Abstract
Homeless veterans have numerous co-occurring medical and behavioral health problems. Identification of common patterns of comorbid conditions may help providers to determine severity of medical conditions and triage health care more effectively. In this study we identify such patterns of comorbid medical and psychiatric disorders using cluster analysis and we evaluate relationships between these patterns and sociodemographic factors. We used data from a survey of 3,595 veterans in a regional VA network who were presently or recently homeless assessing nine major medical disorder and six psychiatric disorder categories. Diagnostic ratings of presence or absence of these disorders were placed into the same cluster analysis to determine whether separable clusters emerged reflecting differing diagnostic profiles. There are recognizable patterns of comorbidity involving several psychiatric and general medical disorders, as well as disorders of both types that exist independently. Cluster membership was associated with various sociodemographic indices. Mental and general medical health problems in homeless veterans often occur in association with each other and form identifiable patterns that vary on sociodemographic factors.
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References
Koegel P, Sullivan G, Burnam A, et al.: Utilization of mental health and substance abuse services among homeless adults in Los Angeles. Medical Care 37:306–317, 1999
Gundlapalli A, Hanks M, Stevens SM, et al.: It takes a village: a multidisciplinary model for the acute illness aftercare of individuals experiencing homelessness. Journal of Health Care for the Poor and Underserved 16:257–272, 2005
Douaihy AB, Stowell KR, Bui T, et al.: HIV/AIDS and homelessness, Part 1: background and barriers to care. AIDS Readings 15:516–520, 2005
Gonzalez, G, Rosenheck RA: Outcomes and service use among homeless persons with serious mental illness and substance abuse. Psychiatric Services 53:437–446, 2002
Snyder LD, Eisner MD: Obstructive lung disease among the urban homeless. Chest 125:1719–1725, 2004
Salize HJ, Dillmann-Lange C, Stern G et al.: Alcoholism and somatic comorbidity among homeless people in Mannheim, Germany. Addiction 97:1593–1600, 2002
Hwang SW: Homelessness and health. CMAJ 164:229–223, 2001
Pitz S, Kramann C, Krummenauer F, et al.: Is homelessness a risk factor for eye disease? Results of a German screening study. Ophtalmologica 219:345–349, 2005
Kermode M, Crofts N, Miller P, et al.: Health indicators and risks among people experiencing homelessness in Melbourne, 1995–1996. Australia and New Zealand Journal of Public Health 22:464–470, 1998
Goldstein G, Luther JF, Jacoby AM, et al.: A preliminary classification system for homeless veterans with mental illness. Psychological Services 5:36–48, 2008
Goldstein G, Luther JF, Jacoby AM, et al.: Developing a taxonomy of medical comorbidity among homeless veterans. Journal of Health Care for the Poor and Underserved 19:991–1005, 2008
Henderson C, Bainbridge, J, Keaton K, et al.: The use of data to assist in the design of a new service system for homeless veterans in New York City. Psychiatric Quarterly 79:3–17, 2008
Kuhn R, Culhane DP: Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: results from the analysis of administrative data. American Journal of Community Psychology 26:207–232, 1998
Wright NM, Tompkins CN: How can health services effectively meet the health needs of homeless people? British Journal of General Practice 56:286–293, 2006
Rosenheck R, Leda C, Gallup P, Astrachan B, Milstein R, Leaf P, Thompson D, Errera P: Initial assessment data from a 43-site program for homeless chronic mentally ill veterans. Hospital and Community Psychiatry 40:937–942, 1989
Rosenheck R, Gallup P: Involvement in an outreach and residential treatment program for homeless mentally ill veterans. Journal of Nervous and Mental Disease 179:750–754, 1991
Kasprow WJ, Rosenheck RA: Substance use and psychiatric problems of homeless Native American veterans. Psychiatric Services 49:345–350, 1998
SAS Institute Inc.: SAS 9.1.3, Cary, NC, SAS Institutes Inc., 2007
Aldenderfer MS, Blashfield RK: Cluster analysis. Beverly Hills, CA, Sage Publications, 1984
North, CS, Smith EM: Posttraumatic stress disorder among homeless men and women. Hospital and Community Psychiatry 43:1010–1016, 1992
Rosenheck R, Fontana A: A model of homelessness among male veterans of the Vietnam War generation. American Journal of Psychiatry 151:421–427, 1994
North CS, Pollio DE, Smith EM, et al.: Correlates of early onset and chronicity of homelessness in a large urban homeless population. Journal of Nervous and Mental Disease 186:393–400, 1998
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Indebtedness is expressed to the Department of Veterans Affairs Medical Research Service, VISN 4 Mental Illness Research, Education, and Clinical Center, and Department of Veterans Affairs Northeast Program Evaluation Center for support of this research.
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Goldstein, G., Luther, J.F., Haas, G.L. et al. Comorbidity Between Psychiatric and General Medical Disorders in Homeless Veterans. Psychiatr Q 80, 199–212 (2009). https://doi.org/10.1007/s11126-009-9106-6
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DOI: https://doi.org/10.1007/s11126-009-9106-6