70% and it is estimated that 4% to 74% of the homeless persons suffer from affective disorders. Substance abuse disorder remains a problem for a significant number of these individuals, with a high frequency of dual diagnosis. Such divergent data highlight the anglo-saxon debate between those who accuse desinstitutionnalisation as a reason of homelessness, and those who blame the socioeconomic background.
自20世纪80年代以来，城市地区聚集的无家可归者越来越常见，无家可归与精神疾病之间的关系引发了越来越多的关注。英国、澳大利亚、加拿大，主要是美国组织了大量的流行病学调查，试图科学评估这一人群的精神疾病发病率。这篇文献综述揭示了在评估无家可归成年人精神疾病的类型和程度时，流行病学方法存在差异。无家可归缺乏统一的定义，研究开展的不同场所选择（街道、健康中心、收容所），以及使用不同的精神科评估工具（临床医生诊断、量表诊断或结构化诊断访谈）导致结果差异很大。因此，三分之一的无家可归成年人有过精神病住院史。精神病发病率高达70%，据估计4%至74%的无家可归者患有情感障碍。物质滥用障碍仍然是这些人中相当一部分人的问题，双重诊断的频率很高。这些截然不同的数据凸显了盎格鲁-撒克逊人之间的争论，一方指责非机构化是无家可归的原因，另一方则归咎于社会经济背景。
