Lam J A, Rosenheck R
Department of Veterans Affairs Northeast Program Evaluation Cennter, VA Medical Center, West Haven, CT 06516, USA.
Psychiatr Serv. 1998 May;49(5):678-83. doi: 10.1176/ps.49.5.678.
The study examined the prevalence and correlates of criminal victimization and the relationship between victimization and client outcomes for homeless clients with mental illness.
Subjects were clients in community treatment programs participating in the Access to Community Care and Effective Services and Supports (ACCESS) program of the Center for Mental Health Services. Data were obtained through interviews conducted at program entry and at three and 12 months after entry with ACCESS clients in 18 sites during the first year of program operation (N = 1,839). Self-reports of victimization during the past two months as well as data on sociodemographic, health, and social adjustment indicators were obtained at each time point. Multiple regression was used to determine both the correlates of victimization among this population and the effect of recent victimization on client outcomes three and 12 months after program entry.
Forty-four percent of the clients were the victims of at least one crime during the two months before entering the program. Women were significantly more likely than men to have been victimized. Multivariate analysis showed that the more severe the client's psychotic symptoms, alcohol abuse, and criminal history, the more likely he or she was to have been victimized. Recent victimization had a significant impact on client outcomes in terms of increased homelessness and decreased quality of life. Victimization shortly before program entry was also the single most important predictor of victimization at both follow-up points.
These findings suggest the critical need for service providers who work with homeless people with serious mental illness to assess the extent to which they have been victims of crime and to address issues of victimization and safety along with psychiatric and social adjustment problems.
本研究调查了患有精神疾病的无家可归者遭受犯罪侵害的发生率及其相关因素，以及侵害与服务对象结局之间的关系。
研究对象为参与心理健康服务中心的“获得社区护理及有效服务与支持”（ACCESS）项目的社区治疗项目中的服务对象。在项目运营的第一年，通过对18个地点的ACCESS服务对象在项目入组时、入组后3个月和12个月进行访谈来获取数据（N = 1,839）。在每个时间点获取过去两个月内遭受侵害的自我报告以及社会人口学、健康和社会适应指标的数据。采用多元回归分析来确定该人群中遭受侵害的相关因素以及近期遭受侵害对项目入组后3个月和12个月时服务对象结局的影响。
44%的服务对象在进入项目前的两个月内至少成为过一次犯罪的受害者。女性比男性更有可能成为受害者。多变量分析表明，服务对象的精神病症状、酒精滥用和犯罪史越严重，其成为受害者的可能性就越大。近期遭受侵害对服务对象的结局产生了重大影响，表现为无家可归情况增加和生活质量下降。项目入组前不久遭受侵害也是两个随访点上遭受侵害的最重要单一预测因素。
这些研究结果表明，为患有严重精神疾病的无家可归者提供服务的人员迫切需要评估他们遭受犯罪侵害的程度，并在解决精神疾病和社会适应问题的同时，处理侵害和安全问题。
