1
|
Armoon B, Mohammadi R, Griffiths MD. The Global Prevalence of Non-suicidal Self-injury, Suicide Behaviors, and Associated Risk Factors Among Runaway and Homeless Youth: A Meta-analysis. Community Ment Health J 2024; 60:919-944. [PMID: 38451378 DOI: 10.1007/s10597-024-01245-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
A meta-analysis was performed to determine pooled prevalence of non-suicidal self-injury (NSSI), suicide behaviors (including ideation, attempts), and associated risk factors among runaway and homeless youth (RHY). The databases PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant studies published from January 1995 to May 2023. Initially, 8465 papers were screened, resulting in 69 included studies. The results showed that among RHY, lifetime prevalence rates were 42% for NSSI, 38% for suicidal ideation, and 27% for suicide attempts. Lifetime prevalence of NSSI and suicide behaviors was higher among adolescent minors (aged 12-17 years) compared to young adults (aged 18-24 years). Also, NSSI and suicide behaviors were associated with having a childhood history of physical and sexual abuse. Developing an impactful community-based suicide prevention campaign tailored for RHY appears warranted. Peer groups and mentorship programs would provide invaluable support for young individuals, as supportive friendships protect against NSSI.
Collapse
Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| |
Collapse
|
2
|
Jones AA, Cho LL, Gicas KM, Procyshyn RM, Vila-Rodriguez F, Stubbs JL, Leonova O, Buchanan T, Thornton AE, Lang DJ, MacEwan GW, Panenka WJ, Barr AM, Field TS, Honer WG. Multilayer depressive symptom networks in adults with bodily pain living in precarious housing or homelessness. Eur Arch Psychiatry Clin Neurosci 2024; 274:643-653. [PMID: 37610500 DOI: 10.1007/s00406-023-01664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023]
Abstract
Housing insecurity is associated with co-occurring depression and pain interfering with daily activities. Network analysis of depressive symptoms along with associated risk or protective exposures may identify potential targets for intervention in patients with co-occurring bodily pain. In a community-based sample of adults (n = 408) living in precarious housing or homelessness in Vancouver, Canada, depressive symptoms were measured by the Beck Depression Inventory; bodily pain and impact were assessed with the 36-item Short Form Health Survey. Network and bootstrap permutation analyses were used to compare depressive symptoms endorsed by Low versus Moderate-to-Severe (Mod + Pain) groups. Multilayer networks estimated the effects of risk and protective factors. The overall sample was comprised of 78% men, mean age 40.7 years, with 53% opioid use disorder and 14% major depressive disorder. The Mod + Pain group was characterized by multiple types of pain, more persistent pain, more severe depressive symptoms and a higher rate of suicidal ideation. Global network connectivity did not differ between the two pain groups. Suicidal ideation was a network hub only in the Mod + Pain group, with high centrality and a direct association with exposure to lifetime trauma. Antidepressant medications had limited impact on suicidal ideation. Guilt and increased feelings of failure represented symptoms from two other communities of network nodes, and completed the shortest pathway from trauma exposure through suicidal ideation, to the non-prescribed opioid exposure node. Interventions targeting these risk factors and symptoms could affect the progression of depression among precariously housed patients.
Collapse
Affiliation(s)
- Andrea A Jones
- Division of Neurology, Department of Medicine, University of British Columbia, 8219-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Thalia S Field
- Division of Neurology, Department of Medicine, University of British Columbia, 8219-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
3
|
Rabasco A, Arias S, Benz MB, Weinstock LM, Miller I, Boudreaux ED, Camargo CA, Kunicki ZJ, Gaudiano BA. Longitudinal risk of suicide outcomes in people with severe mental illness following an emergency department visit and the effects of suicide prevention treatment. J Affect Disord 2024; 347:477-485. [PMID: 38065475 PMCID: PMC10872614 DOI: 10.1016/j.jad.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/29/2023] [Accepted: 12/02/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Individuals with severe mental illness (SMI), including bipolar disorder (BD) and schizophrenia-spectrum disorders (SSD), are at high risk for suicide. However, suicide research often excludes individuals with SMI. The current research examined differences in suicide outcomes (i.e., suicide attempt or death) for adults with and without BD and SSD diagnoses following an emergency department (ED) visit and investigated the efficacy of the Coping Long Term with Active Suicide Program (CLASP) intervention in reducing suicide outcomes among people with SMI. METHODS 1235 adults presenting with recent suicidality were recruited from 8 different EDs across the United States. Using a quasi-experimental, stepped wedge series design, participants were followed for 52-weeks with or without subsequent provision of CLASP. RESULTS Participants in the SSD group and the BD group had significantly shorter time to and higher rate of suicide outcomes than participants with other psychiatric diagnoses in all study phases and in non-CLASP phases, respectively. Participants with BD receiving the CLASP intervention had significantly longer time to suicide outcomes than those not receiving CLASP; these differences were not observed among those with SSD. LIMITATIONS Study limitations include self-reported psychiatric diagnosis, exclusion of homeless participants, and small sample size of participants with SSD. CONCLUSIONS Participants with SMI were at higher risk for suicide outcomes than participants with other psychiatric diagnoses. CLASP was efficacious among those participants with BD. Psychiatric diagnosis may be a key indicator of prospective suicide risk. More intensive and specialized follow-up mental health treatment may be necessary for those with SSD.
Collapse
Affiliation(s)
- Ana Rabasco
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA.
| | - Sarah Arias
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | - Madeline B Benz
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | | | - Ivan Miller
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| | | | - Carlos A Camargo
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Zachary J Kunicki
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Brandon A Gaudiano
- Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Providence, RI, USA
| |
Collapse
|
4
|
Hu D, Comben C, Diminic S, Pagliaro C. Review of Australia's funding commitments for suicide prevention from 2021-22 to 2026-27. AUST HEALTH REV 2024; 48:45-51. [PMID: 38105034 DOI: 10.1071/ah23176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/27/2023] [Indexed: 12/19/2023]
Abstract
Objective Examine the distribution of funding for suicide prevention in Australia from 2021-22 to 2026-27. Methods Government websites were reviewed to locate budget documents related to suicide prevention funding. Information was extracted on the program/service to be funded, and the funder entity, duration, and year allocation. Extracted data was reviewed to identify commonly targeted sub-populations. Results The majority of suicide prevention-related funding was allocated to aftercare for persons who have attempted suicide, consistent with the effectiveness of these services, followed by programs targeting the general population. Little funding was allocated to other specific sub-populations, such as young people and Aboriginal and Torres Strait Islander peoples. The amount of funding allocated to suicide prevention varied across jurisdictions, which is only partially explained by suicide rates. Conclusions There is a need for greater investment in care for specific sub-populations who are at higher risk of suicide. This study provides a baseline for comparing future investments in suicide prevention in Australia.
Collapse
Affiliation(s)
- Di Hu
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; and Queensland Centre for Mental Health Research, Brisbane, Qld, Australia
| | - Charlotte Comben
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; and Queensland Centre for Mental Health Research, Brisbane, Qld, Australia
| | - Sandra Diminic
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; and Queensland Centre for Mental Health Research, Brisbane, Qld, Australia
| | - Claudia Pagliaro
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Qld, Australia; and Queensland Centre for Mental Health Research, Brisbane, Qld, Australia
| |
Collapse
|
5
|
Esparza-Reig J, Julián M. Association between suicidal ideation and burnout: A meta-analysis. DEATH STUDIES 2024:1-12. [PMID: 38180020 DOI: 10.1080/07481187.2023.2300064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Approximately 700,000 people die by suicide annually worldwide. Researchers have explored a spectrum of experiences that involve stress in academic or work environments and potentially intensify suicidal thoughts or behaviors. However, no meta-analysis has examined the relationship between suicidal ideation (SI) and burnout. This study consisted of a meta-analysis to examine the association between SI and burnout syndrome, utilizing the WoS Core Collection, Scopus, PubMed, PsycINFO, DIALNET, and Google Scholar databases. Twenty-one samples met the study's eligibility criteria for inclusion in the analysis. The results revealed a significant relationship between SI and burnout, with the type of burnout (occupational, academic, and parental) emerging as the most significant moderating variable. Occupational burnout exhibited the lowest correlation, followed by academic and parental burnout. These findings suggest the importance of developing tools to assess SI within the context of the work environment, parenting and academics, and psychoeducational programs for managing stress.
Collapse
Affiliation(s)
| | - Martín Julián
- Department of Psychology, Universidad Europea de Valencia, Valencia, Spain
| |
Collapse
|
6
|
Ho ZV, Arias SA, Kunicki ZJ, Sarkar IN, Chen ES. Characterizing suicidal ideation, suicidal behaviors, and service utilization among unhoused individuals using a health information exchange. J Clin Psychol 2023; 79:2542-2555. [PMID: 37433045 PMCID: PMC10592413 DOI: 10.1002/jclp.23566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 05/25/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Unhoused individuals have high rates of suicidal ideation (SI) and suicidal behaviors (SB), but few have studied the relative timing of homelessness and SI/SB. Our study examines the potential to use state-wide electronic health record data from Rhode Island's health information exchange (HIE) to identify temporal relationships, service utilization, and associations of SI/SB among unhoused individuals. METHODS We use timestamped HIE data for 5368 unhoused patients to analyze service utilization and the relative timing of homelessness versus SI/SB onset. Multivariable models identified associations of SI/SB, hospitalization, and repeat acute care utilization within 30 days from clinical features representing 10,000+ diagnoses captured within the HIE. RESULTS The onset of SI typically precedes homelessness onset, while the onset of SB typically follows. Weekly rates of suicide-related service utilization increased over 25 times the baseline rate during the week before and after homelessness onset. Over 50% of encounters involving SI/SB result in hospitalization. Of those engaging in acute care for suicide-related reasons, we found high rates of repeat acute care encounters. CONCLUSION HIEs are a particularly valuable resource for understudied populations. Our study demonstrates how longitudinal, multi-institutional data from an HIE can be used to characterize temporal associations, service utilization, and clinical associations of SI and behaviors among a vulnerable population at scale. Increasing access to services that address co-occurring SI/SB, mental health, and substance use is needed.
Collapse
Affiliation(s)
- Zandra V Ho
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
| | - Sarah A Arias
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
- Department of Psychosocial Research, Butler Hospital, Providence, Rhode Island, USA
| | - Zachary J Kunicki
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
- Department of Psychosocial Research, Butler Hospital, Providence, Rhode Island, USA
| | - Indra Neil Sarkar
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
- Rhode Island Quality Institute, Providence, Rhode Island, USA
| | - Elizabeth S Chen
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, USA
| |
Collapse
|
7
|
Michinaka M, Sai A, Yamauchi T. Impact of COVID-19 on the mental health of men experiencing homelessness: A cross-sectional study in Osaka, Japan. PLoS One 2023; 18:e0292377. [PMID: 37847683 PMCID: PMC10581486 DOI: 10.1371/journal.pone.0292377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 09/19/2023] [Indexed: 10/19/2023] Open
Abstract
The novel coronavirus infectious disease (COVID-19) pandemic has negatively impacted not only our physical health but also mental health, including increasing depressive and anxiety symptoms. In particular, socially and physically vulnerable populations, such as people experiencing homelessness (PEH), may be more likely to have their mental health worsened by the pandemic due to having more difficulty meeting basic human needs. Therefore, this study aims to assess the impact of COVID-19 on mental health of the homeless in Japan by evaluating depressive and anxiety symptoms and identifying the associated factors particularly, sociodemographic variables as age, employment status and the fear and perceived risk of COVID-19 infection. A cross-sectional interview survey among 158 PEH in Osaka Prefecture was conducted from April to May 2022. The survey included sociodemographic questions and history and perceived risk of infection with COVID-19. Depressive symptoms were measured using the nine-item Patient Health Questionnaire (PHQ-9) and anxiety symptoms using the seven-item Generalized Anxiety Disorder Scale (GAD-7), and the fear of COVID-19 using the seven-item Fear of New Coronavirus Scale (FCV-19S). In this study, the prevalence of depression (PHQ-9≥10) was 38.6%, anxiety disorder (GAD≥10) was 19.0%, and high fear of COVID-19 (FCV-19S≥19) was 28.5%. Univariate logistic regression analysis revealed that PEH in younger age groups (18-34 years), and with joblessness, higher perceived infection risk, and higher fear of COVID-19 were more likely to suffer from depression and anxiety (p<0.05). These results indicate that the younger PEHs with worsened economic conditions and therefore, feel threatened by COVID-19 the pandemic are at higher risk of mental health deterioration. More focused research and mental health services need to be provided to this population in the future.
Collapse
Affiliation(s)
- Masahiro Michinaka
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Akira Sai
- Global Station for Indigenous Studies and Cultural Diversity, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Taro Yamauchi
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| |
Collapse
|
8
|
Armoon B, Griffiths MD, Mohammadi R, Ahounbar E. Suicidal Behaviors and Risk Taking Among Homeless Individuals: A Systematic Review and Meta-Analysis. Community Ment Health J 2023; 59:1283-1299. [PMID: 36971972 DOI: 10.1007/s10597-023-01111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
The present systematic review and meta-analysis study aimed to determine sociodemographic characteristics, risky behaviors, mental health disorders, and substance use disorders associated with suicide behaviors including suicidal ideation and suicide attempts among homeless individuals. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched to identify the relevant studies published between January 1, 1995 and November 1, 2022. After initial evaluation of 9,094 papers, a total of 23 studies met the eligibility criteria. Results of the present study showed that chronic physical illnesses, violent behaviors, mood and psychotic disorders, and substance use disorders were significantly associated with both suicidal ideation and suicide attempts, while being older, having a history of physical abuse, and having mood and post-traumatic stress disorders were associated with suicide attempts only. The present study's findings suggest a crucial need for facilitating access to mental healthcare plans and promoting mental healthcare seeking among homeless individuals.
Collapse
Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran.
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Social Determinants of Health Research Center, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| |
Collapse
|
9
|
Mitchell E, Waring T, Ahern E, O'Donovan D, O'Reilly D, Bradley DT. Predictors and consequences of homelessness in whole-population observational studies that used administrative data: a systematic review. BMC Public Health 2023; 23:1610. [PMID: 37612701 PMCID: PMC10463451 DOI: 10.1186/s12889-023-16503-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/10/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Homelessness is a complex societal and public health challenge. Limited information exists about the population-level health and social care-related predictors and consequences of persons with lived experience of homelessness (PEH). Studies that focus on population subgroups or ad hoc questionnaires to gather data are of relatively limited generalisability to whole-population health surveillance and planning. The aim of this study was to find and synthesise information about the risk factors for, and consequences of, experiencing homelessness in whole-population studies that used routine administrative data. METHOD We performed a systematic search using EMBASE, MEDLINE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO research databases for English-language studies published from inception until February 2023 that reported analyses of administrative data about homelessness and health and social care-related predictors and consequences. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS Of the 1224 articles reviewed, 30 publications met the inclusion criteria. The included studies examined a wide range of topic areas, and the homelessness definitions used in each varied considerably. Studies were categorised into several topic areas: Mortality, morbidity and COVID-19; health care usage and hospital re-admission; care home admission and shelter stay; and other (e.g. employment, crime victimisation). The studies reported that that the physical and mental health of people who experience homelessness was worse than that of the general population. Homeless individuals were more likely to have higher risk of hospitalisation, more likely to use emergency departments, have higher mortality rates and were at greater risk of needing intensive care or of dying from COVID-19 compared with general population. Additionally, homeless individuals were more likely to be incarcerated or unemployed. The effects were strongest for those who experienced being homeless as a child compared to those who experienced being homeless later on in life. CONCLUSIONS This is the first systematic review of whole-population observational studies that used administrative data to identify causes and consequences associated with individuals who are experiencing homelessness. While the scientific literature provides evidence on some of the possible risk factors associated with being homeless, research into this research topic has been limited and gaps still remain. There is a need for more standardised best practice approaches to understand better the causes and consequences associated with being homeless.
Collapse
Affiliation(s)
- Eileen Mitchell
- Centre for Public Health, Queen's University Belfast, Belfast, UK.
- Public Health Agency, Belfast, UK.
| | - Tanisha Waring
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Diarmuid O'Donovan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| | - Declan T Bradley
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Public Health Agency, Belfast, UK
| |
Collapse
|
10
|
Cho LL, Jones AA, Gao C, Leonova O, Vila-Rodriguez F, Buchanan T, Lang DJ, MacEwan GW, Procyshyn RM, Panenka WJ, Barr AM, Thornton AE, Gicas KM, Honer WG, Barbic SP. Rasch analysis of the beck depression inventory in a homeless and precariously housed sample. Psychiatry Res 2023; 326:115331. [PMID: 37437487 DOI: 10.1016/j.psychres.2023.115331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
The approach to analysis of and interpretation of findings from the Beck Depression Inventory (BDI), a self-report questionnaire, depends on sample characteristics. To extend work using conventional BDI scoring, the BDI's suitability in assessing symptom severity in a homeless and precariously housed sample was examined using Rasch analysis. Participants (n=478) recruited from an impoverished neighbourhood in Vancouver, Canada, completed the BDI. Rasch analysis using the partial credit model was done, and the structural validity, unidimensionality, and reliability of the BDI were studied. A receiver operating characteristic curve determined a Rasch cut-off score consistent with clinical depression, and Rasch scores were correlated with raw scores. Good fit to the Rasch model was observed after rescoring all items and removing Item 19 (Weight Loss), and unidimensionality and reliability were satisfactory. Item 9 (Suicidal Wishes) represented the most severe symptom. Rasch-based scores detected clinical depression with moderate sensitivity and specificity, and were positively correlated with conventional scores. The BDI in a community-based sample of homeless and precariously housed adults satisfied Rasch model expectations in a 20-item format, and is suitable for assessing symptom severity. Future research on depression in similar samples may reveal more information on using specific symptoms to determine clinical significance.
Collapse
Affiliation(s)
- Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chloe Gao
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna J Lang
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Skye P Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada.
| |
Collapse
|
11
|
Yohannes K, Gezahegn M, Birhanie M, Simachew Y, Moges A, Ayano G, Toitole KK, Mokona H, Abebe L. Suicidality and homelessness: prevalence and associated factors of suicidal behaviour among homeless young adults in Southern Ethiopia. BMC Psychol 2023; 11:121. [PMID: 37072864 PMCID: PMC10111304 DOI: 10.1186/s40359-023-01162-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Research indicates that homelessness is associated with an increased risk of suicide. While street homelessness is a global problem, it is a disproportionately serious concern in low- and middle-income countries such as Ethiopia. Despite their high risk of suicidal thoughts and attempts, there has been limited research on this subject among homeless young people in Ethiopia. Therefore, we assessed the prevalence and factors contributing to suicidal behaviour among homeless young people in the southern region of this country. METHODS We conducted a community-based cross-sectional study from 15 June to 15 August 2020 involving 798 homeless young adults in four southern Ethiopian towns and cities. The Suicide Behaviour Questionnaire-Revised (SBQ-R) was used to assess suicidal behaviour. Data were coded and entered into Epi-Data version 7 and analysed using SPSS version 20. We conducted a multivariable logistic regression analysis to identify factors associated with suicidal behaviour. Variables with a p-value of < 0.05 were considered statistically significant. An adjusted odds ratio with a 95% confidence interval was determined to indicate the association's strength. RESULTS The overall prevalence of suicidal behaviour among young homeless individuals was 38.2% (95% CI: 34.8%, 41.5%). The lifetime prevalence of suicidal ideation, planning and attempt was 10.7% (95% CI: 8.6-12.9%), 5.1% (95% CI: 3.6-6.6%) and 3% (95% CI: 1.9-4.3%), respectively. A longer duration of homelessness (1-2 years) (AOR = 2.244, 95% CI: 1.447-3.481), stressful life events (AOR = 1.655, 95% CI: 1.132-2.418) and the stigma associated with homelessness (AOR = 1.629, 95% CI: 1.149-1.505) were significantly associated with suicidal behaviour. CONCLUSION The results of our study indicate that suicide is a serious public health problem among homeless young people in southern Ethiopia. We have found associations between suicidal behaviour and stressful events, homelessness lasting for one to two years and stigma. Our study suggests that policymakers and programme planners need to develop a strategy for preventing, detecting and managing suicidal behaviour among street-dwelling homeless young adults, a vulnerable and understudied population. A community-based suicide prevention campaign is also essential for street-dwelling homeless young people in Ethiopia.
Collapse
Affiliation(s)
- Kalkidan Yohannes
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia.
- SWEDESD, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Melkamu Gezahegn
- Department of Sociology, Institute of Behavioural science, Dilla University, Dilla, Ethiopia
| | - Mekonnen Birhanie
- School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Yilkal Simachew
- School of Public Health, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Awoke Moges
- Addis Ababa University, Addis Ababa, Ethiopia
| | - Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
- School of Population Health, Curtin University, Perth, WA, Australia
| | | | - Hirbaye Mokona
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
- Department of Psychiatry, College of Medicine and Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lulu Abebe
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| |
Collapse
|
12
|
Dillon EC, Huang Q, Deng S, Li M, de Vera E, Pesa J, Nguyen T, Kiger A, Becker DF, Azar K. Implementing universal suicide screening in a large healthcare system's hospitals: rates of screening, suicide risk, and documentation of subsequent psychiatric care. Transl Behav Med 2023; 13:193-205. [PMID: 36694929 DOI: 10.1093/tbm/ibac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Implementation of suicide risk screening may improve prevention and facilitate mental health treatment. This study analyzed implementation of universal general population screening using the Columbia-Suicide Severity Rating Scale (C-SSRS) within hospitals. The study included adults seen at 23 hospitals from 7/1/2019-12/31/2020. We describe rates of screening, suicide risk, and documented subsequent psychiatric care (i.e., transfer/discharge to psychiatric acute care, or referral/consultation with system-affiliated behavioral health providers). Patients with suicide risk (including those with Major Depressive Disorder [MDD]) were compared to those without using Wilcoxon rank-sum -tests for continuous variables and χ2 tests for categorical variables. Results reported are statistically significant at p < 0.05 level. Among 595,915 patients, 84.5% were screened by C-SSRS with 2.2% of them screening positive (37.6% low risk [i.e., ideation only], and 62.4% moderate or high risk [i.e., with a plan, intent, or suicidal behaviors]). Of individuals with suicide risk, 52.5% had documentation of psychiatric care within 90 days. Individuals with suicide risk (vs. without) were male (48.1% vs 43.0%), Non-Hispanic White (55.0% vs 47.8%), younger (mean age 41.0 [SD: 17.7] vs. 49.8 [SD: 20.4]), housing insecure (12.5% vs 2.6%), with mental health diagnoses (80.3% vs 25.1%), including MDD (41.3% vs 6.7%). Universal screening identified 2.2% of screened adults with suicide risk; 62.4% expressed a plan, intent or suicidal behaviors, and 80.3% had mental health diagnoses. Documented subsequent psychiatric care likely underestimates true rates due to care fragmentation. These findings reinforce the need for screening, and research on whether screening leads to improved care and fewer suicides.
Collapse
Affiliation(s)
- Ellis C Dillon
- Center on Aging, University of Connecticut, Farmington, CT
| | - Qiwen Huang
- Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA
| | - Sien Deng
- Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA
| | - Martina Li
- Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA
| | - Ernell de Vera
- Mental Health & Addiction Care, Sutter Health, Sacramento, CA
| | - Jacqueline Pesa
- Real World Value & Evidence, Janssen Scientific Affairs, Titusville, NJ
| | - Tam Nguyen
- Mental Health & Addiction Care, Sutter Health, Sacramento, CA
| | - Anna Kiger
- Office of the System Chief Nurse Officer, Sutter Health, Sacramento, CA
| | - Daniel F Becker
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA
| | - Kristen Azar
- Institute for Advancing Health Equity, Sutter Health, Walnut Creek, CA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| |
Collapse
|
13
|
Greenwood RM, O’Shaughnessy BR, Manning RM, Vargas Moniz MJ, Sacchetto B, Ornelas J, Almas I, Duarte T, Disperati F, Gaboardi M, Lenzi M, Santinello M, Vieno A, Marques RP, Carmona M, Nave A, Bernad R, Rivero B, Julián M, Bokszczanin A, Zmaczynska-Witek B, Katarzyna S, Rogowska A, Schel S, Peters Y, vanLoenen T, Raben L, Wolf JR, Beijer U, Blid M, Kallmen H, Bispo T, Cruz T, Pereira C, Auquier P, Petit JM, Loubière S, Tinland A. Psychometric properties of the measure of achieved capabilities in homeless services. BMC Public Health 2023; 23:93. [PMID: 36635744 PMCID: PMC9835273 DOI: 10.1186/s12889-022-14755-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/28/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Purposeful participation in personally meaningful life tasks, enjoyment of positive reciprocal relationships, and opportunities to realize one's potential are growth-related aspects of a meaningful life that should be considered important dimensions of recovery from homelessness. The extent to which homeless services support individuals to achieve the capabilities they need to become who they want to be and do what they want to do is, in turn, an important indicator of their effectiveness. In this study, we developed a measure of achieved capabilities (MACHS) for use in homeless services settings, and assessed its construct and concurrent validity. METHODS We analysed data collected from homeless services users at two time points in eight European countries to assess the factor structure and psychometric properties of the new measure. Participants were adults engaged with either Housing First (n = 245) or treatment as usual (n = 320). RESULTS Exploratory and confirmatory factor analyses yielded a four-factor structure of the capabilities measure: community integration, optimism, safety, and self-determination. We obtained evidence for construct validity through observed correlations between achieved capabilities and recovery, working alliance and satisfaction with services. Moreover, we obtained evidence of the measure's concurrent validity from its positive association between HF and personal recovery, which was fully mediated by achieved capabilities. CONCLUSIONS Findings demonstrate that the MACHS is a valid and reliable measure that may be used to assess the extent to which homeless services support their clients to develop capabilities needed for growth-related recovery. Implications for practice and future research directions are discussed.
Collapse
Affiliation(s)
- Ronni Michelle Greenwood
- grid.10049.3c0000 0004 1936 9692Psychology Department, University of Limerick IRELAND, Limerick, Ireland
| | - Branagh R. O’Shaughnessy
- grid.8217.c0000 0004 1936 9705School of Social Work and Social Policy, Trinity College, Dublin, Ireland
| | - Rachel M. Manning
- grid.451052.70000 0004 0581 2008Birmingham Community Healthcare, NHS Foundation Trust, Birmingham, UK
| | - Maria J. Vargas Moniz
- grid.9983.b0000 0001 2181 4263Applied Psychology Research Center, ISPA University Lisboa, Lisbon, Portugal
| | - Beatrice Sacchetto
- grid.9983.b0000 0001 2181 4263Applied Psychology Research Center, ISPA University Lisboa, Lisbon, Portugal
| | - Jose Ornelas
- grid.9983.b0000 0001 2181 4263Applied Psychology Research Center, ISPA University Lisboa, Lisbon, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Peltier B, Raitt JM, Habazi D, Roaten K, Pollio D, North CS. A Longitudinal Study of Suicidality in a Homeless Population Sample. Arch Suicide Res 2023; 27:1-12. [PMID: 34275434 DOI: 10.1080/13811118.2021.1950588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Little research has been conducted on the timing of the onset and course of suicidality relative to the timing of the onset and temporal status of homelessness. Therefore, this longitudinal study investigated suicidal ideation and plans and suicide attempts in a homeless population in relation to housing attainment, psychiatric disorders, and substance use/disorders. METHOD Prospective longitudinal follow-up data were collected from a representative sample of literally homeless adults in St. Louis (N = 255) using the Diagnostic Interview Schedule/Homeless Supplement, the Composite International Diagnostic Interview-Substance Abuse Module, and urine drug screens. Associations among suicidal symptom variables, housing status, psychiatric/substance use disorders, and substance use were examined at baseline and longitudinally. RESULTS Lifetime prevalence of suicidal ideation/plan and suicide attempts in this homeless population were much higher than in the general population. Onset of suicidal symptoms had typically preceded onset of homelessness. Few individuals experienced suicidal ideation/plans or attempted suicide during this study, and even fewer experienced new suicidal symptoms after baseline. Securing stable housing during the study follow-up was associated with lower rates of suicidal ideation/plans. CONCLUSIONS This study's findings contradict assumptions that the high prevalence of suicidal symptoms in homeless populations can be explained by the difficulties and miseries of homelessness. Psychiatric illness, substance abuse, and psychosocial factors associated with homelessness may be direct contributors to suicidal symptoms and thus represent strategic intervention targets.HIGHLIGHTSMost suicidality reported at baseline first emerged long before first homelessnessAfter baseline, few reported new suicidal symptoms or had active suicidal symptomsSignificantly fewer reports of suicidal ideation/plans over time were found in those with the most stable housing outcome.
Collapse
|
15
|
Housing Status as a Predictor for Outpatient Care Following an Emergency or Urgent Care Encounter with a Behavioral Health Diagnosis: A Multivariable Analysis. Community Ment Health J 2022; 59:826-833. [PMID: 36454478 DOI: 10.1007/s10597-022-01063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
Individuals without stable housing experience high rates of mental illness and seek behavioral health care in emergency care settings. Little is known about the effect of homelessness on outpatient follow-up after utilizing emergency or urgent care for behavioral health care. Patient encounters with behavioral health diagnoses among 7 emergency department (ED) or urgent care (UC) locations over 4 years were used to determine the correlation between housing status and outpatient follow-up within 90 days. Of 1,160,386 visits by 269,615 unique patients, 55,738 (23%) encounters included a behavioral health diagnosis. Patients with stable housing were twice as likely to follow up with a primary care provider (PCP) and with an outpatient behavioral health provider than patients without housing (aOR 2.60; aOR 2.00, p < 0.0001). Homelessness is associated with difficulty in accessing follow-up behavioral health care. UCs and EDs may use specific interventions to improve outpatient follow-up.
Collapse
|
16
|
Menezes IRAD, Uchida RR, Tenorio DS, Araújo JEB, Rolim Lima NN, Lopes GCD, Rolim Neto ML. The helplessness and invisibility of the mental health of homeless people in Brazil. LANCET REGIONAL HEALTH. AMERICAS 2022; 15:100368. [PMID: 36778070 PMCID: PMC9903991 DOI: 10.1016/j.lana.2022.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Irwin Rose Alencar de Menezes
- Laboratory of Pharmacology and Molecular Chemistry, Department of Biological Chemistry, Regional University of Cariri-URCA, Crato, Brazil
| | - Ricardo Riyoiti Uchida
- Mental Health Department, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Damiao Soares Tenorio
- State Attorney of Ceará, Researcher and Professor at the University of Fortaleza – UNIFOR, Fortaleza, Ceará, Brazil
| | | | - Nadia Nara Rolim Lima
- Postgraduate Program (Master and Doctorate) in Neuropsychiatry at the Federal University of Pernambuco – UFPE, Recife, Pernambuco, Brazil
| | | | - Modesto Leite Rolim Neto
- Faculty of Medicine, Federal University of Cariri – UFCA, Barbalha, Ceará, Brazil,Corresponding author.
| |
Collapse
|
17
|
Armoon B, Fleury MJ, Bayani A, Mohammadi R, Ahounbar E, Griffiths MD. Suicidal behaviors among intravenous drug users: a meta-analysis. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2120435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, the National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Mark D. Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| |
Collapse
|
18
|
Kippe YD, Adam M, Finck A, Moran JK, Schouler-Ocak M, Bermpohl F, Gutwinski S, Goldschmidt T. Suicidality in psychiatric emergency department situations during the first and the second wave of COVID-19 pandemic. Eur Arch Psychiatry Clin Neurosci 2022; 273:311-323. [PMID: 36071277 PMCID: PMC9451117 DOI: 10.1007/s00406-022-01486-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/29/2022] [Indexed: 11/26/2022]
Abstract
Psychiatric patients are prone to mental health deterioration during the Covid-19 pandemic. Little is known about suicidality in psychiatric patients during the Covid-19 pandemic. This study is a retrospective chart review of psychiatric emergency department (pED) presentations with present or absent suicidality (5634 pED attendances, 4110 patients) in an academic pED in Berlin, Germany. Poisson regression analysis was performed on the effect of Covid-19 period on suicidality (suicidal ideation (SI), suicide plans (SP) or suicide attempt (SA)) during the first (3/2/2020-5/24/2020 "first-wave") and second (9/15/2020-3/1/2021 "second-wave") wave of the Covid-19 pandemic compared to the same periods one year earlier. During the first-wave the number of pED visits per person with SI, SP and SA was higher compared to one year earlier (SI RR = 1.614; p = 0.016; SP RR = 2.900; p = 0.004; SA RR = 9.862; p = 0.003). SI and SP were predicted by interaction between substance use disorder (SUD) and second-wave (SI RR = 1.305, p = 0.043; SP RR = 1.645, p = 0.018), SA was predicted by interaction between borderline personality disorder (BPD) and second-wave (RR = 7.128; p = 0.012). Suicidality increased during the first-wave of Covid-19 pandemic in our sample. In the second-wave this was found in patients with SUD and BPD. These patients may be at particular risk of suicidality during the Covid-19 pandemic.
Collapse
Affiliation(s)
- Yann David Kippe
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Maia Adam
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Anna Finck
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - James Kenneth Moran
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Meryam Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Felix Bermpohl
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Stefan Gutwinski
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Thomas Goldschmidt
- Psychiatrische Universitätsklinik der Charité Im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115, Berlin, Germany.
| |
Collapse
|
19
|
Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
Collapse
Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| |
Collapse
|
20
|
Abstract
Suicide is a major public health concern in the United States. Between 2000 and 2018, US suicide rates increased by 35%, contributing to the stagnation and subsequent decrease in US life expectancy. During 2019, suicide declined modestly, mostly owing to slight reductions in suicides among Whites. Suicide rates, however, continued to increase or remained stable among all other racial/ethnic groups, and little is known about recent suicide trends among other vulnerable groups. This article (a) summarizes US suicide mortality trends over the twentieth and early twenty-first centuries, (b) reviews potential group-level causes of increased suicide risk among subpopulations characterized by markers of vulnerability to suicide, and (c) advocates for combining recent advances in population-based suicide prevention with a socially conscious perspective that captures the social, economic, and political contexts in which suicide risk unfolds over the life course of vulnerable individuals.
Collapse
Affiliation(s)
- Gonzalo Martínez-Alés
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Tammy Jiang
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; ,
| | - Jaimie L Gradus
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts, USA;
- Department of Psychiatry, School of Medicine, Boston University, Boston, Massachusetts, USA;
| |
Collapse
|
21
|
Pain, opioid use, depressive symptoms, and mortality in adults living in precarious housing or homelessness. Pain 2022; 163:2213-2223. [DOI: 10.1097/j.pain.0000000000002619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
|
22
|
Bedmar MA, Bennasar-Veny M, Artigas-Lelong B, Salvà-Mut F, Pou J, Capitán-Moyano L, García-Toro M, Yáñez AM. Health and access to healthcare in homeless people: Protocol for a mixed-methods study. Medicine (Baltimore) 2022; 101:e28816. [PMID: 35363172 PMCID: PMC9282039 DOI: 10.1097/md.0000000000028816] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Homelessness is a more complex problem than the simple lack of a place to live. Homeless people (HP) often suffer from poor health and premature death due to their limited access healthcare, and are also deprived of basic human and social rights. The study protocol described here aims to evaluate the complex relationship between homelessness and health, and identify the barriers and facilitators that impact access to healthcare by HP. METHODS This is a mixed-methods study that uses an explanatory sequential design. The first phase will consist of a cross-sectional study of 300 HP. Specific health questionnaires will be used to obtain information on health status, challenges during the COVID-19 pandemic, self-reported use of healthcare, diagnoses and pharmacologic treatments, substance abuse (DAST-10), diet quality (IASE), depression (PHQ-9), and human basic needs and social support (SSQ-6). The second phase will be a qualitative study of HP using the "life story" technique with purposive sampling. We will determine the effects of different personal, family, and structural factors on the life and health status of participants. The interviews will be structured and defined using Nussbaum's capability approach. DISCUSSION It is well-known that HP experience poor health and premature death, but more information is needed about the influence of the different specific social determinants of these outcomes and about the barriers and facilitators that affect the access of HP to healthcare. The results of this mixed methods study will help to develop global health strategies that improve the health and access to healthcare in HP.
Collapse
Affiliation(s)
- Miguel A. Bedmar
- Research Group on Global Health & Human Development, University of the Balearic Islands, Palma, Spain
| | - Miquel Bennasar-Veny
- Research Group on Global Health & Human Development, University of the Balearic Islands, Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
- Research Group on Global Health & Lifestyle, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Berta Artigas-Lelong
- Research Group on Global Health & Human Development, University of the Balearic Islands, Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
- Research Group on Global Health & Lifestyle, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Francesca Salvà-Mut
- Department of Applied Pedagogy and Education Psychology, Institute for Educational Research and Innovation, University of the Balearic Islands, Palma, Spain
| | - Joan Pou
- Primary Health Care, Balearic Islands Health Services, Palma, Spain
| | - Laura Capitán-Moyano
- Research Group on Global Health & Human Development, University of the Balearic Islands, Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
| | - Mauro García-Toro
- Research Group on Global Health & Lifestyle, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Research Group on Mental Disorders of High Prevalence (TRAMAP), Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Palma, Illes Balears, Spain
| | - Aina M. Yáñez
- Research Group on Global Health & Human Development, University of the Balearic Islands, Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
- Research Group on Global Health & Lifestyle, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Palma, Spain
| |
Collapse
|
23
|
Tang S, Reily NM, Arena AF, Batterham PJ, Calear AL, Carter GL, Mackinnon AJ, Christensen H. People Who Die by Suicide Without Receiving Mental Health Services: A Systematic Review. Front Public Health 2022; 9:736948. [PMID: 35118036 PMCID: PMC8804173 DOI: 10.3389/fpubh.2021.736948] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The majority of people who die by suicide have never seen a mental health professional or been diagnosed with a mental illness. To date, this majority group has largely been ignored, with most existing research focusing on predictors of suicide such as past suicide attempts. Identifying the characteristics of people who die by suicide without receiving services, often with a fatal first attempt, is crucial to reduce suicide rates through guiding improvements to service pathways and “just in time” interventions. Methods In this systematic review, PsycInfo, PubMed, CINAHL, and Web of Science were searched for peer-reviewed articles published from 1980 to 1st March 2021. Included studies examined predictors of non-receipt of formal mental health services among people who died by suicide. Data were extracted from published reports and the quality of included studies was assessed using a modified version of the Joanna Briggs Institute Checklist for Analytical Cross Sectional Studies. This review was registered with PROSPERO, CRD 42021226543. Results Sixty-seven studies met inclusion criteria, with sample sizes ranging from 39 to 193,152 individuals. Male sex, younger or older age, and rural location were consistently associated with non-receipt of mental health services. People not receiving mental health services were also less likely to have a psychiatric diagnosis, past suicidal behavior or contact with general health services, and more likely to use violent means of suicide. There was some evidence that minority ethnicity and psychosocial stressors were associated with service non-receipt. Conclusion People who die by suicide without receiving mental health services are likely to have diverse profiles, indicating the need for multifaceted approaches to effectively support people at risk of suicide. Identifying the needs and preferences of individuals who are at risk of suicide is crucial in developing new support pathways and services, and improving the quality of existing services. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42021226543.
Collapse
Affiliation(s)
- Samantha Tang
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
- *Correspondence: Samantha Tang
| | - Natalie M. Reily
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Andrew F. Arena
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Philip J. Batterham
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Alison L. Calear
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Gregory L. Carter
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | | | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
24
|
Cho LL, Jones AA, Barbic S, Leonova O, Vila-Rodriguez F, Buchanan T, Lang DJ, William MacEwan G, Procyshyn RM, Panenka WJ, Barr AM, Thornton AE, Gicas KM, Honer WG. Psychometric properties and correlates of the Beck Depression Inventory in a community-based and homeless or precariously housed sample. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
25
|
Vitorino LM, Possetti JG, Silva MT, de Souza Santos G, Lucchetti G, Moreira-Almeida A, Guimarães MVC. The role of spirituality and religiosity on suicidal ideation of homeless people in a large Brazilian urban center. J Affect Disord 2021; 295:930-936. [PMID: 34706464 DOI: 10.1016/j.jad.2021.08.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 07/26/2021] [Accepted: 08/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicidal ideation is an important mental health issue among homeless people. Despite the fact that spirituality and religiousness (S/R) have been associated with lower levels of suicide behavior, there is little evidence on this relationship among homeless individuals. Thus, this study aims to investigate the association between S/R and suicidal ideation among homeless people living in a large Brazilian city. METHODS This cross-sectional study included 456 homeless individuals living in Sao Paulo, Brazil. Logistic and linear regression models were used to determine the role of religious and spiritual beliefs (Duke Religion Index, FACIT SP-12 and Brief-RCOPE) on suicidal ideation, after adjustements. RESULTS Most participants were male (75%) with a mean age of 44.53(SD 12.62) years. A total of 49.6% had significant depressive symptoms and the prevalence of suicidal ideation was 29.8%. In the adjusted logistic regression, higher levels of religiousness (organizational, nonorganizational and intrinsic), positive religious/spiritual coping, peace and meaning were associated with a lower suicidal ideation. The same results were found when using linear regression models. LIMITATIONS Long questionnaires can be factors of inhibition and fatigue for the participants. Suicidal ideation was based on a single question. CONCLUSION Our results revealed a high prevalence of suicidal ideation and depression in our sample. Religiousness and spirtuality were important factors in the life of homeless individuals, being negatively associated with suicidal ideation. These results could make healthcare professionals aware of the importance of addressing S/R issues in this vulnerable population.
Collapse
|
26
|
Bai W, Liu ZH, Jiang YY, Zhang QE, Rao WW, Cheung T, Hall BJ, Xiang YT. Worldwide prevalence of suicidal ideation and suicide plan among people with schizophrenia: a meta-analysis and systematic review of epidemiological surveys. Transl Psychiatry 2021; 11:552. [PMID: 34716297 PMCID: PMC8556328 DOI: 10.1038/s41398-021-01671-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 09/19/2021] [Accepted: 09/30/2021] [Indexed: 12/18/2022] Open
Abstract
Schizophrenia is a severe psychiatric disorder with high premature mortality rates. This is a meta-analysis and systematic review of the prevalence of suicidal ideation (SI) and suicide plan (SP) among people with schizophrenia. PubMed, Web of Science, Embase, and PsycINFO were systematically searched from their respective inception to October 10, 2020. Data on prevalence of SI and/or SP were synthesized using the random effects model. Twenty-six studies covering 5079 people with schizophrenia were included for meta-analysis. The lifetime and point prevalence of SI were 34.5% (95% CI: 28.2-40.9%), and 29.9% (95% CI: 24.2-35.6%), respectively. The lifetime prevalence of SP was 44.3% and the point prevalence of SP ranged between 6.4 and 13%. Subgroup and meta-regression analyses revealed that source of patients, survey countries, and sample size were significantly associated with the point prevalence of SI, while male proportion and quality assessment scores were significantly associated with the lifetime and point prevalence of SI. Survey time and mean age were significantly associated with lifetime prevalence of SI. Both SI and SP are common in people living with schizophrenia, especially in males and inpatients. Routine screening and effective interventions for SI and SP should be implemented in this population.
Collapse
Affiliation(s)
- W Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Z H Liu
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Y Y Jiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Q E Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - W W Rao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - T Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - B J Hall
- New York University (Shanghai), Shanghai, China
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Y T Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| |
Collapse
|
27
|
Gutwinski S, Schreiter S, Deutscher K, Fazel S. The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLoS Med 2021; 18:e1003750. [PMID: 34424908 PMCID: PMC8423293 DOI: 10.1371/journal.pmed.1003750] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 08/02/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Homelessness continues to be a pressing public health concern in many countries, and mental disorders in homeless persons contribute to their high rates of morbidity and mortality. Many primary studies have estimated prevalence rates for mental disorders in homeless individuals. We conducted a systematic review and meta-analysis of studies on the prevalence of any mental disorder and major psychiatric diagnoses in clearly defined homeless populations in any high-income country. METHODS AND FINDINGS We systematically searched for observational studies that estimated prevalence rates of mental disorders in samples of homeless individuals, using Medline, Embase, PsycInfo, and Google Scholar. We updated a previous systematic review and meta-analysis conducted in 2007, and searched until 1 April 2021. Studies were included if they sampled exclusively homeless persons, diagnosed mental disorders by standardized criteria using validated methods, provided point or up to 12-month prevalence rates, and were conducted in high-income countries. We identified 39 publications with a total of 8,049 participants. Study quality was assessed using the JBI critical appraisal tool for prevalence studies and a risk of bias tool. Random effects meta-analyses of prevalence rates were conducted, and heterogeneity was assessed by meta-regression analyses. The mean prevalence of any current mental disorder was estimated at 76.2% (95% CI 64.0% to 86.6%). The most common diagnostic categories were alcohol use disorders, at 36.7% (95% CI 27.7% to 46.2%), and drug use disorders, at 21.7% (95% CI 13.1% to 31.7%), followed by schizophrenia spectrum disorders (12.4% [95% CI 9.5% to 15.7%]) and major depression (12.6% [95% CI 8.0% to 18.2%]). We found substantial heterogeneity in prevalence rates between studies, which was partially explained by sampling method, study location, and the sex distribution of participants. Limitations included lack of information on certain subpopulations (e.g., women and immigrants) and unmet healthcare needs. CONCLUSIONS Public health and policy interventions to improve the health of homeless persons should consider the pattern and extent of psychiatric morbidity. Our findings suggest that the burden of psychiatric morbidity in homeless persons is substantial, and should lead to regular reviews of how healthcare services assess, treat, and follow up homeless people. The high burden of substance use disorders and schizophrenia spectrum disorders need particular attention in service development. This systematic review and meta-analysis has been registered with PROSPERO (CRD42018085216). TRIAL REGISTRATION PROSPERO CRD42018085216.
Collapse
Affiliation(s)
- Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Biomedical Innovation Academy, Berlin Institute of Health, Berlin, Germany
| | - Karl Deutscher
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
| |
Collapse
|
28
|
Lifetime prevalence of suicidal attempt among homeless individuals in North America: a meta-analysis. J Affect Disord 2021; 287:341-349. [PMID: 33813254 DOI: 10.1016/j.jad.2021.03.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/10/2021] [Accepted: 03/19/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Homelessness is a compelling public health problem, and homeless individuals are at increased risk for attempting suicide. However, the reported lifetime prevalence of suicidal attempt among homeless individuals in North America varied considerably. Therefore, this meta-analysis aimed to estimate the pooled lifetime prevalence of suicidal attempt among homeless individuals in North America and explore factors that may moderate this estimation. METHODS The protocol was registered in PROSPERO database (CRD42018102593). A systematic literature search was conducted in the electronic databases of PubMed, Embase, Web of Science, PsycINFO, and Google Scholar. Observational studies exploring the lifetime prevalence of suicidal attempt among homeless individuals in North America were included. Heterogeneity across studies was evaluated using the Cochran Q test and quantified using the I2 statistic. Subgroup analyses were performed to identify possible sources of heterogeneity. RESULTS Twenty-two eligible studies with a total of 9,727 homeless individuals were included, of which 2,986 reported having attempted suicide in their lifetime. A high degree of heterogeneity (I2=96.4%, P<0.001) was observed, and the pooled lifetime prevalence was 31.83% (95% confidence interval: 26.87%-36.99%). Subgroup analyses showed that the heterogeneity was quite low when estimating the pooled lifetime prevalence of suicidal attempt among heterosexual (I2=0.0, P=0.401) and non-heterosexual homeless individuals (I2=0.0, P=0.405). LIMITATIONS All eligible studies were exclusively conducted in the US and Canada. CONCLUSIONS Nearly three tenths of homeless individuals in North America have attempted suicide in their lifetime, and the differences in sexual orientation might have contributed to the heterogeneity.
Collapse
|
29
|
Elbogen EB, Lanier M, Blakey SM, Wagner HR, Tsai J. Suicidal ideation and thoughts of self-harm during the COVID-19 pandemic: The role of COVID-19-related stress, social isolation, and financial strain. Depress Anxiety 2021; 38:739-748. [PMID: 33949747 PMCID: PMC8239640 DOI: 10.1002/da.23162] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/17/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There are significant concerns about mental health problems occurring due to the coronavirus disease 2019 (COVID-19) pandemic. To date, there has been limited empirical investigation about thoughts of suicide and self-harm during the COVID-19 pandemic. METHODS A national survey was conducted May 2020 to investigate the association between mental health symptoms, social isolation, and financial stressors during the COVID-19 pandemic and thoughts of suicide and self-harm. A total of 6607 US adults completed an online survey; survey criteria included an age minimum of 22 years old and reported annual gross income of $75,000 or below. Statistical raking procedures were conducted to more precisely weight the sample using US Census data on age, geographic region, sex, race, and ethnicity. RESULTS COVID-19-related stress symptoms, loneliness, and financial strain were associated with thoughts of suicide/self-harm in multivariable logistic regression analyses, as were younger age, being a military veteran, past homelessness, lifetime severe mental illness, current depressive symptoms, alcohol misuse, and having tested positive for COVID-19. Greater social support was inversely related to thoughts of suicide/self-harm whereas running out of money for basic needs (e.g., food), housing instability (e.g., delaying rent), and filing for unemployment or disability were positively related. CONCLUSIONS Public health interventions to decrease risk of suicide and self-harm in the wake of the COVID-19 pandemic should address pandemic-related stress, social isolation, and financial strain experienced including food insecurity, job loss, and risk of eviction/homelessness.
Collapse
Affiliation(s)
- Eric B. Elbogen
- Department of Veterans AffairsNational Center on Homelessness Among VeteransTampaFloridaUSA
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC)Durham VA Health Care SystemDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Megan Lanier
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Shannon M. Blakey
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC)Durham VA Health Care SystemDurhamNorth CarolinaUSA
- Mental and Behavioral Health ServicesDurham VA Health Care SystemDurhamNorth CarolinaUSA
| | - H. Ryan Wagner
- VISN 6 Mental Illness Research, Education, and Clinical Center (MIRECC)Durham VA Health Care SystemDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Jack Tsai
- Department of Veterans AffairsNational Center on Homelessness Among VeteransTampaFloridaUSA
- School of Public HealthUniversity of Texas Health Science Center at HoustonSan AntonioTexasUSA
| |
Collapse
|
30
|
Determinants of suicidal ideation and suicide attempt among former and currently homeless individuals. Soc Psychiatry Psychiatr Epidemiol 2021; 56:747-757. [PMID: 32909051 DOI: 10.1007/s00127-020-01952-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/01/2020] [Indexed: 12/29/2022]
Abstract
PURPOSES This study identified determinants associated with suicidal ideation, suicide attempt and no suicidal behavior in a 12-month period among 455 former or currently homeless individuals in Quebec (Canada). METHODS Study recruitment took place in 27 organizations located in two major Quebec urban areas, where services for homelessness are offered. Independent variables including clinical, socio-demographic, and service use/outcome variables were measured with eight standardized instruments. Significant associations between these variables and suicidal ideation or attempt in bivariate analyses were produced to build a multinomial logistic regression model using a block approach. RESULTS Of 455 participants, 72 (15.8%) reported suicidal ideation and 30 (6.6%) suicide attempt, while 353 (77.6%) had not experienced suicidal behavior. Suicide ideation was particularly high among those with generalized anxiety disorder and substance use disorders, and suicide attempt even higher. Participants with higher functional disability and hospitalizations had a higher incidence of suicide attempt, whereas participants with schizophrenia spectrum and other psychotic disorders, those placed in foster care during childhood and with higher stigma scores experienced more suicidal ideation. CONCLUSIONS Suicidal ideation and suicide attempt among currently or recently homeless individuals were both strongly associated with clinical variables. Based on the study results, specific interventions may be promoted to improve screening of homeless individuals with suicidal behavior and prevent hospitalization such as training programs and brief care management interventions, addiction liaison nurses, improved access to primary or specialized ambulatory services, and further development of case management and outreach programs for homeless individuals, especially those with functional disabilities.
Collapse
|
31
|
Abstract
ABSTRACT COVID-19 hit the world amidst an unprecedented suicide epidemic in this century. As the world focuses on limiting the spread of the virus and prioritizing acutely medically ill patients, containment measures are not without mental health consequences. With rising anxiety and depression, risk of suicide-acutely and in the aftermath of the pandemic-also rises. This article aims to shed light on this major public health problem and better understand what factors may create or exacerbate psychiatric symptoms and suicide. We review suicide data predating the pandemic and examine impact of previous epidemics on suicide rates. We then focus on the current pandemic's impacts and the world's response to COVID-19. We examine how these may lead to increased suicide rates, focusing on the US population. Finally, we offer suggestions on mitigating interventions to curb the impending rise in suicide and the resultant increased burden on an already stretched health care system.
Collapse
Affiliation(s)
| | - Gaelle Rached
- Faculty of Medicine, University of Saint Joseph of Beirut, Beirut, Lebanon
| | - Jeffrey Geller
- Department of Psychiatry, University of Massachusetts Medical School
| |
Collapse
|
32
|
Smartt C, Ketema K, Frissa S, Tekola B, Birhane R, Eshetu T, Selamu M, Prince M, Fekadu A, Hanlon C. Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study. BMC Public Health 2021; 21:568. [PMID: 33752638 PMCID: PMC7986271 DOI: 10.1186/s12889-021-10629-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about the pathways followed into and out of homelessness among people with experience of severe mental illness (SMI) living in rural, low-income country settings. Understanding these pathways is essential for the development of effective interventions to address homelessness and promote recovery. The aim of this study was to explore pathways into and out of homelessness in people with SMI in rural Ethiopia. Methods In-depth interviews were conducted with 15 people with SMI who had experienced homelessness and 11 caregivers. Study participants were identified through their participation in the PRIME project, which implemented a multi-component district level plan to improve access to mental health care in primary care in Sodo district, Ethiopia. People enrolled in PRIME who were diagnosed with SMI (schizophrenia, schizoaffective disorder or bipolar disorder) and who had reported experiencing homelessness at recruitment formed the sampling frame for this qualitative study. We used OpenCode 4.0 and Microsoft Excel for data management. Thematic analysis was conducted using an inductive approach. Results Study participants reported different patterns of homelessness, with some having experienced chronic and others an intermittent course. Periods of homelessness occurred when family resources were overwhelmed or not meeting the needs of the person with SMI. The most important pathways into homelessness were reported to result from family conflict and the worsening of mental ill health, interplaying with substance use in many cases. Participants also mentioned escape and/or wanting a change in environment, financial problems, and discrimination from the community as contributing to them leaving the home. Pathways out of homelessness included contact with (mental and physical) health care as a catalyst to the mobilization of other supports, family and community intervention, and self-initiated return. Conclusions Homelessness in people with SMI in this rural setting reflected complex health and social needs that were not matched by adequate care and support. Our study findings indicate that interventions to prevent and tackle homelessness in this and similar settings ought to focus on increasing family support, and ensuring access to acceptable and suitable housing, mental health care and social support. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10629-8.
Collapse
Affiliation(s)
- Caroline Smartt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | | | - Souci Frissa
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Bethlehem Tekola
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Rahel Birhane
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia
| | - Tigist Eshetu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia
| | - Medhin Selamu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia
| | - Martin Prince
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.,King's College London, King's Global Health Institute, London, UK
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia.,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia.,Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK. .,King's College London, King's Global Health Institute, London, UK. .,Addis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, Addis Ababa, Ethiopia. .,Addis Ababa University, Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa, Ethiopia.
| |
Collapse
|
33
|
Ayano G, Belete A, Duko B, Tsegay L, Dachew BA. Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people. BMJ Open 2021; 11:e040061. [PMID: 33622940 PMCID: PMC7907847 DOI: 10.1136/bmjopen-2020-040061] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the global prevalence estimates of depressive symptoms, dysthymia and major depressive disorders (MDDs) among homeless people. DESIGN Systematic review and meta-analysis. DATA SOURCES Databases including PubMed, Scopus and Web of Science were systematically searched up to February 2020 to identify relevant studies that have reported data on the prevalence of depressive symptoms, dysthymia and MDDs among homeless people. ELIGIBILITY CRITERIA Original epidemiological studies written in English that addressed the prevalence of depressive problems among homeless people. DATA EXTRACTION AND SYNTHESIS A random-effect meta-analysis was performed to pool the prevalence estimated from individual studies. Subgroup and sensitivity analyses were employed to compare the prevalence across the groups as well as to identify the source of heterogeneities. The Joanna Briggs Institute's quality assessment checklist was used to measure the study quality. Cochran's Q and the I2 test were used to assess heterogeneity between the studies. RESULTS Forty publications, including 17 215 participants, were included in the final analysis. This meta-analysis demonstrated considerably higher prevalence rates of depressive symptoms 46.72% (95% CI 37.77% to 55.90%), dysthymia 8.25% (95% CI 4.79% to 11.86%), as well as MDDs 26.24% (95% CI 21.02% to 32.22%) among homeless people. Our subgroup analysis showed that the prevalence of depressive symptoms was high among younger homeless people (<25 years of age), whereas the prevalence of MDD was high among older homeless people (>50 years of age) when compared with adults (25-50 years). CONCLUSION This review showed that nearly half, one-fourth and one-tenth of homeless people are suffering from depressive symptoms, dysthymia and MDDs, respectively, which are notably higher than the reported prevalence rates in the general population. The findings suggest the need for appropriate mental health prevention and treatment strategies for this population group.
Collapse
Affiliation(s)
- Getinet Ayano
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
- Department of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Asmare Belete
- Department of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Duko
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Light Tsegay
- Department of Psychiatry, Aksum University, Aksum, Ethiopia
| | - Berihun Assefa Dachew
- Department of Public Health, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
| |
Collapse
|
34
|
Ayano G, Demelash S, Yohannes Z, Haile K, Tulu M, Assefa D, Tesfaye A, Haile K, Solomon M, Chaka A, Tsegay L. Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia. Ann Gen Psychiatry 2021; 20:10. [PMID: 33531016 PMCID: PMC7856725 DOI: 10.1186/s12991-021-00333-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/18/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There are limited studies on the prevalence of misdiagnosis as well as detection rates of severe psychiatric disorders in specialized and non-specialized healthcare settings. To the best of our knowledge, this is the first study to determine the prevalence of misdiagnosis and detection rates of severe psychiatric disorders including schizophrenia, schizoaffective, bipolar, and depressive disorders in a specialized psychiatric setting. METHOD In this cross-sectional study, a random sample of 309 patients with severe psychiatric disorders was selected by systematic sampling technique. Severe psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV (SCID). The potential determinates of misdiagnosis were explored using univariable and multivariable logistic regression models, adjusting for the potential confounding factors. RESULT This study revealed that more than a third of patients with severe psychiatric disorders were misdiagnosed (39.16%). The commonly misdiagnosed disorder was found to be a schizoaffective disorder (75%) followed by major depressive disorder (54.72%), schizophrenia (23.71%), and bipolar disorder (17.78%). Among the patients detected with the interview by SCID criteria, the highest level of the correct diagnosis was recorded in the medical record for schizophrenia (76.29%) followed by bipolar (72.22%), depressive (42.40%), and schizoaffective (25%) disorders with detection rate (sensitivity) of 0.76 (95% CI 0.69-0.84), 0.42 (95% CI 0.32-0.53), 0.72 (95% CI 0.60-0.84), and 0.25 (95% CI 0.09-0.41), respectively for schizophrenia, depressive, bipolar, and schizoaffective disorders. Patients with bipolar disorder were more likely to be misdiagnosed as having schizophrenia (60%), whereas schizophrenic patients were more likely to be misdiagnosed as having bipolar disorder (56.25%) and patients with depressive disorders were more likely to be misdiagnosed as having schizophrenia (54.72%). Having a diagnosis of schizoaffective and depressive disorders, as well as suicidal ideation, was found to be significant predictors of misdiagnosis. CONCLUSION This study showed that roughly four out of ten patients with severe psychiatric disorders had been misdiagnosed in a specialized psychiatric setting in Ethiopia. The highest rate of misdiagnosis was observed for schizoaffective disorder (3 out of 4), followed by major depressive disorder (1 out of 2), schizophrenia (1 out of 4), and bipolar disorders (1 in 5). The detection rates were highest for schizophrenia, followed by bipolar, depressive, and schizoaffective disorders. Having a diagnosis of schizoaffective and depressive disorders as well as suicidal ideation was found to be significant predictors of misdiagnosis.
Collapse
Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. .,School of Public Health, Curtin University, Perth, WA, Australia.
| | | | - Zegeye Yohannes
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Kibrom Haile
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Mikiyas Tulu
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Dawit Assefa
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Abel Tesfaye
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.,Department of Medicine, Hawassa University, Hawassa, Ethiopia
| | - Kelemua Haile
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Melat Solomon
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Asrat Chaka
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Light Tsegay
- Department of Psychiatry, Axum University, Axum, Ethiopia
| |
Collapse
|
35
|
Necho M, Tsehay M, Zenebe Y. Suicidal ideation, attempt, and its associated factors among HIV/AIDS patients in Africa: a systematic review and meta-analysis study. Int J Ment Health Syst 2021; 15:13. [PMID: 33485362 PMCID: PMC7825170 DOI: 10.1186/s13033-021-00437-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/12/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Suicidal ideation and suicidal attempt are warning signs for and determine the prognosis of completed suicide. These suicidal behaviors are much more pronounced in people living with HIV/AIDS. Despite this, there is a scarcity of aggregate evidence in Africa. This study was therefore aimed to fill this gap. METHODS we extensively searched Psych-info, PubMed, Scopus, and EMBASE to obtain eligible studies. Further screening for a reference list of articles was also done. Meta XL package was used to extract data and the Stata-11 was also employed. Cochran's Q- and the Higgs I2 test were engaged to check heterogeneity. Sensitivity and subgroup analysis were implemented. Egger's test and funnel plots were used in detecting publication bias. RESULTS The pooled prevalence of suicidal ideation was 21.7% (95% CI 16.80, 26.63). The pooled prevalence of suicidal ideation in Ethiopia, Nigeria, Uganda, and South Africa was 22.7%, 25.3%, 9.8%, and 18.05% respectively. The pooled prevalence of suicidal ideation was larger; 27.7% in studies that used Composite International Diagnostic Interview (CIDI) than Mini-international Neuropsychiatric Interview (MINI); 16.96%. Moreover, the prevalence of suicidal ideation in studies with a sample size of < 400 was 23.42% whereas it was 18.3% in studies with a sample size ≥ of 400 participants. The pooled prevalence of suicidal attempts in this study was 11.06% (95% CI 6.21, 15.92). A suicidal attempt was higher in Ethiopia (16.97%) and Nigeria (16.20%) than Uganda (3.51%). This pooled prevalence of suicidal attempt was higher among studies that used a smaller sample (< 400 participants) (15.5%) than studies that used a larger sample size (≥ 400 participants) (8.4%). The pooled prevalence of suicidal attempt was 3.75%, and 16.97% in studies that used MINI and CIDI respectively. Our narrative synthesis revealed that advanced stages of AIDS, co-morbid depression, perceived HIV stigma, and poor social support was among the factors strongly associated with suicidal ideation and attempt. CONCLUSION The pooled magnitude of suicidal ideation and attempt was high and factors like advanced stages of AIDS, co-morbid depression, perceived stigma, and poor social support were related to it. Clinicians should be geared towards this mental health problem of HIV patients during management.
Collapse
Affiliation(s)
- Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Mekonnen Tsehay
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yosef Zenebe
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| |
Collapse
|
36
|
Bommersbach TJ, Stefanovics EA, Rhee TG, Tsai J, Rosenheck RA. Suicide Attempts and Homelessness: Timing of Attempts Among Recently Homeless, Past Homeless, and Never Homeless Adults. Psychiatr Serv 2020; 71:1225-1231. [PMID: 32988323 DOI: 10.1176/appi.ps.202000073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Homelessness is associated with increased risk of suicide attempts. This study examined whether suicide attempts typically precede or occur during episodes of homelessness in a representative national sample. METHODS Data from 36,127 adults in the National Epidemiologic Survey on Alcohol and Related Conditions-III were used to identify 1,992 respondents who reported a lifetime suicide attempt. Bivariate analyses compared attempt histories between adults who reported past-year homelessness, homelessness prior to the past year, and no history of homelessness. Measures included years since most recent attempt and first attempt and proportion attempting suicide in the past year. Multivariable analyses adjusted for potentially confounding effects of age and identified independent factors associated with past-year attempts along with past-year homelessness. RESULTS Among respondents who experienced homelessness in the past year, 21.0% reported a past-year suicide attempt, compared with 5.8% among those experiencing homelessness prior to the past year and 6.3% of those who were never homeless. However, the most recent attempt among those with past-year homelessness occurred 8.4 years previously, on average-3.8 years and 4.5 years more recently than among those experiencing homelessness prior to the past year and those who were never homeless, after age adjustment. Overall, first suicide attempts occurred 19.9 years previously, on average, with no significant group differences after age adjustment. CONCLUSIONS Rates of past-year suicide attempts and past-year homelessness were strongly associated, suggesting that homelessness and suicidality strongly co-occur. However, among adults with recent homelessness and a suicide attempt history, suicidal behavior began decades ago and likely preceded homelessness.
Collapse
Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Bommersbach, Stefanovics, Rhee, Rosenheck); New England Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA), West Haven, Connecticut (Stefanovics, Rosenheck); Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee); School of Public Health, University of Texas Health Science Center at Houston, San Antonio, Texas, and National Center on Homelessness Among Veterans, VA, Tampa, Florida (Tsai)
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Bommersbach, Stefanovics, Rhee, Rosenheck); New England Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA), West Haven, Connecticut (Stefanovics, Rosenheck); Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee); School of Public Health, University of Texas Health Science Center at Houston, San Antonio, Texas, and National Center on Homelessness Among Veterans, VA, Tampa, Florida (Tsai)
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Bommersbach, Stefanovics, Rhee, Rosenheck); New England Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA), West Haven, Connecticut (Stefanovics, Rosenheck); Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee); School of Public Health, University of Texas Health Science Center at Houston, San Antonio, Texas, and National Center on Homelessness Among Veterans, VA, Tampa, Florida (Tsai)
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Bommersbach, Stefanovics, Rhee, Rosenheck); New England Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA), West Haven, Connecticut (Stefanovics, Rosenheck); Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee); School of Public Health, University of Texas Health Science Center at Houston, San Antonio, Texas, and National Center on Homelessness Among Veterans, VA, Tampa, Florida (Tsai)
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (Bommersbach, Stefanovics, Rhee, Rosenheck); New England Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA), West Haven, Connecticut (Stefanovics, Rosenheck); Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington (Rhee); School of Public Health, University of Texas Health Science Center at Houston, San Antonio, Texas, and National Center on Homelessness Among Veterans, VA, Tampa, Florida (Tsai)
| |
Collapse
|
37
|
Montgomery AE, Dichter M, Byrne T, Blosnich J. Intervention to address homelessness and all-cause and suicide mortality among unstably housed US Veterans, 2012-2016. J Epidemiol Community Health 2020; 75:jech-2020-214664. [PMID: 33208386 DOI: 10.1136/jech-2020-214664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/18/2020] [Accepted: 10/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND People without stable housing-and Veterans specifically-are at increased risk of suicide. This study assessed whether unstably housed Veterans' participation in homeless services is associated with reduced risk of all-cause and suicide mortality. METHODS This retrospective cohort study used a sample of 169 221 Veterans across the US who self-reported housing instability between 1 October 2012 and 30 September 2016. Multivariable Cox regression models assessed the association between Veterans' utilisation of homeless services and all-cause and suicide mortality, adjusting for sociodemographics and severity of medical comorbidities. RESULTS More than one-half of unstably housed Veterans accessed homeless services during the observation period; utilisation of any homeless services was associated with a 6% reduction in hazards for all-cause mortality (adjusted HR[aHR]=0.94, 95% CI[CI]=0.90-0.98). An increasing number of homeless services used was associated with significantly reduced hazards of both all-cause (aHR=0.93, 95% CI=0.91-0.95) and suicide mortality (aHR=0.81, 95% CI=0.73-0.89). CONCLUSIONS The use of homeless services among Veterans reporting housing instability was significantly associated with reduced hazards of all-cause and suicide mortality. Addressing suicide prevention and homelessness together-and ensuring 'upstream' interventions-within the context of the VHA healthcare system holds promise for preventing suicide deaths among Veterans. Mental health treatment is critical for suicide prevention, but future research should investigate if social service programmes, by addressing unmet human needs, may also reduce suicide.
Collapse
Affiliation(s)
- Ann Elizabeth Montgomery
- National Center on Homelessness among Veterans, US Department of Veterans Affairs, Birmingham, Alabama, USA
- Health Behavior, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Melissa Dichter
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA
- School of Social Work, Temple University, Philadelphia, Pennsylvania, USA
| | - Thomas Byrne
- School of Social Work, Boston University, Boston, Massachusetts, USA
- Center for Healthcare Organization and Implementation Research, US Department of Veterans Affairs, Bedford, Massachusetts, USA
| | - John Blosnich
- Center for Health Equity Research and Promotion, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| |
Collapse
|
38
|
Elbogen EB, Lanier M, Montgomery AE, Strickland S, Wagner HR, Tsai J. Financial Strain and Suicide Attempts in a Nationally Representative Sample of US Adults. Am J Epidemiol 2020; 189:1266-1274. [PMID: 32696055 DOI: 10.1093/aje/kwaa146] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 02/01/2023] Open
Abstract
Although research has identified many suicide risk factors, the relationship between financial strain and suicide has received less attention. Using data representative of the US adult population (n = 34,653) from wave 1 (2001-2002) and wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions, we investigated the association between financial strain-financial debt/crisis, unemployment, past homelessness, and lower income-and subsequent suicide attempts and suicidal ideation. Multivariable logistic regression controlling for demographic and clinical covariates showed that cumulative financial strain was predictive of suicide attempts between waves 1 and 2 (odds ratio (OR) = 1.53, 95% confidence interval (CI): 1.32, 1.77). Wave 1 financial debt/crisis (OR = 1.58, 95% CI: 1.06, 2.34), unemployment (OR = 1.52, 95% CI: 1.10, 2.10), past homelessness (OR = 1.50, 95% CI: 1.03, 2.17), and lower income (OR = 1.51, 95% CI: 1.01, 2.25) were each associated with subsequent suicide attempts. Respondents endorsing these 4 financial-strain variables had 20 times higher predicted probability of attempting suicide compared with respondents endorsing none of these variables. Analyses yielded similar results examining suicidal ideation. Financial strain accumulated from multiple sources (debt, housing instability, unemployment, and low income) should be considered for optimal assessment, management, and prevention of suicide.
Collapse
|
39
|
Widom CS, Li X. The role of psychiatric symptoms and environmental vulnerability factors in explaining the relationship between child maltreatment and suicidality: A prospective investigation. J Affect Disord 2020; 276:720-731. [PMID: 32871705 PMCID: PMC9375955 DOI: 10.1016/j.jad.2020.06.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 05/06/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Childhood maltreatment has been associated with suicide thoughts and attempts; however, few longitudinal studies have assessed risk of suicidality into adulthood. Fewer have examined potential mediators (psychiatric symptoms and environmental vulnerability factors). METHODS Prospective cohort design. Children with documented cases of maltreatment (N = 495, ages 0-11) were matched with non-maltreated children (N = 395) and followed up into adulthood. Psychiatric symptoms (depression, anxiety, dysthymia, post-traumatic stress,antisocial personality,and substance use) and environmental vulnerability (social isolation, physical disability/illness, and homelessness) were assessed at mean age 29 and suicide thoughts and attempts at 39. Structural equation models tested for mediation, controlling for age, sex, race, and IQ. RESULTS Childhood maltreatment predicted suicide attempts (Beta = 0.44, p<0.001), but not suicide thoughts only.Individuals with only suicide thoughts differed significantly from those with suicide attempts in psychiatric symptoms, physical disability/ illness, and homelessness. There were significant paths from child maltreatment to suicide attempts through psychiatric symptoms (0.18, p<0.001), ASPD (0.13, p<0.001), substance use (0.07, p<0.01), and homelessness (0.10, p<0.05). LIMITATIONS Court cases of child maltreatment may not generalize to middle- or upper- class and non-reported cases.Effect sizes were small but significant. CONCLUSIONS Psychiatric risk factors for suicide are well recognized. These new results provide strong evidence that environmental vulnerability factors, particularly homelessness, are associated with increased risk for suicide attempts and warrant attention.Although many people report suicide thoughts, maltreated children with more psychiatric symptoms and experience homelessness are more likely to attempt suicide and warrant targeted interventions.
Collapse
Affiliation(s)
- Cathy Spatz Widom
- Psychology Department, John Jay College and City University of New York, New York City, NY, United States.
| | | |
Collapse
|
40
|
Kerman N, Lem M, Witte M, Kim C, Rhoades H. A Multilevel Intervention Framework for Supporting People Experiencing Homelessness with Pets. Animals (Basel) 2020; 10:ani10101869. [PMID: 33066290 PMCID: PMC7602009 DOI: 10.3390/ani10101869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
Simple Summary Approximately one in 10 people experiencing homelessness have pets. Despite pets having psychosocial benefits for their owners, pets can also present challenges for people experiencing homelessness related to meeting their basic needs and obtaining housing. This article proposes a framework of policy, public, and service interventions for improving the health and well-being of pet owners experiencing homelessness. At the policy level, the framework proposes an increase of pet-friendly emergency shelters, access to market rental housing and veterinary medicine, and the use of a Housing First approach. At the public level, educational interventions are needed to improve knowledge and reduce stigma about the relationship between homelessness and pet ownership. At the service delivery level, direct service providers can support pet owners experiencing homelessness by recognizing their strengths, connecting them to community services, being aware of the risks associated with pet loss, providing harm reduction strategies, documenting animals as emotional support animals, and engaging in advocacy. By targeting policies and service approaches that exacerbate the hardships faced by pet owners experiencing homelessness, the framework is a set of deliberate actions to better support this vulnerable group. Abstract Approximately one in 10 people experiencing homelessness have pets. Despite the psychosocial benefits derived from pet ownership, systemic and structural barriers can prevent this group from meeting their basic needs and exiting homelessness. A multilevel framework is proposed for improving the health and well-being of pet owners experiencing homelessness. Informed by a One Health approach, the framework identifies interventions at the policy, public, and direct service delivery levels. Policy interventions are proposed to increase the supply of pet-friendly emergency shelters, access to market rental housing and veterinary medicine, and the use of a Housing First approach. At the public level, educational interventions are needed to improve knowledge and reduce stigma about the relationship between homelessness and pet ownership. Direct service providers can support pet owners experiencing homelessness by recognizing their strengths, connecting them to community services, being aware of the risks associated with pet loss, providing harm reduction strategies, documenting animals as emotional support animals, and engaging in advocacy. By targeting policies and service approaches that exacerbate the hardships faced by pet owners experiencing homelessness, the framework is a set of deliberate actions to better support a group that is often overlooked or unaccommodated in efforts to end homelessness.
Collapse
Affiliation(s)
- Nick Kerman
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | - Michelle Lem
- Community Veterinary Outreach, Carp, ON K0A 1L0, Canada; (M.L.); (M.W.)
| | - Mike Witte
- Community Veterinary Outreach, Carp, ON K0A 1L0, Canada; (M.L.); (M.W.)
| | | | - Harmony Rhoades
- USC Suzanne Dworak-Peck School of Social Work, University of South California, Los Angeles, CA 90089, USA;
| |
Collapse
|
41
|
Ayano G, Shumet S, Tesfaw G, Tsegay L. A systematic review and meta-analysis of the prevalence of bipolar disorder among homeless people. BMC Public Health 2020; 20:731. [PMID: 32513264 PMCID: PMC7282102 DOI: 10.1186/s12889-020-08819-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/30/2020] [Indexed: 12/28/2022] Open
Abstract
Background Bipolar disorder (BD) is a common severe mental disorder among homeless people and is associated with an increased risk of disability and mortality from suicide, medical causes (including HIV/AIDS, hepatitis infection, hypertension, and tuberculosis), as well as substance use disorders. However, a systematic synthesis of the existing evidence on the subject is lacking. To fill this gap in the literature, this study aimed to carry out systematic review and meta-analysis to determine the consolidated prevalence of BD among homeless people. Methods In this systematic review and meta-analysis, we searched Embase, PubMed, and Scopus to identify pertinent studies that reported the prevalence of BD among homeless people in March 2019. Random effect meta-analysis was employed to pool data from the eligible studies. Subgroup and sensitivity analysis was conducted and Cochran’s Q- and the I2 test were utilized to quantify heterogeneity. Publication bias was assessed by using Egger’s test and visual inspection of the symmetry in funnel plots. Results Of 3236 studies identified, 10 studies with 4300 homeless individuals were included in the final analysis. Among the 10 studies, five studies used the Diagnostic Statistical Manual of Mental disorders (DSM), three studies used Mini-International Neuropsychiatric Interview (MINI), one study used Schedule for Clinical Assessment of Neuropsychiatry (SCAN), and one study used Composite International Neuropsychiatric Interview (CIDI) to assess BD among homeless individuals. Based on the results of the random effect model, the prevalence of BD among homeless people was 11.4% (95% CI; 7.5–16.9). The prevalence of BD was 10.0% (95% CI; 3.1–27.9) in Europe and it was 13.2% (95% CI; 8.9–19.3) in other countries. Moreover, the prevalence of BD was 11.5% (95% CI; 5.5–22.3) for studies that used DSM to assess BD and it was 11.0% (95% CI; 6.1–19.2) for studies that used other instruments (MINI, SCAN, and CIDI). Conclusion Our meta-analysis demonstrated that BD is highly prevalent among homeless individuals, underlying the importance of early screening and targeted interventions for BD among homeless individuals.
Collapse
Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. .,School of Public Health, Curtin University, Perth, WA, Australia.
| | - Shegaye Shumet
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Tesfaw
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Light Tsegay
- Department of Psychiatric Nursing, College of Health Sciences, Axum University, Axum, Ethiopia
| |
Collapse
|
42
|
Monteith LL, Holliday R, Brown TL, Brenner LA, Mohatt NV. Preventing Suicide in Rural Communities During the COVID-19 Pandemic. J Rural Health 2020; 37:179-184. [PMID: 32282968 PMCID: PMC7262063 DOI: 10.1111/jrh.12448] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lindsey L Monteith
- Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ryan Holliday
- Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Talia L Brown
- Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado
| | - Lisa A Brenner
- Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado.,Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Nathaniel V Mohatt
- Department of Veterans Affairs Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
43
|
Tesfaw G, Kibru B, Ayano G. Prevalence and factors associated with higher levels of perceived stigma among people with schizophrenia Addis Ababa, Ethiopia. Int J Ment Health Syst 2020; 14:19. [PMID: 32190107 PMCID: PMC7071705 DOI: 10.1186/s13033-020-00348-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 02/29/2020] [Indexed: 01/09/2023] Open
Abstract
Background Schizophrenia is a severe and disabling chronic mental disorder and accompanied by different levels of a perceived stigma that affects almost all age groups. This perceived stigma negatively impacts the quality of life, physical, and mental well-being of people with schizophrenia. It is also linked with a poor level of functioning, poor adherence to drugs, and increased dropout rate. However, research into perceived stigma and associated factors among people with schizophrenia in low- and middle-income countries are limited. Therefore, this study aimed to explore the perceived stigma and correlates among people with schizophrenia in Ethiopia. Methods An institution based cross-sectional study was conducted from May to June 2018. A structured, pre-tested, and interviewer-administered questionnaire was used to collect data. The standardized perceived devaluation and discrimination questionnaire was used to assess perceived stigma. The systematic random sampling technique was used to select study participants. Binary logistic regression analysis was used to identify factors associated with perceived stigma. An odds ratio (OR) with a 95% confidence interval (CI) was computed to assess the strength of the association. Results The prevalence of high perceived stigma was found to be 62.6% [95% CI 58.3, 67.4]. In the multivariate logistic regression, female sex [AOR = 2.30, 95% CI 1.42, 3.71], age of onset of schizophrenia [AOR = 1.85, 95% CI 1.19, 2.89], multiple hospitalizations [AOR = 1.7, 95% CI 1.16, 3.27], and duration of illness 1–5 years [AOR = 2, 95% CI 1.01, 3.27], 6–10 years [AOR = 2.48, 95% CI 1.29, 4.74], and ˃10 years [AOR = 2.85, 95% CI 1.40, 5.79] were factors significantly associated with higher perceived stigma. Conclusion In the present study, the prevalence of high perceived stigma among people with schizophrenia was found to be 62.6%. Female sex, age of onset of schizophrenia, multiple hospitalizations, and duration of illness were factors significantly associated with higher perceived stigma. Measures to enhance the awareness of the patients, their families and their social networks about perceived stigma and associated factors, by the leading government and healthcare institutions are warranted.
Collapse
Affiliation(s)
- Getachew Tesfaw
- 1Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Boki Kibru
- Gefersa Mental Health Rehabilitation Centre, Addis Ababa, Ethiopia
| | - Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.,4School of Public Health, Curtin University, Perth, Australia
| |
Collapse
|