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Three year course and outcome of mental illness in homeless men

A prospective longitudinal study based on a representative sample

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Abstract

Objective

To report on the 3–year course and outcome of mental illness and social aspects in a representative sample of 265 homeless men living on the street or using overnight shelter.

Method

Expert interviews at baseline and at follow–up included the SCID–I and covered cognitive impairment, somatic complaints, use of medical services and psychosocial areas. Of 247 homeless men still alive, at 3–year follow–up, 185 (74.9 %) were successfully traced and interviewed face to face.

Results

There was considerable improvement regarding the housing situation after 3 years. Rates of mental illness decreased from 79 % to 66% over 3 years possibly due to an improved housing situation and increased medical/psychiatric attention and service. The prevalence of mood disorders, substance use disorders and anxiety disorders was significantly lower at 3–year follow–up while psychotic disorders showed a slight increase over time. Thus, in general, more remission than incidence was observed in the 3–year follow–up period. A high rate of use of general medical inpatient services was found. Considering the very high prevalence of mental illness, the use of psychiatric services was very low with some increase over time. Mental health status at 1st assessment did not predict the housing situation at 3 year follow–up. Having had a substance use disorder diagnosis at 1st assessment was a powerful predictor of an unfavorable mental health status at 3 year follow-up. Standardized mortality ratio over 3 years was 4.4.

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References

  1. Alstrom CH, Lindelius R, Salum I (1975) Mortality among homeless men. Brit J Addict 70:245–252

    CAS  Google Scholar 

  2. American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders. 4th Edition DSM IV American Psychiatric Press, Washington DC

  3. Babidge NC, Buhrich N, Butler T (2001) Mortality among homeless people with schizophrenia in Sydney,Australia: a 10 year follow- up. Acta Psychiatr Scand 103:105–110

    Article  CAS  PubMed  Google Scholar 

  4. Barrow SM, Herman DB, Córdova P, Struening EL (1999) Mortality among homeless shelter residents in New York City. Am J Public Health 89:529–534

    CAS  PubMed  Google Scholar 

  5. Burnam MA, Koegel P (1988) Methodology for obtaining a representative sample of homeless persons: The Los Angeles Skid Row study. Eval Rev 12:117–152

    Google Scholar 

  6. Caton CLM, Wyatt RJ, Felix A, Grunberg J, Dominguez B (1993) Follow-up of Chronically Homeless Mentally Ill Men. Am J Psychiat 150:1639–1642

    CAS  PubMed  Google Scholar 

  7. Cook JA, Pickett-Schenk SA, Grey D,Banghart M, Rosenheck RA, Randolph F (2001) Vocational outcome among formerly homeless persons with severe mental illness in the ACCESS program. Psychiatr Serv 52:1075–1080

    Article  CAS  PubMed  Google Scholar 

  8. Craig TKJ, Hodson S (1998) Homeless youth in London: I.Childhood antecedents and psychiatric disorder. Psychol Med 28:1379–1388

    Article  CAS  PubMed  Google Scholar 

  9. Craig TKJ, Hodson S (2000) Homeless youth in London: II. Accommodation, employment and health outcomes at 1 year. Psychol Med 30:187–194

    CAS  PubMed  Google Scholar 

  10. Dayson D (1993) The TAPS project. 12: Crime, vagrancy, death and readmission of the long-term mentally ill during their first year of local reprovision. Br J Psychiatry 162(Suppl 19):40–44

    Google Scholar 

  11. Fichter MM, Koniarczyk M,Greifenhagen A,Koegel P, Quadflieg N, Wittchen HU, Wölz J (1996) Mental illness in a representative sample of homeless men in Munich, Germany. Eur Arch Psychiatry Clin Neurosci 246:185–196

    CAS  PubMed  Google Scholar 

  12. Fichter MM, Quadflieg N (1999) Alcoholism in Homeless Men in the Mid-Nineties: Results from the Bavarian Public Health Study on Homelessness. Eur Arch Psychiatry Clin Neurosci 249:34–44

    Article  CAS  PubMed  Google Scholar 

  13. Fichter MM, Quadflieg N, Cuntz U (2000) Prävalenz körperlicher und seelischer Erkrankungen. Daten einer repräsentativen Stichprobe obdachloser Männer. (Prevalence of physical and mental disorders in homeless men in Germany). Deutsches Ärzteblatt 97:1148–1154

    Google Scholar 

  14. Fichter MM, Quadflieg N (2001) Prevalence of mental illness in homeless men in Munich, Germany: results from a representative sample. Acta Psychiat Scand 103:94–104

    Article  CAS  PubMed  Google Scholar 

  15. Fichter MM, Quadflieg N (2003) Course of alcoholism in homeless men in Munich,Germany: Results from a prospective longitudinal study based on a representative sample. Subs Use Misuse 38:395–427

    Article  Google Scholar 

  16. Fichter MM, Quadflieg N (2004) Intervention effects of supplying homeless individuals with permanent housing: A three year prospective study. Acta Psychiatr Scand (in press)

  17. First MB,Gibbon M,Spitzer RL (1996) User’s Guide for the SCIDI Structured Clinical Interview for DSM-IV (SCID-I Version 2.0, February 1996 Final Version). Biometrics Research Department, New York State Psychiatric Institute, 722 West, 168th Street, New York, NY 10032

  18. Folstein NF, Folstein SE,Hughes PR (1975) Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  CAS  PubMed  Google Scholar 

  19. Greifenhagen A, Fichter MM (1997) Mental Illness in Homeless Women: An Epidemiological Study in Munich, Germany. Eur Arch Psychiatry Clin Neurosci 247:162–172

    CAS  PubMed  Google Scholar 

  20. Herman DB, Susser ES, Jandorf L, Lavelle J, Bromet EJ (1998) Homelessness Among Individuals With Psychotic Disorders Hospitalized for the First Time: Findings From the Suffolk County Mental Health Project. Am J Psychiatry 155:109–113

    CAS  PubMed  Google Scholar 

  21. Herrman H, McGorry P, Bennett P, Riel R van, McKenzie D, Singh B (1989) Prevalence of Severe Mental Disorders in Disaffiliated and Homeless People in Inner Melbourne. Am J Psychiatry 146(9):1179–1184

    CAS  PubMed  Google Scholar 

  22. Humphreys K, Rosenheck R (1998) Treatment involvement and outcomes for four subtypes of homeless veterans. Am J Orthopsychiatry 68:285–294

    Google Scholar 

  23. Jones K, Colson P, Valencia E, Susser E (1994) A preliminary cost effectiveness analysis of an intervention to reduce homelessness among the mentally ill. Psychiatr Q 65:243–256

    CAS  PubMed  Google Scholar 

  24. Kashner TM, Rosenheck R, Campinell AB, Suris A, Crandall R, Garfield NJ, Lapuc P, Pyrcz K, Soyka T, Wicker A (2002) Impact of work therapy on health status among homeless substance-dependent veterans.A randomized controlled trial. Arch Gen Psychiatry 59:938–944

    Article  PubMed  Google Scholar 

  25. Kasprow WJ, Rosenheck R (2000) Mortality among homeless and nonhomeless mentally ill veterans. J Nerv Ment Dis 188:141–147

    Article  CAS  PubMed  Google Scholar 

  26. Koegel P, Burnam MA (1988) Alcoholism Among Homeless Adults in the Inner City of Los Angeles. Arch Gen Psychiatry 45:1011–1018

    Google Scholar 

  27. Koegel P, Burnam MA, Farr RK (1988) The Prevalence of Specific Psychiatric Disorders Among Homeless Individuals in the Inner City of Los Angeles. Arch Gen Psychiatry 45:1085–1092

    Google Scholar 

  28. Kovess V, Lazarus C (1999) The prevalence of psychiatric disorders and use of care by homeless people in Paris. Soc Psychiatry Psychiatr Epidemiol 34:580–587

    CAS  PubMed  Google Scholar 

  29. Krautgartner M, Scherer M, Katschnig H (2002) Psychiatrische Krankenhaustage: Wer konsumiert die meisten? Eine Record- Linkage-Studie über fünf Jahre in einem österreichischen Bundesland. (Days in psychiatric hospitals:Who consumes most of them? A five-year record-linkage study of “heavy users” in an Austrian province). Psychiatr Prax 29:355–363

    Article  PubMed  Google Scholar 

  30. Lehman AF, Dixon LB, Kernan E, DeForge BR, Postrado LT (1997) A randomized trial of assertive community treatment for homeless persons with severe mental illness. Arch Gen Psychiatry 54:1038–1043

    CAS  PubMed  Google Scholar 

  31. Leff J, Thornicroft G, Coxhead N, Crawford C (1994) The TAPS project. 22: A five-year follow-up of long-stay psychiatric patients discharged to the community. Br J Psychiatry 165(Suppl 25):13–17

    PubMed  Google Scholar 

  32. Lipton FR, Nutt S, Sabatini A (1988) Housing the homeless mentally ill: A longitudinal study of a treatment approach. Hosp Commun Psychiatry 39:40–45

    Google Scholar 

  33. Lipton FR, Siegel C, Hannigan A, Samuels J, Baker S (2000) Tenure in supportive housing for homeless persons with severe mental illness. Psychiatr Serv 51:479–486

    Article  CAS  PubMed  Google Scholar 

  34. Meller I, Fichter M, Quadflieg N, Koniarczyk M, Greifenhagen A, Wolz J (2000) Die Inanspruchnahme medizinischer und psychosozialer Dienste durch psychisch erkrankte Obdachlose (Acceptance of medical and social services by the homeless mentally ill). Nervenarzt 71:543–551

    Article  CAS  PubMed  Google Scholar 

  35. Nordentoft M, Wandall-Holm N (2003) 10 year follow-up study of mortality among users of hostels for homeless people in Copenhagen. Br Med J 327:81

    Google Scholar 

  36. Richter D, Venzke A, Settelmayer J, Reker T (2002) Häufige Wiederaufnahmen suchtkranker Patienten in die stationäre psychiatrische Behandlung – “Heavy User” oder chronisch Kranke? (High rates of inpatient readmissions of alcohol addicted patients – heavy users or chronically ill patients?). Psychiatr Prax 29:364–368

    Article  PubMed  Google Scholar 

  37. Rössler W, Salize HJ, Biechele U (1994) Psychisch kranke Wohnsitzlose – Die vergessene Minderheit. (Mentally ill homeless – the forgotten minority). Psychiatr Prax 21:173–178

    PubMed  Google Scholar 

  38. Roick C, Gaertner A, Heider D, Angermeyer MC (2002) Heavy user psychiatrischer Versorgungsdienste. Ein Ueberblick ueber den Stand der Forschung. (Heavy users of psychiatric care,A review of the state of research). Psychiatr Prax 29:334–342

    Article  PubMed  Google Scholar 

  39. Rosenheck RA,Lam J,Morrissey JP,Calloway MO, Stolar M,Randolph F, ACCESS National Evaluation Team (2002) Service systems integration and outcomes for mentally ill homeless persons in the ACCESS program. Psychiatr Serv 53:958–966

    Article  PubMed  Google Scholar 

  40. Schnell R, Hill P, Esser E (1988) Methoden der empirischen Sozialforschung. (Empirical methods in the social sciences). Oldenbourg, München Wien

  41. Sosin M, Piliavin I, Westerfelt H (1990) Toward a longitudinal analysis of homelessness. J Soc Issues 46:157–174

    Google Scholar 

  42. Sosin MR, Bruni M, Reidy M (1995) Paths and impacts in the progressive independence model: a homelessness and substance abuse intervention in Chicago. J Add Dis 14:1–20

    Google Scholar 

  43. Sullivan G, Burnam A, Koegel P, Hollenberg J (2000) Quality of life of homeless persons with mental illness: Results from the Course-of-Homelessness Study. Psychiatr Serv 51:1135–1141

    Article  CAS  PubMed  Google Scholar 

  44. Susser E, Moore R, Link B (1993) Risk factors for homelessness. Am J Epidemiol 15:546–556

    CAS  Google Scholar 

  45. Susser E, Valencia E, Conover S, Felix A,Tsai WY, Wyatt RJ (1997) Preventing recurrent homelessness among mentally ill men: A “critical time” intervention after discharge from a shelter. Am J Public Health 87:256–262

    CAS  PubMed  Google Scholar 

  46. Susser E, Valencia E, Miller M, Tsai WY, Meyer-Bahlburg H, Conocer S (1995) Sexual Behavior of Homeless Mentally Ill Men at Risk for HIV. Am J Psychiatry 152:583–587

    CAS  PubMed  Google Scholar 

  47. Tsemberis S, Eisenberg RF (2000) Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatr Serv 51:487–493

    Article  CAS  PubMed  Google Scholar 

  48. Vázquez C, Muñoz M, Sanz J (1997) Lifetime and 12-month Prevalence of DSM-III-R Mental Disorders Among the Homeless in Madrid: A European Study Using the CIDI. Acta Psychiatr Scand 95:523–530

    PubMed  Google Scholar 

  49. Wittchen HU, Wunderlich U, Gruschwitz S, Zaudig M (1997) Strukturiertes Klinisches Interview für DSM-IV (SKID). (Structured Clinical Interview for DSM-IV (SCID)). Hogrefe, Göttingen Bern Toronto Seattle

  50. Zerssen D von (1976) Klinische Selbstbeurteilungs-Skalen (KS) aus dem Münchner Psychiatrischen Informationssystem. (Clinical self-rating scales from the Munich Psychiatric Information System). Beltz, Weinheim

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Authors and Affiliations

  1. Klinik Roseneck, 83209, Prien, Germany

    M. M. Fichter

  2. Department of Psychiatry, Ludwig-Maximilians-University Munich, Nussbaumstraße 7, 80336, Munich, Germany

    M. M. Fichter &  N. Quadflieg

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  1. M. M. Fichter
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  2. N. Quadflieg
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Correspondence to M. M. Fichter.

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Fichter, M.M., Quadflieg, N. Three year course and outcome of mental illness in homeless men. Eur Arch Psychiatry Clin Neurosci 255, 111–120 (2005). https://doi.org/10.1007/s00406-004-0543-9

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  • DOI: https://doi.org/10.1007/s00406-004-0543-9

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