North C S, Pollio D E, Smith E M, Spitznagel E L
Department of Psychiatry, Washington University, School of Medicine, St. Louis, Missouri 63110, USA.
J Nerv Ment Dis. 1998 Jul;186(7):393-400. doi: 10.1097/00005053-199807000-00002.
This study examined temporal relationships between relative onsets of mental illness and homelessness in a cross-sectional study of 900 homeless people compared with a matched, never-homeless sample from the Epidemiologic Catchment Area study. All psychiatric disorders preceded homelessness in the majority. Only one disorder, alcohol use disorder (in men only), had significantly earlier onset in homeless subjects. Regarding number of symptoms or earlier age of onset of psychiatric disorders, earlier onset of homelessness was associated with several diagnoses: schizophrenia, major depression, generalized anxiety disorder, alcohol and drug use disorders, and antisocial personality. In multiple regression models, history of dysfunctional family background and maternal psychiatric illness were also associated with earlier onset of homelessness, whereas education was protective. Chronicity of homelessness was associated with number of symptoms of alcohol use disorder and earlier age of onset of drug use disorder, presence and number of symptoms of schizophrenia and antisocial personality, and earlier onset of major depression and conduct disorder. In multiple regression models, more education, but not family background problems, was associated with shorter lifetime duration of homelessness. These findings provide information relevant to the roles of mental illness and personal vulnerability factors in the onset and chronicity of homelessness.
在一项横断面研究中，对900名无家可归者与来自流行病学集水区研究的匹配的、从未无家可归的样本进行了比较，以考察精神疾病相对发病时间与无家可归之间的时间关系。在大多数情况下，所有精神疾病都先于无家可归出现。只有一种疾病，即酒精使用障碍（仅在男性中），在无家可归者中的发病时间明显更早。关于精神疾病的症状数量或更早发病年龄，更早出现无家可归与几种诊断相关：精神分裂症、重度抑郁症、广泛性焦虑症、酒精和药物使用障碍以及反社会人格。在多元回归模型中，功能失调的家庭背景史和母亲的精神疾病也与更早出现无家可归相关，而教育则具有保护作用。无家可归的长期性与酒精使用障碍的症状数量、药物使用障碍的更早发病年龄、精神分裂症和反社会人格的存在及症状数量，以及重度抑郁症和品行障碍的更早发病相关。在多元回归模型中，更多的教育，而非家庭背景问题，与无家可归的终生时长较短相关。这些发现提供了与精神疾病和个人易感性因素在无家可归的发生和长期性中所起作用相关的信息。
