Are Substance use and Mental Illness Associated to an Earlier Onset of Homelessness

Purpose: Substance use and complex concurrent mental disorders are highly common among the homeless, contributing to a higher burden of disease and mortality. Are they associated to an earlier loss of housing? Methods: Participants of the Vancouver arm of the At Home/Chez Soi study suffering from at least one psychiatric illness (n=490) were included in this cross-sectional analysis. Alcohol and substance use patterns were assessed at baseline using the highly validated Mini questionnaire. Age of first homelessness was a self-reported measure. To investigate the independent association between these variables, a linear regression model was created. Results: Sixty percent of the participants had a diagnosis of psychoactive substance use disorder. Thirty-two percent an alcohol abuse and dependence disorder at baseline. While all participants had one mental disorder, over ninety percent had from two to eight diagnoses. According to our model, each additional psychiatric diagnosis was associated to an earlier onset of homelessness by 0.86 years and each category of drug used by 0.51 years. Conclusions: The number of psychiatric comorbidities and abused substances were found to be associated to earlier onset of homelessness. These findings provide information on the path into homelessness, general health conditions and social marginalization, helping the researchers understand how to better face this challenge. The data suggest an increased need for proactive integration of homeless individuals suffering from psychiatric disorders.