The public health significance of prior homelessness: findings on multimorbidity and mental health from a nationally representative survey.

IF 5.9 2区医学 Q1 PSYCHIATRY

Epidemiology and Psychiatric Sciences Pub Date : 2024-11-08 DOI:10.1017/S2045796024000659

N Chilman, P Schofield, S McManus, A Ronaldson, A Stagg, J Das-Munshi

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引用次数: 0

Abstract

Aims: The associations of prior homelessness with current health are unknown. Using nationally representative data collected in private households in England, this study aimed to examine Common Mental Disorders (CMDs), physical health, alcohol/substance dependence, and multimorbidities in people who formerly experienced homelessness compared to people who never experienced homelessness.

Methods: This cross-sectional study utilised data from the 2007 and 2014 Adult Psychiatric Morbidity Surveys. Former homelessness and current physical health problems were self-reported. Current CMDs, alcohol dependence and substance dependence were ascertained using structured validated scales. Survey-weighted logistic regression was used to compare multimorbidities (conditions in combination) for participants who formerly experienced homelessness with those who had never experienced homelessness, adjusting for sociodemographic characteristics, smoking status and adverse experiences. Population attributable fractions (PAFs) were calculated.

Results: Of 13,859 people in the sample, 535 formerly experienced homelessness (3.6%, 95% CI 3.2-4.0). 44.8% of people who formerly experienced homelessness had CMDs (95% CI 40.2-49.5), compared to 15.0% (95% CI 14.3-15.7) for those who had never experienced homelessness. There were substantial associations between prior homelessness and physical multimorbidity (adjusted odds ratio [aOR] 1.98, 95% CI 1.53-2.57), CMD-physical multimorbidity (aOR 3.43, 95% CI 2.77-4.25), CMD-alcohol/substance multimorbidity (aOR 3.53, 95% CI 2.49-5.01) and trimorbidity (CMD-alcohol/substance-physical multimorbidity) (aOR 3.26, 95% CI 2.20-4.83), in models adjusting for sociodemographic characteristics and smoking. After further adjustment for adverse experiences, associations attenuated but persisted for physical multimorbidity (aOR 1.40, 95% CI 1.10-1.79) and CMD-physical multimorbidity (aOR 1.55, 95% CI 1.20-2.00). The largest PAFs were observed for CMD-alcohol/substance multimorbidity (17%) and trimorbidity (16%).

Conclusions: Even in people currently rehoused, marked inequities across multimorbidities remained evident, highlighting the need for longer-term integrated support for people who have previously experienced homelessness.

查看原文本刊更多论文

以前无家可归对公共健康的意义：一项全国代表性调查对多病症和心理健康的发现。

目的：以前无家可归与目前健康状况之间的关系尚不清楚。本研究利用在英格兰私人家庭中收集的具有全国代表性的数据，旨在研究曾有过无家可归经历的人与从未有过无家可归经历的人相比在常见精神障碍（CMDs）、身体健康、酒精/药物依赖和多病症方面的情况：这项横断面研究利用了 2007 年和 2014 年成人精神病发病率调查的数据。曾经的无家可归经历和目前的身体健康问题均为自我报告。目前的慢性精神疾病、酒精依赖和药物依赖通过结构化验证量表确定。调查加权逻辑回归用于比较曾有过无家可归经历的参与者与从未有过无家可归经历的参与者的多病症（合并症），并对社会人口特征、吸烟状况和不良经历进行调整。结果显示，在 13,859 名研究对象中，有 13,859 人患有多种疾病（合并症）：在 13859 个样本中，有 535 人曾有过无家可归的经历（3.6%，95% CI 3.2-4.0）。44.8%曾经无家可归的人患有CMD（95% CI 40.2-49.5），而从未有过无家可归经历的人患有CMD的比例为15.0%（95% CI 14.3-15.7）。在调整了社会人口学特征和吸烟的模型中，CMD-酒精/药物多病性（aOR 3.53，95% CI 2.49-5.01）和三联症（CMD-酒精/药物-躯体多病性）（aOR 3.26，95% CI 2.20-4.83）的相关性最高。进一步调整不良经历后，相关性减弱，但身体多病（aOR 1.40，95% CI 1.10-1.79）和慢性阻塞性肺病-身体多病（aOR 1.55，95% CI 1.20-2.00）的相关性持续存在。在 CMD-酒精/药物多病症（17%）和三病症（16%）中观察到的 PAFs 最大：即使在目前已重新安置的人群中，多种疾病之间的明显不平等仍然很明显，这凸显了为曾经经历过无家可归的人群提供长期综合支持的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Epidemiology and Psychiatric Sciences PSYCHIATRY-

CiteScore

7.80

自引率

1.20%

发文量

121

审稿时长

>12 weeks

期刊介绍： Epidemiology and Psychiatric Sciences is a prestigious international, peer-reviewed journal that has been publishing in Open Access format since 2020. Formerly known as Epidemiologia e Psichiatria Sociale and established in 1992 by Michele Tansella, the journal prioritizes highly relevant and innovative research articles and systematic reviews in the areas of public mental health and policy, mental health services and system research, as well as epidemiological and social psychiatry. Join us in advancing knowledge and understanding in these critical fields.