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Thurman W, Heitkemper E, Hutson T, Preston A, Hecht J. "The System Tends to Scoop You Up and Spit You Out and They're Done With You": The Intersection of Intellectual/Developmental Disability and Homelessness From the Perspectives of Service Providers. QUALITATIVE HEALTH RESEARCH 2023; 33:1017-1029. [PMID: 37550990 PMCID: PMC10494477 DOI: 10.1177/10497323231186880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
People with intellectual and developmental disabilities (IDD) experience elevated risk for poor health and social outcomes in adulthood and are at risk for experiencing homelessness and housing instability. Although the exact prevalence of IDD among homeless populations is unknown, a small body of literature related to the intersection of IDD and homelessness suggests differential health needs and service use patterns, with a need for targeted health and social services. In this study, we explore the perceptions and experiences of 18 homeless or disability service providers about (a) their clients at the intersection of IDD and homelessness and (b) their role and the services provided at the intersection of IDD and homelessness. Participants struggled to provide appropriate, accessible services for this population, owing to lack of training and awareness of specific needs, fragmented systems, and inadequately funded healthcare and housing support. Our findings also reveal that clients at this intersection have high contact with public systems, which places them at risk for losing their right to self-determination. Recommendations center on systems transformation to facilitate the ability of providers to collaborate and to make data-driven decisions to deliver person-centered care.
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Affiliation(s)
- Whitney Thurman
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | | | - Tara Hutson
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Angela Preston
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Jonathan Hecht
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
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Roberts JA, Mohan A. Housing in Delaware for the Intellectual and Developmental Disabilities Population. Dela J Public Health 2023; 9:30-33. [PMID: 37622146 PMCID: PMC10445611 DOI: 10.32481/djph.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
Individuals with intellectual and developmental disabilities (IDD) encounter numerous barriers in attempting to access housing. Those barriers - financial, physical, and cultural in nature - have been exacerbated by the COVID-19 public health emergency and the related, or co-occurring, shifts that have characterized the housing market in the United States, and Delaware specifically, over these last three years. In this brief introductory research report, we examine the system of housing supports and their availability to individuals with IDD through a subset of those served by the state's Division of Developmental Disabilities Services through interviews with representatives across the housing support system. Our findings fall into four areas of work: scale and scope; housing availability; housing assistance; and housing supports. We find that: the estimated scale of the housing crisis (in terms of homelessness and insecurity) affecting this population is much greater than the general population, but in line with other national estimates for individuals with IDD; there is limited available housing that is accessible to individuals with IDD available in the state; there is limited assistance available for navigating the housing that might be available; and that there are too few options for providing more supports for individuals living, or trying to live, independently. We conclude with a few suggested recommendations that could provide more reliable data and tracking of need and a call for research that connects housing for individuals with IDD into the growing body of research looking at the relationship between access to housing and health.
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Facer BD, Bingham B, Fleisch SB, Walker JN, Ahmad M, Osmundson EC. Radiation Therapy Adherence Among Patients Experiencing Homelessness. Int J Radiat Oncol Biol Phys 2021; 109:1019-1027. [PMID: 33127492 DOI: 10.1016/j.ijrobp.2020.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE Radiation therapy is a valuable, yet time- and resource-intense therapy. Patients experiencing homelessness (PEH) face many barriers related to the timely receipt of radiation therapy. Owing to a paucity of data regarding cancer treatment and homelessness, clinicians have a limited evidence base when recommending therapy to PEH. This study was performed to evaluate adherence to radiation therapy treatment regimens in PEH with cancer. METHODS AND MATERIALS The study cohort was primarily derived from the Vanderbilt University Medical Center Homeless Health Services program. Patients in the Homeless Health Services program with radiation oncology visits were identified by query of the electronic medical record. Manual chart review was performed to gather standard treatment parameters and data describing missed appointments. A comparison group of patients not experiencing homelessness (non-PEH) was generated by aggregating appointment data for all other patients receiving similar treatments at Vanderbilt University Medical Center during multiple, consecutive years. RESULTS In the study, 3408 PEH were identified, of whom 48 underwent radiation oncology consultation. Thirty-two were prescribed at least 1 course of radiation therapy, for a total of 54 unique courses. Out of these courses, 34 (62.9%) were completed as prescribed without delay, 12 (22.2%) were completed with delay(s), and 8 (14.8%) were not fully completed. Although the PEH cohort had significantly higher rates of delayed and undelivered fractions, the proportion of delayed or incomplete courses was not significantly different from the comparison group of non-PEH, particularly for courses with 10 or fewer fractions. Reasons for missed appointments for PEH were variable. CONCLUSIONS This is the first publication describing adherence to radiation therapy in PEH. Our data suggest that PEH are as likely as non-PEH to complete a course of radiation therapy, albeit with more treatment interruptions. When treatment courses of >10 fractions are expected, PEH may benefit from more hypofractionated regimens, provided they have equivalent clinical efficacy to longer regimens. Documenting reasons for missed appointments will be essential to further understanding the needs of PEH. This study serves as a foundation for further analysis regarding homelessness and radiation therapy.
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Affiliation(s)
- Benjin D Facer
- Vanderbilt University School of Medicine, Nashville, Tennessee; University of Texas Rio Grande Valley, Edinburg, Texas.
| | - Brian Bingham
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sheryl B Fleisch
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica N Walker
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mahmoud Ahmad
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Evan C Osmundson
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
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Buitenweg DC, van de Mheen D, van Oers HAM, van Nieuwenhuizen C. Psychometric Properties of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems. Front Psychiatry 2021; 12:789704. [PMID: 35069291 PMCID: PMC8767156 DOI: 10.3389/fpsyt.2021.789704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/29/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Quality of Life (QoL) assessment in people with severe mental health problems may benefit from improved personalization and accessibility. Therefore, an innovative, digital, visual, and personalized QoL assessment app for people with severe mental health problems was recently developed: the QoL-ME. The aim of this study was to evaluate the psychometric quality of the QoL-ME by assessing its reliability, validity, and responsiveness. Methods: To examine the reliability of the QoL-ME, the internal consistency of its subscales was assessed using Cronbach's Alpha. Correlations between the QoL-ME and the MANSA were computed to appraise the construct validity of the QoL-ME. Internal responsiveness was evaluated using the standardized response mean and external responsiveness was investigated using hierarchical regression. Results: Cronbach's Alpha's of the subscales of the QoL-ME ranged between 0.5 and 0.84. In accordance with expectations, the language-based core version of the QoL-ME correlated strongly (r = between 0.55 and 0.76) with the MANSA, whilst the picture-based additional modules of the QoL-ME correlated moderately (r = 0.3) with the MANSA. The standardized response mean was 0.23 and the regression model revealed a coefficient β of -0.01. Conclusions: The QoL-ME has adequate psychometric properties. In comparison with similar pictorial instruments, both the QoL-ME's reliability and validity can be considered as sufficient. The results indicate that the responsiveness of the QoL-ME is insufficient. Additional research is needed to evaluate and potentially modify the instrument to improve its responsiveness.
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Affiliation(s)
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Hans A M van Oers
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Chijs van Nieuwenhuizen
- GGzE Institute for Mental Health Care, Eindhoven, Netherlands.,Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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Buitenweg D, van de Mheen D, Grund JP, van Oers H, van Nieuwenhuizen C. Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems: Qualitative Evaluation. JMIR Ment Health 2020; 7:e19593. [PMID: 33270036 PMCID: PMC7746488 DOI: 10.2196/19593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND QoL-ME is a digital visual personalized quality of life assessment app for people with severe mental health problems. Research reveals that e-mental health apps frequently suffer from low engagement and fall short of expectations regarding their impact on patients' daily lives. Studies often indicate that e-mental health apps ought to respect the needs and preferences of end users to achieve optimal user engagement. OBJECTIVE The aim of this study was to explore the experiences of users regarding the usability and functionality of QoL-ME and whether the app is actionable and beneficial for patients. METHODS End users (n=8) of QoL-ME contributed to semistructured interviews. An interview guide was used to direct the interviews. All interviews were audiorecorded and transcribed verbatim. Transcriptions were analyzed and coded thematically. RESULTS Analysis revealed 3 main themes: (1) benefit, (2) actionability, and (3) characteristics of the QoL-ME. The first theme reveals that the QoL-ME app was beneficial for the majority of respondents, primarily by prompting them to reflect on their quality of life. The current version is not yet actionable; the actionability of the QoL-ME app may be improved by enabling users to view their scores over time and by supplying practical advice for quality of life improvements. Overall, participants had positive experiences with the usability, design, and content of the app. CONCLUSIONS The QoL-ME app can be beneficial to users as it provides them with insight into their quality of life and elicits reflection. Incorporating more functionalities that facilitate self-management, such as advice and strategies for improving areas that are lacking, will likely make the app actionable. Patients positively regarded the usability, design, and contents of the QoL-ME app.
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Affiliation(s)
- David Buitenweg
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Geestelijke Gezondheids Zorg Eindhoven Institute for Mental Health Care, Eindhoven, Netherlands
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Hans van Oers
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Chijs van Nieuwenhuizen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,Geestelijke Gezondheids Zorg Eindhoven Institute for Mental Health Care, Eindhoven, Netherlands
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6
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Brown M, McCann E. Homelessness and people with intellectual disabilities: A systematic review of the international research evidence. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:390-401. [PMID: 32959955 DOI: 10.1111/jar.12815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND People with intellectual disabilities can experience homelessness, and some of the reasons differ from the general homeless population. Specific policy and practice responses are required. METHOD A systematic review of studies examining homelessness among people with intellectual disabilities utilizing CINAHL, MEDLINE, PsycINFO and Sociological Abstracts databases from inception to November 2019. RESULTS The search produced 259 papers, and following screening, a total of 13 papers were included in the review. The themes identified were (i) pathways into homelessness, (ii) experiencing homelessness and (iii) routes out of homelessness. CONCLUSIONS People with ID become homeless due to multifactorial issues. The identification of people within homeless services and their care and support concerns remains challenging, impacting upon the provision of assessments, interventions, care and supports. Psychosocial assessments, interventions and supports are necessary to assist people with ID to leave homelessness.
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Affiliation(s)
- Michael Brown
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Edward McCann
- School of Nursing and Midwifery, University of Dublin, Trinity College, Dublin, Ireland
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Reid N, Kron A, Lamanna D, Wen S, Durbin A, Rajakulendran T, Lunsky Y, Roy S, DuBois D, Stergiopoulos V. Building Bridges to Housing for homeless adults with intellectual and developmental disabilities: outcomes of a cross-sector intervention. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:16-27. [PMID: 32715590 DOI: 10.1111/jar.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 06/08/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adults with intellectual and developmental disabilities (IDD) have high rates of homelessness. This observational study evaluates Bridges to Housing, a cross-sector intervention offering immediate access to housing and supports to this population in Toronto, Canada. METHODS Twenty-six participants, enrolled between April 2016 and December 2017, were assessed at baseline, six and 12 months post-enrolment. Descriptive statistics and generalized linear modelling evaluated quality of life (QOL) and service needs outcomes. Twenty-one service users and providers participated in semi-structured interviews between August 2017 and June 2018 to elicit their experiences of the intervention, which were analysed thematically. RESULTS Twelve months post-enrolment, 24 participants were successfully housed and reported increased QOL scores (F(2,43) = 13.73, p = <.001) and decreased perceived unmet service needs (Wald χ2 (2) = 12.93, p = .002). Individual-, intervention- and system-level characteristics facilitated housing stability in this population. CONCLUSIONS Cross-sector approaches can improve outcomes for homeless adults with IDD and may have an important role in supporting this marginalized population.
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Affiliation(s)
- Nadine Reid
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Amie Kron
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Denise Lamanna
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sophia Wen
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Durbin
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sylvain Roy
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Inner City Family Health Team, Toronto, Ontario, Canada.,York University, Toronto, Ontario, Canada
| | - Denise DuBois
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Providence Care Hospital, Kingston, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Lamanna D, Lunsky Y, Wen S, Dubois D, Stergiopoulos V. Supporting Efforts by Intellectually Disabled Adults to Exit Homelessness: Key Ingredients of a Cross-Sector Partnership. Psychiatr Serv 2020; 71:96-99. [PMID: 31615367 DOI: 10.1176/appi.ps.201800590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This column describes the development of a partnership between health care, housing, and intellectual disability services to support efforts by homeless adults with intellectual disabilities to exit homelessness. Applying a Housing First approach and philosophy, the partners launched a pilot intervention, which at its first phase engaged 26 homeless adults with intellectual disabilities in Toronto. This cross-sector service model was acceptable to service users, who reported positive experiences and good program engagement. Key enablers of success included the program's capacity to address complexity, stakeholders' approach to choice and compromise, and fulsome collaboration and communication at every level.
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Affiliation(s)
- Denise Lamanna
- Centre for Addiction and Mental Health, Toronto (Lamanna, Stergiopoulos); Azrieli Centre for Adult Neurodevelopmental Disabilities and Mental Health at the Centre for Addiction and Mental Health, Toronto (Lunsky); Department of Psychiatry (Lunsky, Stergiopoulos) and Rehabilitation Sciences Institute (Dubois), Faculty of Medicine (Wen), University of Toronto, Toronto; Dual Diagnosis Consultative Outreach Team, Providence Care Hospital, Kingston, Ontario, Canada (Dubois); Centre for Urban Health Solutions, St. Michael's Hospital, Toronto (Stergiopoulos). Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
| | - Yona Lunsky
- Centre for Addiction and Mental Health, Toronto (Lamanna, Stergiopoulos); Azrieli Centre for Adult Neurodevelopmental Disabilities and Mental Health at the Centre for Addiction and Mental Health, Toronto (Lunsky); Department of Psychiatry (Lunsky, Stergiopoulos) and Rehabilitation Sciences Institute (Dubois), Faculty of Medicine (Wen), University of Toronto, Toronto; Dual Diagnosis Consultative Outreach Team, Providence Care Hospital, Kingston, Ontario, Canada (Dubois); Centre for Urban Health Solutions, St. Michael's Hospital, Toronto (Stergiopoulos). Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
| | - Sophia Wen
- Centre for Addiction and Mental Health, Toronto (Lamanna, Stergiopoulos); Azrieli Centre for Adult Neurodevelopmental Disabilities and Mental Health at the Centre for Addiction and Mental Health, Toronto (Lunsky); Department of Psychiatry (Lunsky, Stergiopoulos) and Rehabilitation Sciences Institute (Dubois), Faculty of Medicine (Wen), University of Toronto, Toronto; Dual Diagnosis Consultative Outreach Team, Providence Care Hospital, Kingston, Ontario, Canada (Dubois); Centre for Urban Health Solutions, St. Michael's Hospital, Toronto (Stergiopoulos). Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
| | - Denise Dubois
- Centre for Addiction and Mental Health, Toronto (Lamanna, Stergiopoulos); Azrieli Centre for Adult Neurodevelopmental Disabilities and Mental Health at the Centre for Addiction and Mental Health, Toronto (Lunsky); Department of Psychiatry (Lunsky, Stergiopoulos) and Rehabilitation Sciences Institute (Dubois), Faculty of Medicine (Wen), University of Toronto, Toronto; Dual Diagnosis Consultative Outreach Team, Providence Care Hospital, Kingston, Ontario, Canada (Dubois); Centre for Urban Health Solutions, St. Michael's Hospital, Toronto (Stergiopoulos). Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto (Lamanna, Stergiopoulos); Azrieli Centre for Adult Neurodevelopmental Disabilities and Mental Health at the Centre for Addiction and Mental Health, Toronto (Lunsky); Department of Psychiatry (Lunsky, Stergiopoulos) and Rehabilitation Sciences Institute (Dubois), Faculty of Medicine (Wen), University of Toronto, Toronto; Dual Diagnosis Consultative Outreach Team, Providence Care Hospital, Kingston, Ontario, Canada (Dubois); Centre for Urban Health Solutions, St. Michael's Hospital, Toronto (Stergiopoulos). Debra A. Pinals, M.D., and Marcia Valenstein, M.D., M.S., are editors of this column
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McKenzie K, Murray G, Wilson H, Delahunty L. Homelessness-'It will crumble men': The views of staff and service users about facilitating the identification and support of people with an intellectual disability in homeless services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e514-e521. [PMID: 30983058 DOI: 10.1111/hsc.12750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/26/2019] [Accepted: 03/13/2019] [Indexed: 06/09/2023]
Abstract
People with an intellectual disability (ID) face significant health inequalities and barriers to accessing appropriate support, which are made worse if the person is also homeless. An important barrier is that services may not recognise that the person has ID. This qualitative study explored the views of staff members and service users about the identification and support needs of homeless people with ID and the role of an ID screening questionnaire as a way to help improve service provision. Semi-structured interviews were conducted with 16 staff members and 8 service users from homeless services in the South East of Scotland between March 2017 and 2018. Thematic analysis identified four themes: 'not diagnosed or declared', which explored the barriers to support due to the person's ID not being identified by others or disclosed by the person; 'It will crumble men', which reported on the additional challenges faced by homeless people with ID; 'disabling environment' which identified the ways in which organisations can make support difficult for people with ID to access; and 'It's not against them, it's to help them' which explored the benefits and issues associated with screening for ID in homeless services. The results identified the complex support needs likely to be experienced by many homeless people with ID and suggested a number of implications for practice. First, the screening tool was seen as having a number of benefits, if used where there is a process to provide the person with further specialist assessment and support. Second, staff members identified a need for training in relation to identifying and supporting this group of people. Third, the screening tool was seen as a way to help provide information about the prevalence and needs of people with ID, in order to inform and shape policy, service development, and delivery.
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Affiliation(s)
- Karen McKenzie
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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Stone B, Dowling S, Cameron A. Cognitive impairment and homelessness: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e125-e142. [PMID: 30421478 PMCID: PMC6849546 DOI: 10.1111/hsc.12682] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/20/2018] [Accepted: 10/12/2018] [Indexed: 06/09/2023]
Abstract
This paper reports the findings of a scoping review designed to identify research which has explored the relationship between cognitive impairment and homelessness. A systematic search of databases for articles published between 2007 and 2017 was conducted using keywords relating to cognitive impairments and homelessness. Sources were expanded using manual searches of citations and grey literature. Forty studies represented in 45 papers were selected for review using predefined inclusion criteria. Sources were subject to quality appraisal and data were extracted in line with review questions. Prevalence studies were over-represented in the review, while qualitative data were lacking. Aetiology of impairments was delineated by acquired and developmental causes. A variety of measures were employed by studies which were not validated in homeless populations. Studies did not give sufficient consideration to co-occurring disorders and overlapping symptoms between aetiologies. Because of these factors, it was difficult to conclude that all studies had accurately measured what they set out to; however, the evidence suggested that cognitive impairment was disproportionately over-represented in homeless populations. Cognitive impairment was found to be both a risk factor to and perpetuator of homelessness. Risk factors for homelessness were similar to those of the general population, though exaggerated by sequelae of certain cognitive impairments. The results of this review suggest that more attention needs to be paid to the underlying socioeconomic disadvantages, persons with cognitive impairments face which may lead to homelessness. Further research should prioritise the voice of homeless persons with cognitive impairments, to better understand both causes of homelessness and effective methods of rehabilitation.
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Buitenweg DC, Bongers IL, van de Mheen D, van Oers HA, van Nieuwenhuizen C. Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems. JMIR Ment Health 2019; 6:e12378. [PMID: 30920381 PMCID: PMC6458539 DOI: 10.2196/12378] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language-based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. OBJECTIVE This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. METHODS This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants' previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. RESULTS In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability. CONCLUSIONS The cocreative development of the QoL-ME resulted in an app that corresponds to the preferences of participants and has strong usability. Further research is needed to evaluate the psychometric quality of the QoL-ME and to investigate its usefulness in practice.
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Affiliation(s)
- David C Buitenweg
- Scientific Center for Care and Wellbeing (Tranzo), Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,GGzE Institute for Mental Health Care, Eindhoven, Netherlands
| | - Ilja L Bongers
- Scientific Center for Care and Wellbeing (Tranzo), Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,GGzE Institute for Mental Health Care, Eindhoven, Netherlands
| | - Dike van de Mheen
- Scientific Center for Care and Wellbeing (Tranzo), Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,IVO Addiction Research Institute, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Hans Am van Oers
- Scientific Center for Care and Wellbeing (Tranzo), Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Chijs van Nieuwenhuizen
- Scientific Center for Care and Wellbeing (Tranzo), Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands.,GGzE Institute for Mental Health Care, Eindhoven, Netherlands
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12
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Buitenweg DC, Bongers IL, van de Mheen D, van Oers HAM, Van Nieuwenhuizen C. Worth a thousand words? Visual concept mapping of the quality of life of people with severe mental health problems. Int J Methods Psychiatr Res 2018; 27:e1721. [PMID: 29797745 PMCID: PMC6175345 DOI: 10.1002/mpr.1721] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/22/2018] [Accepted: 04/09/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Conventional approaches to quality of life (QoL) measurement rely heavily on verbal, language-based communication. They require respondents to have significant cognitive and verbal ability, making them potentially unsuitable for people with severe mental health problems. To facilitate an alternative approach to QoL assessment, the current study aims to develop an alternative, visual representation of QoL for people with severe mental health problems. METHODS An alternative, visual adaptation of the concept mapping method was used to construct this visual representation of QoL. Eighty-two participants (i.e., patients, care professionals, and family members) contributed to this study. Results were processed statistically to construct the concept map. RESULTS The concept map contains 160 unique visual statements, grouped into 8 clusters labelled (1) Support and Attention, (2) Social Contacts, (3) Happiness and Love, (4) Relaxation and Harmony, (5) Leisure, (6) Lifestyle, (7) Finances, and (8) Health and Living. Examples of visual statements are pictures of family silhouettes, romantic couples, natural scenes, houses, sports activities, wallets and coins, smiley faces, and heart shapes. The clusters were interpreted and labelled by participants. CONCLUSIONS Almost all of the statements correspond to clusters found in previous (non-visual) QoL research. Hence, QoL domains can also be presented visually.
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Affiliation(s)
- David C Buitenweg
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,Centre for Child and Adolescent Psychiatry, GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
| | - Ilja L Bongers
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,Centre for Child and Adolescent Psychiatry, GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
| | - Dike van de Mheen
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,IVO Addiction Research Institute, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Hans A M van Oers
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Chijs Van Nieuwenhuizen
- Tranzo Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands.,Centre for Child and Adolescent Psychiatry, GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
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13
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Durbin A, Isaacs B, Mauer-Vakil D, Connelly J, Steer L, Roy S, Stergiopoulos V. Intellectual Disability and Homelessness: a Synthesis of the Literature and Discussion of How Supportive Housing Can Support Wellness for People with Intellectual Disability. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0141-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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van der Laan J, van Straaten B, Boersma SN, Rodenburg G, van de Mheen D, Wolf JRLM. Predicting homeless people's perceived health after entering the social relief system in The Netherlands. Int J Public Health 2017; 63:203-211. [PMID: 28821908 PMCID: PMC5829105 DOI: 10.1007/s00038-017-1026-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/15/2017] [Accepted: 07/29/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives We explored whether changes in the perceived health of homeless people after entering the social relief system (SRS) in The Netherlands were predicted by housing, income, hours of work, social support, unmet care needs, arrests, physical and mental health, substance use, and experiences of autonomy, competence and relatedness, in addition to perceived health at baseline, demographics, suspected intellectual disability, the duration of homelessness and the company of children in the shelter facility. Methods A hierarchical regression analysis was used to explore the significant predictors of the perceived health of 344 homeless persons 18 months after entering the social relief system. Results A decrease in psychological distress and an increase in hours of (paid/voluntary) work as well as competence predicted a better perceived health. Conclusions Perceived health is not only influenced by objective circumstances related to work and mental health, but also self-determination, as shown by the influence of competence. Services should aim to reduce psychological distress of homeless people, support them in increasing their working hours and focus on strengthening their competence.
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Affiliation(s)
- Jorien van der Laan
- Department of Primary and Community Care, Radboud University Medical Center, Impuls - Netherlands Center for Social Care Research, Nijmegen, The Netherlands.,Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Barbara van Straaten
- Erasmus Medical Centre, Rotterdam, The Netherlands.,IVO Addiction Research Institute, Rotterdam, The Netherlands
| | - Sandra N Boersma
- Department of Primary and Community Care, Radboud University Medical Center, Impuls - Netherlands Center for Social Care Research, Nijmegen, The Netherlands
| | - Gerda Rodenburg
- Erasmus Medical Centre, Rotterdam, The Netherlands.,IVO Addiction Research Institute, Rotterdam, The Netherlands
| | - Dike van de Mheen
- Erasmus Medical Centre, Rotterdam, The Netherlands.,IVO Addiction Research Institute, Rotterdam, The Netherlands.,Tilburg University, Scientific Centre for Care and Welfare (Tranzo), Tilburg, The Netherlands
| | - Judith R L M Wolf
- Department of Primary and Community Care, Radboud University Medical Center, Impuls - Netherlands Center for Social Care Research, Nijmegen, The Netherlands.
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15
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Levine KA, Proulx J, Schwartz K. Disconnected lives: Women with intellectual disabilities in conflict with the law. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 31:249-258. [PMID: 28718998 DOI: 10.1111/jar.12387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women with intellectual/developmental disabilities in conflict with the law experience childhood trauma, substance abuse and intimate partner violence but continue to have difficulty accessing appropriate therapeutic services, both within correctional settings and upon discharge. The aim of this study is to explore women's service needs and to critically assess whether the available services are meeting their identified needs. METHOD Semi-structured interviews were conducted with 16 women with intellectual/developmental disabilities who were in the Special Needs Unit of a women's correctional centre from December 2014 to March 2015. RESULTS Women with intellectual/developmental disabilities struggle to manage the impact of intergenerational trauma, exacerbated by issues of substance abuse and addiction, poor coping skills and minimal education, all of which impact their sense of well-being. CONCLUSIONS This study highlights the need for increasing trauma treatment for women with intellectual/developmental disabilities, and emphasizes the need for accessible intervention to facilitate coping, trauma processing and community integration.
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16
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Nishio A, Horita R, Sado T, Mizutani S, Watanabe T, Uehara R, Yamamoto M. Causes of homelessness prevalence: Relationship between homelessness and disability. Psychiatry Clin Neurosci 2017; 71:180-188. [PMID: 27778418 DOI: 10.1111/pcn.12469] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/14/2016] [Accepted: 10/18/2016] [Indexed: 11/28/2022]
Abstract
AIM Many studies have reported that the prevalence of mental illness and cognitive disability is higher among homeless individuals compared to the general population, and the rates of mental illness among the homeless population have recently increased. This study: (i) compares causes of homelessness or barriers to escaping homelessness for people with/without mental illness/cognitive disability; (ii) reveals problems with the Japanese homeless policy; and (iii) proposes an effective and necessary support system. METHODS The participants were 114 homeless individuals. A psychiatric diagnostic interview and the Wechsler Adult Intelligence Scale, version III were used to measure participants' mental health and cognitive abilities. A questionnaire was administered comprising 17 items related to the causes of their homelessness and barriers to escaping from it. Participants were divided into four groups - with/without mental illness or cognitive disability - and Fisher's exact test was used to compare the questionnaire results. RESULTS Individuals with cognitive disabilities considered bad relationships with their family members to be the cause of their homelessness. Conversely, normal individuals considered their homelessness to be the result of debt more so than did individuals with mental problems. Individuals with mental illness had more difficulties escaping homelessness than did either normal individuals or individuals with cognitive disability. This tendency was observed most strongly among individuals with both mental illness and cognitive disability. CONCLUSION Most homeless individuals considered economic problems to be the cause of their homelessness; however, difficulties with human relationships were also important factors and were more difficult for participants to acknowledge. Furthermore, these difficulties were exacerbated among those individuals with mental problems.
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Affiliation(s)
- Akihiro Nishio
- Health Administration Center, Gifu, Japan.,Division of Neuroscience, Department of Psychopathology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Ryo Horita
- Health Administration Center, Gifu, Japan
| | - Tadahiro Sado
- Health Administration Center, Gifu, Japan.,Faculty of Health Promotional Sciences, Tokoha University, Hamamatsu, Japan
| | - Seiko Mizutani
- Faculty of Nursing, Nihon Fukushi University, Tokai, Japan
| | | | | | - Mayumi Yamamoto
- Health Administration Center, Gifu, Japan.,United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan
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Nishio A, Yamamoto M, Horita R, Sado T, Ueki H, Watanabe T, Uehara R, Shioiri T. Prevalence of Mental Illness, Cognitive Disability, and Their Overlap among the Homeless in Nagoya, Japan. PLoS One 2015; 10:e0138052. [PMID: 26378447 PMCID: PMC4574782 DOI: 10.1371/journal.pone.0138052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/24/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While the prevalence of mental illness or cognitive disability is higher among homeless people than the general population in Western countries, few studies have investigated its prevalence in Japan or other Asian countries. The present study conducted a survey to comprehensively assess prevalence of mental illness, cognitive disability, and their overlap among homeless individuals living in Nagoya, Japan. METHODS Participants were 114 homeless individuals. Mental illness was diagnosed based on semi-structured interviews conducted by psychiatrists. The Wechsler Adult Intelligence Scale-III (WAIS-III, simplified version) was used to diagnose intellectual/ cognitive disability. RESULTS Among all participants, 42.1% (95% CI 33.4-51.3%) were diagnosed with a mental illness: 4.4% (95% CI 1.9-9.9%) with schizophrenia or other psychotic disorder, 17.5% (95% CI 11.6-25.6%) with a mood disorder, 2.6% (95% CI 0.9-7.5%) with an anxiety disorder, 14.0% (95% CI 8.8-21.6%) with a substance-related disorder, and 3.5% (95% CI 1.4-8.8%) with a personality disorder. Additionally, 34.2% (95% CI 26.1-43.3%) demonstrated cognitive disability: 20.2% (95% CI 13.8-28.5%) had mild and 14.0% (95% CI 8.8-21.6%) had moderate or severe disability. The percent overlap between mental illness and cognitive disability was 15.8% (95% CI 10.2-23.6%). Only 39.5% (95% CI 26.1-43.3%) of the participants were considered to have no psychological or cognitive dysfunction. Participants were divided into four groups based on the presence or absence of mental illness and/or cognitive disability. Only individuals with a cognitive disability reported a significant tendency toward not wanting to leave their homeless life. CONCLUSION This is the first report showing that the prevalence of mental illness and/or cognitive disability among homeless individuals is much higher than in the general Japanese population. Appropriate support strategies should be devised and executed based on the specificities of an individual's psychological and cognitive condition.
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Affiliation(s)
- Akihiro Nishio
- Health Administration Center, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
| | - Mayumi Yamamoto
- Health Administration Center, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
- United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
| | - Ryo Horita
- Health Administration Center, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
| | - Tadahiro Sado
- Health Administration Center, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
- Faculty of Health Promotional Sciences, Tokoha University, 1230 Kitaku, Miyakoda, Hamamatsu, 431–2102, Japan
| | - Hirofumi Ueki
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
| | | | - Ryosuke Uehara
- Yoshida Hospital, 1-7-1 Saidaiji Akoda, Nara, 631–0818, Japan
| | - Toshiki Shioiri
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, 1–1 Yanagido, Gifu, 501–1193, Japan
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Nishio A, Yamamoto M, Ueki H, Watanabe T, Matsuura K, Tamura O, Uehara R, Shioiri T. Prevalence of mental illness, intellectual disability, and developmental disability among homeless people in Nagoya, Japan: A case series study. Psychiatry Clin Neurosci 2015; 69:534-42. [PMID: 25523066 DOI: 10.1111/pcn.12265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 11/06/2014] [Accepted: 12/11/2014] [Indexed: 11/30/2022]
Abstract
AIM While it has been reported that the prevalence of mental illness is higher in homeless people than in the national population, few studies have investigated the prevalence of intellectual and developmental disability among the homeless. In this study, we conducted a survey to comprehensively assess these mental problems among homeless people in Nagoya, Japan. METHODS The subjects were 18 homeless men. Mental illness was diagnosed with semi-structured interviews conducted by psychiatrists. We used the Wechsler Adult Intelligence Scale III to diagnose intellectual disability. Discrepancies between Wechsler Adult Intelligence Scale III subtest scores were used as criteria for developmental disability. RESULTS Eleven of the 18 participants were diagnosed with mental illness: six with mood disorder, two with psychotic disorder, and six with alcohol problems. The mean IQ of all subjects was 83.4 ± 27.4. The 95% confidence interval (CI) was 96.2-69.1. Seven participants were found to have intellectual disability. Three men showed discrepancies of more than 10 between subtest scores, and all of them were diagnosed with a mental illness. We divided the participants into four groups: those with mental illness only; those with intellectual disability only; those with both problems; and those without diagnosis. The men with intellectual disability only were significantly younger and had been homeless since a younger age than the other groups. Participants diagnosed with a mental illness had been homeless for longer than those without mental health problems. CONCLUSION Although the sample size was limited, this study revealed the high prevalence of mental illness and intellectual disability, 61% (95%CI, 35-83%) and 39% (95%CI, 17-64%), respectively, in homeless people in Nagoya, Japan.
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Affiliation(s)
- Akihiro Nishio
- Health Administration Center, Gifu University, Gifu, Japan.,Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Mayumi Yamamoto
- Health Administration Center, Gifu University, Gifu, Japan.,United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan
| | - Hirofumi Ueki
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, Gifu, Japan
| | | | | | | | | | - Toshiki Shioiri
- Department of Psychopathology, Division of Neuroscience, Graduate School of Medicine, Gifu University, Gifu, Japan
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Intellectual disability among Dutch homeless people: prevalence and related psychosocial problems. PLoS One 2014; 9:e86112. [PMID: 24465905 PMCID: PMC3897643 DOI: 10.1371/journal.pone.0086112] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 12/04/2013] [Indexed: 11/19/2022] Open
Abstract
Background There is a higher prevalence of intellectual disability (ID) among homeless people than in the general population. However, little is known about the additional psychosocial problems faced by homeless people with ID. We describe the prevalence of ID in a cohort of homeless people in the Netherlands, and report relationships between ID and psychosocial problems in terms of psychological distress, substance (mis)use and dependence, as well as demographic characteristics in this cohort. Methods This cross-sectional study is part of a cohort study among homeless people in the four major cities of the Netherlands. Data were derived from 387 homeless people who were interviewed and screened for ID six months after the baseline measurement. Multivariate logistic regression analyses and χ2 tests were performed to analyze relationships between ID, psychosocial problems and demographic characteristics. Findings Of all cohort members, 29.5% had a suspected ID. Participants with a suspected ID had a higher mean age, were more likely to be male and to fall in the lowest category of education than participants without a suspected ID. Having a suspected ID was related to general psychological distress (OR = 1.56, p<0.05), somatization (OR = 1.84, p<0.01), depression (OR = 1.58, p<0.05) and substance dependence (OR = 1.88, p<0.05). No relationships were found between a suspected ID and anxiety, regular substance use, substance misuse and primary substance of use. Conclusion The prevalence of ID among Dutch homeless people is higher than in the general population, and is related to more psychosocial problems than among homeless people without ID. Homeless people with a suspected ID appear to be a vulnerable subgroup within the homeless population. This endorses the importance of the extra attention required for this subgroup.
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