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A longitudinal study of suicidal ideation among homeless, mentally ill individuals

Abstract

Purpose

Previous cross-sectional studies have indicated that homeless individuals may present with high rates of suicidal ideation, which are strongly associated with completed suicide. We conducted the first known longitudinal study of suicidal ideation in the homeless.

Methods

We used data collected over 24 months in the Vancouver At Home project (N = 497), comprised two randomized-controlled trials of housing interventions for homeless individuals with mental disorders. Presence of suicidal ideation was determined using the Colorado symptom index.

Results

Suicidal ideation significantly decreased over time [odds ratio (OR) = 0.31 at 24 months, 95 % confidence interval (CI) 0.21–0.46]. Baseline diagnoses of mood (OR = 2.18, 95 % CI 1.48–3.21) and anxiety disorders (OR = 2.05, 95 % CI 1.42–2.97), as well as depressive mood (OR = 2.52, 95 % CI 1.90–3.33), use of any substance (OR = 1.59, 95 % CI 1.09–2.32), and polysubstance use (OR = 1.90, 95 % CI 1.40–2.60) were significantly associated with suicidal ideation in the multivariate model. Baseline diagnosis of a psychotic disorder (protective effect), daily substance use, intravenous drug use, recent arrest, multiple physical illnesses and history of traumatic brain injury were significantly associated with suicidal ideation in the unadjusted model only.

Conclusions

Interventions targeting depressive symptoms and substance use could help decrease suicide risk in homeless individuals. Mental health services need to be tailored to address the complex needs of socially marginalized individuals.

Trial registration

Current controlled trials: ISRCTN57595077 (Vancouver At Home study: Housing First plus Assertive Community Treatment versus congregate housing plus supports versus treatment as usual) and ISRCTN66721740 (Vancouver At Home study: Housing first plus intensive case management versus treatment as usual). Assigned 9 Oct. 2012.

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Acknowledgments

Special thanks to the Vancouver At Home participants, service providers, and field research team members. The authors also thank the At Home/Chez Soi project collaborative.

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Correspondence to François Noël.

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Conflict of interest

This research was funded by Health Canada and the Mental Health Commission of Canada. The views expressed herein solely represent the authors. The authors declare no conflict of interest.

Ethical standards

All participants gave their informed consent prior to inclusion in the study. The Simon Fraser University Research Ethics Board approved the study protocol.

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Noël, F., Moniruzzaman, A., Somers, J. et al. A longitudinal study of suicidal ideation among homeless, mentally ill individuals. Soc Psychiatry Psychiatr Epidemiol 51, 107–114 (2016). https://doi.org/10.1007/s00127-015-1142-y

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  • DOI: https://doi.org/10.1007/s00127-015-1142-y

Keywords

  • Suicidal ideation
  • Mood disorders
  • Substance-related disorders
  • Homeless persons