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McIntyre M, Cullen J, Turner C, Bohanna I, Lakhini A, Rixon K. The development of a cognitive screening protocol for Aboriginal and/or Torres Strait Islander peoples: the Guddi Way screen. BRAIN IMPAIR 2024; 25:IB23058. [PMID: 39222469 DOI: 10.1071/ib23058] [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: 01/06/2023] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
Background Many Aboriginal and/or Torres Strait Islander peoples are exposed to risk factors for cognitive impairment. However, culturally appropriate methods for identifying potential cognitive impairment are lacking. This paper reports on the development of a screen and interview protocol designed to flag possible cognitive impairments and psychosocial disability in Aboriginal and/or Torres Strait Islander adults over the age of 16years. Methods The Guddi Way screen includes items relating to cognition and mental functions across multiple cognitive domains. The screen is straightforward, brief, and able to be administered by non-clinicians with training. Results Early results suggest the Guddi Way screen is reliable and culturally acceptable, and correctly flags cognitive dysfunction among Aboriginal and/or Torres Strait Islander adults. Conclusions The screen shows promise as a culturally appropriate and culturally developed method to identify the possibility of cognitive impairments and psychosocial disability in Aboriginal and/or Torres Strait Islander adults. A flag on the Guddi Way screen indicates the need for referral to an experienced neuropsychologist or neuropsychiatrist for further assessment and can also assist in guiding support services.
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Affiliation(s)
- Michelle McIntyre
- Synapse Australia, Impact & Evaluation, West End, Qld 4101, Australia
| | - Jennifer Cullen
- Synapse Australia, Impact & Evaluation, West End, Qld 4101, Australia
| | | | - India Bohanna
- Synapse Australia, Impact & Evaluation, West End, Qld 4101, Australia
| | - Ali Lakhini
- La Trobe University, Melbourne, Vic 3086, Australia
| | - Kylie Rixon
- Synapse Australia, Impact & Evaluation, West End, Qld 4101, Australia
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Peralta V, Sánchez-Torres AM, Gil-Berrozpe G, de Jalón EG, Moreno-Izco L, Peralta D, Janda L, Cuesta MJ. Neurocognitive and social cognitive correlates of social exclusion in psychotic disorders: a 20-year follow-up cohort study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02742-x. [PMID: 39090439 DOI: 10.1007/s00127-024-02742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Little is known about the relationship between social exclusion and cognitive impairment in psychosis. We conducted a long-term cohort study of first-episode psychosis to examine the association between comprehensive measures of cognitive impairment and social exclusion assessed at follow-up. METHODS A total of 173 subjects with first-episode psychosis were assessed after a 20-year follow-up for 7 cognitive domains and 12 social exclusion indicators. Associations between sets of variables were modeled using multivariate regression, where social exclusion indicators were the dependent variables, cognitive domains were the independent variables, and age, gender, and duration of follow-up were covariates. RESULTS The total scores on the measures of cognition and social exclusion were strongly associated (β = - .469, ∆R2 = 0.215). Participants with high social exclusion were 4.24 times more likely to have cognitive impairment than those with low social exclusion. Verbal learning was the cognitive function most related to social exclusion domains, and legal capacity was the exclusion domain that showed the strongest relationships with individual cognitive tests. Neurocognition uniquely contributed to housing, work activity, income, and educational attainment, whereas social cognition uniquely contributed to neighborhood deprivation, family and social contacts, and discrimination/stigma. Neurocognition explained more unique variance (11.5%) in social exclusion than social cognition (5.5%). CONCLUSION The domains of cognitive impairment were strongly and differentially related to those of social exclusion. Given that such an association pattern is likely bidirectional, a combined approach, both social and cognitive, is of paramount relevance in addressing the social exclusion experienced by individuals with psychotic disorders.
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Affiliation(s)
- Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain.
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Ana M Sánchez-Torres
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Gustavo Gil-Berrozpe
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Elena García de Jalón
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
| | - David Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Lucía Janda
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Manuel J Cuesta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
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Blumberg MJ, Petersson AM, Jones PW, Jones AA, Panenka WJ, Leonova O, Vila-Rodriguez F, Lang DJ, Barr AM, MacEwan GW, Buchanan T, Honer WG, Gicas KM. Differential sensitivity of intraindividual variability dispersion and global cognition in the prediction of functional outcomes and mortality in precariously housed and homeless adults. Clin Neuropsychol 2024:1-24. [PMID: 38444068 DOI: 10.1080/13854046.2024.2325167] [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: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To examine cognitive intraindividual variability (IIV) dispersion as a predictor of everyday functioning and mortality in persons who are homeless or precariously housed. METHOD Participants were 407 community-dwelling adults, followed for up to 13 years. Neurocognition was assessed at baseline and IIV dispersion was derived using a battery of standardized tests. Functional outcomes (social, physical) were obtained at baseline and last follow-up. Mortality was confirmed with Coroner's reports and hospital records (N = 103 deaths). Linear regressions were used to predict current social and physical functioning from IIV dispersion. Repeated measures Analysis of Covariance were used to predict long-term change in functioning. Cox regression models examined the relation between IIV dispersion and mortality. Covariates included global cognition (i.e. mean-level performance), age, education, and physical comorbidities. RESULTS Higher IIV dispersion predicted poorer current physical functioning (B = -0.46 p = .010), while higher global cognition predicted better current (B = 0.21, p = .015) and change in social functioning over a period of up to 13 years (F = 4.23, p = .040). Global cognition, but not IIV dispersion, predicted mortality in individuals under 55 years old (HR = 0.50, p = .013). CONCLUSIONS Our findings suggest that indices of neurocognitive functioning (i.e. IIV dispersion and global cognition) may be differentially related to discrete dimensions of functional outcomes in an at-risk population. IIV dispersion may be a complimentary marker of emergent physical health dysfunction in precariously housed adults and may be best used in conjunction with traditional neuropsychological indices.
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Affiliation(s)
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Canada
- Department of Psychology, University of the Fraser Valley, Abbotsford, Canada
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Boilson AM, Churchard A, Connolly M, Casey B, Sweeney MR. Screening for Autism Spectrum Condition Through Inner City Homeless Services in the Republic of Ireland. J Autism Dev Disord 2023; 53:3987-3998. [PMID: 35948814 PMCID: PMC9365201 DOI: 10.1007/s10803-022-05669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
Homeless service users were screened for autism spectrum disorder through one of Ireland's leading not for profit service providers. Keyworkers acted as proxy informants; their caseloads were screened using the DSM-5-Autistic Traits in the Homeless Interview (DATHI). Client current and historical health and behaviour data was collated. A representative sample of 106 eligible keyworkers caseloads were screened, identifying 3% "present" and 9% "possibly present" for autistic traits with the DATHI. These findings suggest a high estimate of autism prevalence and support emerging evidence that, people with autism are overrepresented in the homeless population, compared to housed populations. Autism may be a risk factor for entry into homelessness and a challenge to exiting homeless and engaging with relevant services.
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Affiliation(s)
- A M Boilson
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - A Churchard
- Buckinghamshire Older People's Psychological Services, Oxford Health NHS Foundation Trust, Whiteleaf Centre, Bierton Road, Aylesbury, HP20 1EG, UK
| | - M Connolly
- Dublin Simon Community, 5 Red Cow Lane Smithfield, Dublin 7, Ireland
| | - B Casey
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - M R Sweeney
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland.
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Maye JE, Van Patten R, Lykins HC, Vella L, Mahmood Z, Clark JMR, Twamley EW. Memory, fluid reasoning, and functional capacity in adults experiencing homelessness. Clin Neuropsychol 2023; 37:1441-1454. [PMID: 36154911 PMCID: PMC10039959 DOI: 10.1080/13854046.2022.2125906] [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: 04/27/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE In individuals experiencing homelessness, determinants of functional capacity (i.e. the ability to perform activities of daily living) are poorly understood. Identifying potentially modifiable correlates of functional capacity, such as cognitive abilities, may inform treatment targets to address independence and housing stability. This study aimed to identify the strongest neuropsychological predictors of variance in functional performance in 100 adults living in a homeless shelter. METHODS Participants completed a brief cognitive screening test, from which four composite scores were derived, as well as tests of processing speed, fluid reasoning, premorbid intellectual function, and performance-based functional capacity. We conducted a hierarchical linear regression to predict variance in functional capacity. RESULTS Beyond the impact of education and premorbid intellectual function, better memory and fluid reasoning predicted better functional performance. CONCLUSIONS Although our cross-sectional design does not permit causal inference, it is possible that interventions targeting memory and fluid reasoning may improve functional ability in individuals experiencing homelessness.
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Affiliation(s)
- Jacqueline E. Maye
- Research Service, VA San Diego Healthcare System
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
| | - Ryan Van Patten
- Department of Psychiatry and Human Behavior, Brown University
- VA Providence Healthcare System
| | | | - Lea Vella
- University of California San Francisco Health, Department of Quality and Patient Safety
| | - Zanjbeel Mahmood
- Research Service, VA San Diego Healthcare System
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - Jillian M. R. Clark
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Mental Health Service, VA San Diego Healthcare System
| | - Elizabeth W. Twamley
- Research Service, VA San Diego Healthcare System
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
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Rapaport P, Kidd G, Jeraldo RE, Mason A, Knapp M, Manthorpe J, Shulman C, Livingston G. A qualitative exploration of older people's lived experiences of homelessness and memory problems - stakeholder perspectives. BMC Geriatr 2023; 23:556. [PMID: 37700235 PMCID: PMC10498566 DOI: 10.1186/s12877-023-04250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The numbers of older people experiencing both homelessness and memory problems are growing, yet their complex health, housing and care needs remain undelineated and unmet. There is a critical gap in understanding what can improve the care, support and experiences of this group. In this qualitative study we explore how stakeholders understand memory problems among older people in the context of homelessness and consider what they judge gets in the way of achieving positive outcomes. METHOD We conducted reflexive thematic analysis of qualitative interviews (n = 49) using a semi-structured topic guide, with 17 older people (aged ≥ 50 years) experiencing memory problems and homelessness, 15 hostel staff and managers, and 17 health, housing and social care practitioners. We recruited participants from six homelessness hostels, one specialist care home and National Health and Local Authority Services in England. RESULTS We identified four overarching themes. The population is not taken seriously; multiple causes are hard to disentangle; risk of exploitation and vulnerability; and (dis)connection and social isolation. The transience and lack of stability associated with homelessness intensified the disorienting nature of memory and cognitive impairment, and those providing direct and indirect support required flexibility and persistence, with staff moving beyond traditional roles to advocate, provide care and safeguard individuals. Memory problems were perceived by frontline staff and older people to be overlooked, misinterpreted, and misattributed as being caused by alcohol use, resulting in pervasive barriers to achieving positive and desired outcomes. CONCLUSIONS Efforts to meet the needs of older people living with memory problems and experiencing homelessness and future interventions must reflect the complexity of their lives, often in the context of long-term alcohol use and current service provision and we make suggestions as to what could be done to improve the situation.
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Affiliation(s)
- Penny Rapaport
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK.
| | - Garrett Kidd
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Rosario Espinoza Jeraldo
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Ava Mason
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
- NIHR Applied Research Collaboration (ARC) South London, London, UK
| | - Caroline Shulman
- Pathway, London, UK
- Healthy London Partnership, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Gill Livingston
- UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Fearn-Smith EM, Scanlan JN, Hancock N. Exploring and Mapping Screening Tools for Cognitive Impairment and Traumatic Brain Injury in the Homelessness Context: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3440. [PMID: 36834133 PMCID: PMC9966671 DOI: 10.3390/ijerph20043440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Cognitive impairment is common amongst people experiencing homelessness, yet cognitive screening and the collection of history of brain injury rarely features in homelessness service delivery practice. The purpose of this research was to scope and map strategies for screening for the potential presence of cognitive impairment or brain injury amongst people experiencing homelessness and identify instruments that could be administered by homelessness service staff to facilitate referral for formal diagnosis and appropriate support. A search was conducted across five databases, followed by a hand search from relevant systematic reviews. A total of 108 publications were included for analysis. Described in the literature were 151 instruments for measuring cognitive function and 8 instruments screening for history of brain injury. Tools that were described in more than two publications, screening for the potential presence of cognitive impairment or history of brain injury, were included for analysis. Of those regularly described, only three instruments measuring cognitive function and three measuring history of brain injury (all of which focused on traumatic brain injury (TBI)) may be administered by non-specialist assessors. The Trail Making Test (TMT) and the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) are both potentially viable tools for supporting the identification of a likely cognitive impairment or TBI history in the homelessness service context. Further population-specific research and implementation science research is required to maximise the potential for practice application success.
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Affiliation(s)
- Erin M. Fearn-Smith
- Faculty of Medicine and Health, Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2050, Australia
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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.
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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
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9
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Homelessness and Research: Methodological Obstacles and Lessons Learned from a Psychological Study in Parisian Homeless Services. PSYCH 2021. [DOI: 10.3390/psych3020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Homelessness, defined as a lack of appropriate, stable, and permanent housing, is a common issue in many societies and is linked to both structural and individual factors. These factors include psychological mechanisms and disorders which can trigger or worsen already precarious situations. In order for these factors to be taken into account in social rehabilitation programs, they need to be precisely described. However, at present, studies in this field are lacking in France. Despite homelessness being an issue across the country, few studies have evaluated the underlying psychological or neuropsychological mechanisms. More data are needed, not only to provide an accurate description of the situation in France, but also to ensure that foreign observations and interventions are relevant for application to the homeless population. In order to achieve this, more quantitative and qualitative data and investigative methodologies and studies are needed. Sharing experience and methods within the scientific community is one way to support further research, particularly in complex domains such as homelessness. At the moment, only a few such papers have been published. In this paper, we share our experiences from a research project that started in 2020 (currently unpublished) on the prevalence of cognitive disorders among homeless service users in Paris. We describe the exploratory phase of our project, obstacles encountered during the implementation of the study, including how we dealt with ethical issues, and data collection. We end the paper with recommendations for future psychological studies on homelessness.
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White P, Townsend C, Lakhani A, Cullen J, Bishara J, White A. The Prevalence of Cognitive Impairment among People Attending a Homeless Service in Far North Queensland with a Majority Aboriginal and/or Torres Strait Islander People. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul White
- Specialist Disability Services Assessment & Outreach Team (SDSAOT),
| | | | - Ali Lakhani
- Synapse, and
- Menzies Health Institute Queensland, The Hopkins Centre, Griffith University
| | | | | | - Alan White
- Specialist Disability Services Assessment & Outreach Team (SDSAOT),
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11
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Andrews L, Botting N. The speech, language and communication needs of rough sleepers in London. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:917-935. [PMID: 32909664 DOI: 10.1111/1460-6984.12572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is very little awareness of the speech, language and communication needs (SLCN) of rough sleepers. The small amount of documentation that does exist involves a wider group of homeless adults (not just rough sleepers), and reports that communication needs are an area of concern. AIMS To investigate: (1) the reported prevalence of SLCN amongst UK nationals recorded on the Combined Homeless and Information Network (CHAIN) as sleeping on the streets of London; (2) whether rough sleepers with reported SLCN differ from those without; and (3) what factors best predict patterns of rough sleeping and accommodation stays. METHODS & PROCEDURES A data set of 513 participants was provided by CHAIN, which contained information relating to all new rough sleepers and people with long-term histories of rough sleeping (UK nationals only) recorded by street outreach teams in London between 1 April and 30 June 2013. Also included was data about UK nationals provided with support by the Homelessness and Brain Injury Project. The data set contained information including basic demographics, communication skills, health and social care needs, and institutional background and extended to a 5-year period. OUTCOMES & RESULTS (1) SLCN data were often not recorded with data available for only 62% of individuals on the CHAIN databases. However, for those with SLCN data, the prevalence of SLCN was significantly higher than for the general population (17.1%; p < 0.001). (2) There were no significant differences between those with and without SLCN on additional risk factors, quarters rough sleeping, accommodation stays or staff-recorded alerts. (3) There was a positive correlation between rough sleeping and additional risk factors for those with SLCN (r = 0.32, p < 0.001) and for those without (r = 0.25, p < 0.001). Regression analysis indicated that additional risk factors were more predictive than SLCN in explaining the number of quarters rough sleeping and accommodation stays. CONCLUSIONS & IMPLICATIONS SLCN are highly prevalent amongst rough sleepers and significantly greater than for the UK general population. SLCN are not clearly related to rough sleeping behaviour, but the presence of additional risk factors is highly significant in this regard. Homelessness organizations should provide training for staff in SLCN in order to promote better recording of SLCN, inclusive communication and appropriate support to people who are homeless. Further research is also needed to understand better the communication needs of rough sleepers. What this study adds What is already known on the subject There is very little literature concerning the SLCN of rough sleepers, but that which exists suggests that communication needs are an area of concern. There is relatively little awareness of SLCN in practice in this field. What this paper adds to existing knowledge This study is the first to provide information on SLCN recording in this population. It reports large-scale prevalence data on SLCN in rough sleepers, showing a significantly higher risk in this group. Unexpectedly, SLCN did not clearly relate to patterns of rough sleeping and accommodation, but this may be due to the relatively crude data available in routine practice. What are the potential or actual clinical implications of this work? Wider awareness and training on SLCN in the homelessness sector is needed coupled with more systematic and objective assessment of communication in rough sleepers.
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Affiliation(s)
- Leigh Andrews
- Language and Communication Science, City University of London, London, UK
| | - Nicola Botting
- Language and Communication Science, City University of London, London, UK
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Cabán-Alemán C, Iobst S, Luna AM, Foster A. Addressing the Poverty Barrier in Collaborative Care for Adults Experiencing Homelessness: A Case-Based Report. Community Ment Health J 2020; 56:652-661. [PMID: 31907804 DOI: 10.1007/s10597-019-00526-1] [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: 06/13/2018] [Accepted: 12/11/2019] [Indexed: 11/24/2022]
Abstract
The Collaborative Care (CC) model of integrated care is an evidence-based, systematic approach in which primary care and behavioral health teams work together to deliver effective treatment for depression and other common mental illnesses in primary care settings. Because people experiencing homelessness have high rates of chronic medical conditions, mental illness and substance use disorders, interventions that integrate the physical, mental and social determinants of health have been shown to be effective to provide healthcare for this population in primary care outpatient settings. In this article we describe the implementation of a collaborative care program to treat depression in a population of adults experiencing homelessness and receiving primary care in a Federally Qualified Health Center (FQHC) located in Downtown Miami, Florida. We present three case studies that highlight key concepts, potential benefits and limitations in using this model to treat patients experiencing depression and homelessness in urban areas.
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Affiliation(s)
- Carissa Cabán-Alemán
- Department of Psychiatry & Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, SHC 133, Miami, FL, 33199, USA.
| | - Saraswati Iobst
- Camillus Health Concern, 336 NW 5th Street, Miami, FL, 33128, USA
| | - Aniuska M Luna
- Department of Psychiatry & Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC1 345, Miami, FL, 33199, USA
| | - Adriana Foster
- Department of Psychiatry & Behavioral Health, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, AHC1 335A, Miami, FL, 33199, USA
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Synovec CE, Berry S. Addressing brain injury in health care for the homeless settings: A pilot model for provider training. Work 2020; 65:285-296. [PMID: 32007973 DOI: 10.3233/wor-203080] [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] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Brain injury has been recently understood to be a common occurrence among adults experiencing homelessness, resulting in the need for modifications to clinical practice in agencies serving this population. OBJECTIVE A health care agency for adults experiencing homelessness initiated a pilot training for mental health providers to address the issues of brain injury. METHODS Providers attended eight training sessions which focused on: screening for a history of brain injury, treatment planning, and specific strategies to implement with individuals with a history of brain injury. Strategies taught were based on current literature and therapeutic methods, adapted specifically for the clinic's population of adults experiencing homelessness. RESULTS Screening for a history of brain injury at the clinic indicated a high prevalence of a history of brain injury that was previously unidentified, indicating need for provider training. Providers reported increased ability to screen for and address the needs of individuals with brain injury within their clinical setting. Providers reported benefit from sessions tailored to address various cognitive functions which incorporated evidence-based practice and familiar therapeutic methods. CONCLUSION Providers who engage individuals experiencing homelessness benefit from structured training in order to increase ability to screen for and modify interventions for a history of brain injury to better address their clients' needs.
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Affiliation(s)
| | - Sean Berry
- Florida Cancer Specialists, Tampa, FL, USA
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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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Stergiopoulos V, Naidu A, Schuler A, Bekele T, Nisenbaum R, Jbilou J, Latimer EA, Schütz C, Twamley EW, Rourke SB. Housing Stability and Neurocognitive Functioning in Homeless Adults With Mental Illness: A Subgroup Analysis of the At Home/Chez Soi Study. Front Psychiatry 2019; 10:865. [PMID: 31849725 PMCID: PMC6889850 DOI: 10.3389/fpsyt.2019.00865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 11/04/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: This study examined the association of housing stability with neurocognitive outcomes of a well-characterized sample of homeless adults with mental illness over 18 months and sought to identify demographic and clinical variables associated with changes in neurocognitive functioning. Method: A total of 902 participants in the At Home/Chez Soi study completed neuropsychological measures 6 and 24 months after study enrollment to assess neurocognitive functioning, specifically verbal learning and memory, cognitive flexibility, and complex processing speed. Multivariable linear regression was performed to assess the association of housing stability with changes in neurocognitive functioning between 6 and 24 months and to examine the effect of demographic and clinical variables on changes in neurocognitive functioning. Results: Overall neurocognitive impairment remained high over the study period (70% at 6 months and 67% at 24 months) with a small but significant improvement in the proportion of those experiencing more severe impairment (54% vs. 49% p < 0.002). Housing stability was not associated with any of the neuropsychological measures or domains examined; improvement in neurocognitive functioning was associated with younger age, and bipolar affective disorder at baseline. Conclusions: The high prevalence and persistence of overall neurocognitive impairment in our sample suggests targeted approaches to improve neurocognitive functioning merit consideration as part of health interventions to improve everyday functioning and outcomes for this population. Further efforts are needed to identify potential modifiable factors that contribute to improvement in cognitive functioning in homeless adults with mental illness.
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Affiliation(s)
- Vicky Stergiopoulos
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Adonia Naidu
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | - Andrée Schuler
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
| | | | - Rosane Nisenbaum
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jalila Jbilou
- School of Psychology, Université de Moncton, Moncton, NB, Canada
- Centre de formation médicale du Nouveau-Brunswick, Université de Sherbrooke et Université de Moncton, Moncton, NB, Canada
| | - Eric A. Latimer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Institute Research Centre, Montreal, QC, Canada
| | - Christian Schütz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Elizabeth W. Twamley
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, United States
| | - Sean B. Rourke
- MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Chevreau G, Castillo MC, Vallat-Azouvi C. [One homeless person out of ten suffers from cognitive disorders: What do we know about these impairments? A systematic review of homeless people's cognition]. Encephale 2019; 45:424-432. [PMID: 31421812 DOI: 10.1016/j.encep.2019.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Homelessness is associated with several issues (psychiatric and neurological disorders, neurodevelopmental difficulties, malnutrition…) which are also risk factors for cognitive disorders. However, little is known about the relationship between the cognition of homeless people and these eventual explicative etiologies. The aim of this work is to complete the results of Depp et al. about cognition in homelessness by proposing a systematic review of the neuropsychological disorders of homeless people associated with an analysis of the etiologies likely to explain these disorders. METHODS We followed the PRISMA recommendations to build up this work. We analyzed the abstracts of 385 papers found on databases PSYCINFO and PubMed. Twenty-two studies have been selected for respecting our criteria (at least one valid neuropsychological test ; general group of homeless people and not a sub-group of this population ; study published in English). The prevalence quality has been evaluated through the criteria of Loney et al. Cognitive scores and etiological factors have been compared between studies. RESULTS The 22 studies represent only nine countries. More than half of them are considered as having a poor prevalence quality. In total, 4,256 participants have been evaluated. Their mean age was around 40 years, and 85 % of the participants were men. The results show a prevalence of cognitive disorders (MMSE) in 8.77 % of the sample. The mean IQ was 87.47 and the premorbid IQ 94.59. We also notice possible disorders affecting the episodic memory and the executive functions. Mean scores for short-term memory, speech and visuo-spatial functions are relatively low. None of the studies evaluated the praxia, the gnosia or the social cognition. The heterogeneity of studies and the lack of data did not allow us to give general conclusions about the etiology of these disorders. However, we see that around 40 % of the time subjects had histories of brain injuries and 89 % of childhood trauma. Intellectual disability is found in 49 % of the sample of a single study. Also, 70 % of the homeless population have been diagnosed with substance-related disorders and 65 % with psychiatric disorders. It appears that the only factors correlated with cognitive disorders would be the history of brain injuries and childhood traumas. CONCLUSIONS We confirm that homeless people often suffer from cognitive difficulties, and some of these difficulties (memory, executive functioning) are severe. Yet the etiology of these disorders remain relatively unknown: even if we observe a high prevalence of psychiatric, substance-related, neurodevelopmental and neurological issues by the homeless population, only a few of them (brain injury history and childhood trauma) seem to be correlated with cognition in homelessness. The potential explicative factors have been too rarely explored to bring a powerful explanation of cognitive disorders in homeless people. Further research needs to be done in order to give a more precise neuropsychological profile of the homeless population and to better understand what the disorders are rooted in. Last but not least, all this research and knowledge should be applied more to the care of homeless people by providing neuropsychological assessment and rehabilitation and by training the team to detect cognitive disorders and to support the person with a cognitive disability.
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Affiliation(s)
- G Chevreau
- Laboratoire de Psychopathologie et Neuropsychologie (LPN), Université Paris 8 Vincennes Saint-Denis, 93526 Saint-Denis, France.
| | - M-C Castillo
- Laboratoire de Psychopathologie et Neuropsychologie (LPN), Université Paris 8 Vincennes Saint-Denis, 93526 Saint-Denis, France
| | - C Vallat-Azouvi
- Laboratoire de Psychopathologie et Neuropsychologie (LPN), Université Paris 8 Vincennes Saint-Denis, 93526 Saint-Denis, France
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17
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Exploring the experiences and needs of homeless aboriginal and torres strait islander peoples with neurocognitive disability. BRAIN IMPAIR 2019. [DOI: 10.1017/brimp.2019.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:The current study explored the experiences and aspirations of a cohort of Aboriginal and Torres Strait Islander adults with neurocognitive disability residing in a homeless shelter in regional Queensland, Australia. Neurocognitive disability (NCD) refers to any acquired disorder or injury to the brain where the primary clinical deficit is in cognitive function.Method:The data reported on in this paper emerged from a broader study that aimed to understand the extent and nature of neurocognitive disability amongst homeless Aboriginal and Torres Strait Islander people. The broader study found high levels of NCD which impacted on people’s ability to participate in society. As part of the study, qualitative information was sought regarding participant life experiences. A culturally safe and acceptable structure of “past, present and future” was applied to open-ended questions.Results:Thematic analysis of the data identified four broad themes of i) normalisation of illness and disability; ii) trauma and loss; iii) socioeconomic disadvantage; and iv) hope and disempowerment. This paper reports on these themes and experiences, which occurred across the life span, intersected with NCD, and contributed to what we have termed ‘complex disablement’ amongst this cohort.Conclusions:While causal links between life experience, disability and disablement are not always clear, our findings suggest that attempts to address homelessness must engage with this complexity. The application of holistic, intersectoral supports, which encompass culturally informed, community driven approaches are needed. Understanding the impacts of individual and intergenerational trauma is crucial to safe and effective service provision for this cohort.
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18
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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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Fry CE, Langley K, Shelton KH. Executive functions in homeless young people: Working memory impacts on short-term housing outcomes. Child Neuropsychol 2019; 26:27-53. [DOI: 10.1080/09297049.2019.1628930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
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20
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Salem BE, Brecht ML, Ekstrand ML, Faucette M, Nyamathi AM. Correlates of physical, psychological, and social frailty among formerly incarcerated, homeless women. Health Care Women Int 2019; 40:788-812. [PMID: 30901288 PMCID: PMC6755073 DOI: 10.1080/07399332.2019.1566333] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 11/28/2018] [Accepted: 01/04/2019] [Indexed: 01/11/2023]
Abstract
Frailty is a deficit accumulation in physical, psychological and social domains. Correlates of frailty were explored among formerly incarcerated, homeless women (N = 130, Mage = 38.9). Significant correlates of physical frailty were age, years homeless, prior violence, witnessing less violence, drug dependence, PTSD symptoms and tangible support. Significant correlates of psychological frailty were age, years homeless, witnessed violence, jail time, divorced less, drug use/dependence, prison time, methamphetamine use, and bodily pain. Significant correlates of social frailty were drug use, emotional regulation, and daily alcohol use. Reentry interventions are needed for formerly incarcerated, homeless women who experience physical, psychological and social frailty.
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Affiliation(s)
- Benissa E Salem
- UCLA School of Nursing, University of California , Los Angeles , California , USA
| | - Mary-Lynn Brecht
- School of Nursing, University of California , Los Angeles , California , USA
| | - Maria L Ekstrand
- School of Medicine, University of California, San Francisco School of Medicine , San Francisco , California , USA
| | - Mark Faucette
- Los Angeles County Department of Health Services, Housing for Health/Office of Diversion and Reentry , Los Angeles , California , USA
| | - Adeline M Nyamathi
- School of Nursing, University of California Irvine , Irvine , California , USA
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Manthorpe J, Samsi K, Joly L, Crane M, Gage H, Bowling A, Nilforooshan R. Service provision for older homeless people with memory problems: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Early or timely recognition of dementia is a key policy goal of the National Dementia Strategy. However, older people who are homeless are not considered in this policy and practice imperative, despite their high risk of developing dementia.
Objectives and study design
This 24-month study was designed to (1) determine the prevalence of memory problems among hostel-dwelling homeless older people and the extent to which staff are aware of these problems; (2) identify help and support received, current care and support pathways; (3) explore quality of life among older homeless people with memory problems; (4) investigate service costs for older homeless people with memory problems, compared with services costs for those without; and (5) identify unmet needs or gaps in services.
Participants
Following two literature reviews to help study development, we recruited eight hostels – four in London and four in North England. From these, we first interviewed 62 older homeless people, exploring current health, lifestyle and memory. Memory assessment was also conducted with these participants. Of these participants, 47 were included in the case study groups – 23 had ‘memory problems’, 17 had ‘no memory problems’ and 7 were ‘borderline’. We interviewed 43 hostel staff who were participants’ key workers. We went back 3 and 6 months later to ask further about residents’ support, service costs and any unmet needs.
Findings
Overall, the general system of memory assessment for this group was found to be difficult to access and not patient-centred. Older people living in hostels are likely to have several long-term conditions including mental health needs, which remain largely unacknowledged. Participants frequently reported experiences of declining abilities and hostel staff were often undertaking substantial care for residents.
Limitations
The hostels that were accessed were mainly in urban areas, and the needs of homeless people in rural areas were not specifically captured. For many residents, we were unable to access NHS data. Many hostel staff referred to this study as ‘dementia’ focused when introducing it to residents, which may have deterred recruitment.
Conclusions
To the best of our knowledge, no other study and no policy acknowledges hostels as ‘dementia communities’ or questions the appropriateness of hostel accommodation for people with dementia. Given the declining number of hostels in England, the limits of NHS engagement with this sector and growing homelessness, this group of people with dementia are under-recognised and excluded from other initiatives.
Future work
A longitudinal study could follow hostel dwellers and outcomes. Ways of improving clinical assessment, record-keeping and treatment could be investigated. A dementia diagnosis could trigger sustained care co-ordination for this vulnerable group.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jill Manthorpe
- National Institute for Health Research Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Kritika Samsi
- National Institute for Health Research Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Louise Joly
- National Institute for Health Research Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Maureen Crane
- National Institute for Health Research Health and Social Care Workforce Research Unit, King’s College London, London, UK
| | - Heather Gage
- Surrey Health Economics Centre, School of Economics, University of Surrey, Guildford, UK
| | - Ann Bowling
- Health Sciences, University of Southampton, Southampton, UK
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Twamley EW, Hays CC, Van Patten R, Seewald PM, Orff HJ, Depp CA, Olsen DC, Jak AJ. Neurocognition, psychiatric symptoms, and lifetime homelessness among veterans with a history of traumatic brain injury. Psychiatry Res 2019; 271:167-170. [PMID: 30481694 DOI: 10.1016/j.psychres.2018.11.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
We retrospectively investigated archival clinical data, including correlates of lifetime homelessness, in 503 Veterans with a history of traumatic brain injuries (86.5% mild) who completed neuropsychological evaluations and passed performance validity tests. The 471 never-homeless and 32 ever-homeless Veterans were compared on demographic factors, TBI severity, psychiatric diagnosis, subjective symptoms, and neuropsychological functioning. Homelessness history was significantly associated with unemployment, lower disability income, more severe depressive, anxiety, posttraumatic stress disorder, and postconcussive symptoms, and lower performances on two of fifteen neurocognitive tests. In a multiple logistic regression model, current unemployment and substance use disorder remained significantly associated with lifetime homelessness.
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Affiliation(s)
- Elizabeth W Twamley
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA.
| | - Chelsea C Hays
- San Diego State University / University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA 92120, USA
| | - Ryan Van Patten
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA
| | - P Michelle Seewald
- Research Service, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Henry J Orff
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA; Research Service, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA; Psychology Service, VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Donald C Olsen
- California School of Professional Psychology at Alliant International University, 10455 Pomerado Road, San Diego, CA 92131, USA
| | - Amy J Jak
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA 92161, USA; Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093, USA; Psychology Service, VA San Diego Healthcare System, San Diego, CA 92161, USA
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Llerena K, Gabrielian S, Green MF. Clinical and cognitive correlates of unsheltered status in homeless persons with psychotic disorders. Schizophr Res 2018; 197:421-427. [PMID: 29486957 DOI: 10.1016/j.schres.2018.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/22/2017] [Accepted: 02/16/2018] [Indexed: 12/18/2022]
Abstract
Homeless persons with psychosis are particularly susceptible to unsheltered homelessness, which includes living on the streets, in cars, and other places not meant for human habitation. Homeless persons with psychosis have distinct barriers to accessing care and comprise a high-need and hard-to-serve homeless subpopulation. Therefore, this study sought to understand unsheltered homelessness in persons with psychosis and its relationship to cognitive impairment, clinical symptoms, and community functioning, examined both categorically and dimensionally. This study included 76 homeless participants with a history of a psychotic diagnosis who were enrolled in a supported housing program but had not yet received housing. This study used two different housing stability thresholds (literally homeless at any point vs. literally homeless >20% of days) for comparing homeless Veterans with psychosis living in sheltered versus unsheltered situations on cognition, clinical symptoms, and community integration. Dimensional analyses also examined the relationship between percentage of days spent in unsheltered locations and cognition, clinical symptoms, and community integration. Sheltered and unsheltered Veterans with psychosis did not differ on clinical symptoms or community integration, but there was an inconsistent group difference on cognition depending on the threshold used for determining housing stability. In the unsheltered group, cognitive deficits in overall cognition, visual learning, and social cognition were related to more days spent in unsheltered locations. Rehabilitation efforts targeting specific cognitive deficits may be useful to facilitate greater access to care and successful interventions in this population.
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Affiliation(s)
- Katiah Llerena
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States; Department of Veterans Affairs VISN 21 Mental Illness Research, Education, and Clinical Center, San Francisco, CA, United States.
| | - Sonya Gabrielian
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States
| | - Michael F Green
- Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, United States; UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, United States
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24
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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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Rodríguez-Pellejero JM, Núñez JL. Relationship between attachment and executive dysfunction in the homeless. SOCIAL WORK IN HEALTH CARE 2018; 57:67-78. [PMID: 28708044 DOI: 10.1080/00981389.2017.1344754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The executive functions of the homeless may be contributing to the success or failure of social integration processes. The goal of this study was to analyze the relationship between attachment and executive dysfunction in the homeless, specifically, to analyze the prevalence of adult attachment and executive dysfunction patterns, as well as the predictive power of different types of attachment for executive functioning. Participants were 107 homeless. Descriptive analysis revealed the prevalence of insecure attachment, and a high prevalence of clinically significant executive dysfunction. Regression analysis showed that attachment predicts all the executive functions, although the predictive power of attachment decreased when entering the variable drug addiction. People in a situation of chronic social exclusion are characterized by an insecure attachment style and moderate levels of executive dysfunction.
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Affiliation(s)
- José M Rodríguez-Pellejero
- a Department of Psychology and Sociology , University of Las Palmas de Gran Canaria , Las Palmas de Gran Canaria , Spain
| | - Juan L Núñez
- a Department of Psychology and Sociology , University of Las Palmas de Gran Canaria , Las Palmas de Gran Canaria , Spain
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26
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Piche J, Kaylegian J, Smith D, Hunter SJ. The Relationship between Self-Reported Executive Functioning and Risk-Taking Behavior in Urban Homeless Youth. Behav Sci (Basel) 2018; 8:E6. [PMID: 29301347 PMCID: PMC5791024 DOI: 10.3390/bs8010006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/11/2017] [Accepted: 12/21/2017] [Indexed: 01/03/2023] Open
Abstract
Introduction: Almost 2 million U.S. youth are estimated to live on the streets, in shelters, or in other types of temporary housing at some point each year. Both their age and living situations make them more likely to engage in high-risk behaviors, particularly during adolescence, a time of increased risk taking. Much of self-control appears related to the development of the prefrontal cortex, which is at a particularly crucial period of elaboration and refinement during adolescence and emerging adulthood. Executive processes like decision-making, inhibition, planning, and reasoning may be vulnerable to adversity experienced as a result of homelessness and related impoverishment during childhood and adolescence. No study to date, to our knowledge, has directly investigated differences in risk-taking by homeless youth as it relates to their developing executive control. Objective: Examine the relationship between the level of self-reported executive function (EF) and engagement in risk taking behaviors among a sample of shelter-living urban homeless youth. We predicted that homeless youth who have lower levels of self-reported EF would more readily engage in risky behaviors that could lead to negative outcomes. Participants: One hundred and forty-nine youths between 18 and 22 years of age were recruited from homeless agencies in Chicago. Of this study sample, 53% were female and 76% African American. Measures: All participants completed, as part of a broader neuropsychological assessment, the Behavior Rating Inventory of Executive Functioning-Adult Version (BRIEF-A), the National Youth Risk Behavior Survey (YRBS), and the Mini-International Neuropsychiatric Interview (MINI). Analyses: Groups were separated based on level of self-reported EF, with two groups identified: High self-reported EF fell >1 SD above the normative average, and low self-reported EF fell >1 SD below the normative average. All analyses utilized Chi-square and Mann-Whitney tests. Results and Conclusions: Analyses revealed a relationship between the level of self-reported EF and risk taking behaviors in this group of sheltered homeless urban youths. Those with lower self-reported executive functioning had higher rates of engagement in multiple substance-related risk taking behaviors. These findings are important because they are a first step towards identifying contributions to risk-taking behavior in urban homeless youths. Identifying potential factors like low self-reported EF better allows us to potentially intervene, thereby providing focused support to youths who are at higher risk for engaging in problematic behaviors.
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Affiliation(s)
- Joshua Piche
- Pritzker School of Medicine, The University of Chicago, Chicago, IL 60637, USA.
| | - Jaeson Kaylegian
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA.
| | - Dale Smith
- Department of Psychology, Olivet Nazarene University, Bourbonnais, IL 60914, USA.
| | - Scott J Hunter
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S. Maryland Ave., MC 3077, Chicago, IL 60637, USA.
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA.
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27
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Durbin A, Lunsky Y, Wang R, Nisenbaum R, Hwang SW, O’Campo P, Stergiopoulos V. The Effect of Housing First on Housing Stability for People with Mental Illness and Low Intellectual Functioning. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:706743718782940. [PMID: 29916270 PMCID: PMC6299190 DOI: 10.1177/0706743718782940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Housing First (HF) has been linked to increased tenure in housing for homeless people with mental illness, but the effect of HF on housing stability for people with borderline or lower intellectual functioning has not been examined. This study of homeless adults with mental illness in Toronto, Ontario assessed whether the association between housing stability and HF differed for adults with borderline or lower intellectual functioning, compared to adults with above borderline intellectual functioning. METHOD This study included 172 homeless adults with mental illness from the Toronto site of the At Home-Chez Soi randomized trial that compared receiving HF relative to treatment as usual. This sample was divided into two intellectual functioning groups: 1) adults with borderline or lower intellectual functioning (IQ < 85, 16%), and 2) adults with above borderline intellectual functioning (IQ ≥ 85, 84%). We compared these groups by modelling the percentage of days stably housed using a linear multivariable generalized estimating equation and included interaction between treatment and intellectual functioning. An interaction between treatment and time was also included. RESULTS There were no overall differences in housing stability for individuals with borderline or lower intellectual functioning compared to people with higher than borderline intellectual functioning in either the HF or the treatment as usual groups. CONCLUSION This study is the first to demonstrate that for homeless adults with mental illness, borderline or lower intellectual functioning did not significantly affect housing stability. This accentuates the need for more research and potentially wider consideration of their inclusion in housing interventions, such as HF.
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Affiliation(s)
- Anna Durbin
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Yona Lunsky
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario
| | - Ri Wang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
| | - Rosane Nisenbaum
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Stephen W. Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Patricia O’Campo
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario
| | - Vicky Stergiopoulos
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Centre for Addiction and Mental Health, Toronto, Ontario
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28
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Hurstak E, Johnson JK, Tieu L, Guzman D, Ponath C, Lee CT, Jamora CW, Kushel M. Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study. Drug Alcohol Depend 2017; 178:562-570. [PMID: 28738314 PMCID: PMC5568464 DOI: 10.1016/j.drugalcdep.2017.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/27/2017] [Accepted: 06/01/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND We evaluated cognitive function and factors associated with cognitive impairment in a cohort of older homeless adults. We hypothesized that substance use and a history of traumatic brain injury would be associated with cognitive impairment. METHODS We recruited 350 homeless individuals aged ≥50 years using population-based sampling and conducted structured interviews and neuropsychological testing. We evaluated alcohol use with the Alcohol Use Disorder Identification Test, defining high-severity alcohol use as a total score ≥16 or ≥4 on the alcohol dependency sub-scale. We assessed global cognition with the Modified Mini-Mental State Test (3MS) and processing speed and executive function with the Trail Making Test (TMTB), defining impairment as performing 1.5 standard deviations below the standardized mean. We used multivariable logistic regression to examine the association between alcohol use and cognition. RESULTS Participants had a median age of 58 years [IQR 54-61], 76.7% were men, and 79.9% were African American. A quarter (25.1%) of participants met criteria for impairment on the 3MS; 32.9% met criteria for impairment on TMTB. In models adjusted for sociodemographic variables and health conditions, high-severity alcohol use was associated with global cognitive impairment (AOR 2.39, CI 1.19-4.79) and executive dysfunction (AOR 3.09, CI 1.61-5.92). CONCLUSIONS Older homeless adults displayed a prevalence of cognitive impairment 3-4 times higher than has been observed in general population adults aged 70 and older. Impaired cognition in older homeless adults could impact access to housing programs and the treatment of health conditions, including the treatment of alcohol use disorders.
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Affiliation(s)
- Emily Hurstak
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
| | - Julene K Johnson
- Institute for Health and Aging, University of California, San Francisco, San Francisco, CA, USA; Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, CA, USA
| | - Lina Tieu
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - David Guzman
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Claudia Ponath
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Christopher T Lee
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Christina Weyer Jamora
- Center for Aging in Diverse Communities, University of California, San Francisco, San Francisco, CA, USA; Department of Psychiatry, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - Margot Kushel
- Division of General Internal Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA; Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA.
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29
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Okamura T, Awata S, Ito K, Takiwaki K, Matoba Y, Niikawa H, Tachimori H, Takeshima T. Elderly men in Tokyo homeless shelters who are suspected of having cognitive impairment. Psychogeriatrics 2017; 17:206-207. [PMID: 27357238 DOI: 10.1111/psyg.12211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/01/2016] [Accepted: 05/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Tsuyoshi Okamura
- Department of Neuropsychiatry, University of Tokyo, Tokyo, Japan.,Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kae Ito
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | | | | | - Hirotoshi Niikawa
- Department of Neuropsychiatry, University of Tokyo, Tokyo, Japan.,Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hisateru Tachimori
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tadashi Takeshima
- Department of Health and Social Welfare for the Disabled, Health and Welfare Bureau, Kawasaki, Japan
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30
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Yim LCL, Leung HCM, Chan WC, Lam MHB, Lim VWM. Prevalence of Mental Illness among Homeless People in Hong Kong. PLoS One 2015; 10:e0140940. [PMID: 26484889 PMCID: PMC4618481 DOI: 10.1371/journal.pone.0140940] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/30/2015] [Indexed: 11/22/2022] Open
Abstract
Metholodogy This study examined the prevalence and correlates of mental illness in homeless people in Hong Kong and explored the barriers preventing their access to health care. Ninety-seven Cantonese-speaking Chinese who were homeless during the study period were selected at random from the records of the three organisations serving the homeless population. The response rate was 69%. Seventeen subjects could not give valid consent due to their poor mental state, so their responses were excluded from the data analysis. A psychiatrist administered the Structured Clinical Interview for DSM-IV Axis-I disorders (SCID-I) and the Mini -Mental State Examination. Consensus diagnoses for subjects who could not complete the SCID-I were established by three independent psychiatrists. Findings The point prevalence of mental illness was 56%. Seventy-one percent of the subjects had a lifetime history of mental illness, 30% had a mood disorder, 25% had an alcohol use disorder, 25% had a substance use disorder, 10% had a psychotic disorder, 10% had an anxiety disorder and 6% had dementia. Forty-one percent of the subjects with mental illness had undergone a previous psychiatric assessment. Only 13% of the subjects with mental illness were receiving psychiatric care at the time of interview. The prevalence of psychotic disorders, dementia and the rate of under treatment are hugely underestimated, as a significant proportion (18%) of the subjects initially selected were too ill to give consent to join the study. Conclusion The low treatment rate and the presence of this severely ill and unreached group of homeless people reflect the fact that the current mode of service delivery is failing to support the most severely ill homeless individuals.
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Affiliation(s)
- Larina Chi-Lap Yim
- Department of Psychiatry, Prince of Wales Hospital, Shatin, Hong Kong
- * E-mail:
| | | | - Wai Chi Chan
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Marco Ho-Bun Lam
- Department of Psychiatry, Prince of Wales Hospital, Shatin, Hong Kong
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31
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Stergiopoulos V, Schuler A, Nisenbaum R, deRuiter W, Guimond T, Wasylenki D, Hoch JS, Hwang SW, Rouleau K, Dewa C. The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study. BMC Health Serv Res 2015; 15:348. [PMID: 26315398 PMCID: PMC4551376 DOI: 10.1186/s12913-015-1014-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 08/21/2015] [Indexed: 11/17/2022] Open
Abstract
Background Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model. Methods In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains. Results We observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures. Conclusions Our findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.
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Affiliation(s)
- Vicky Stergiopoulos
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. .,Mental Health Services, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Andrée Schuler
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Rosane Nisenbaum
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, M5T 3M7, Canada.
| | - Wayne deRuiter
- Centre for Research on Employment and Workplace Health (CREWH), Centre for Addiction and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, Ontario, M5S 2G8, Canada.
| | - Tim Guimond
- Mental Health Services, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Donald Wasylenki
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. .,Mental Health Services, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Jeffrey S Hoch
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Centre for Excellence in Economic Analysis Research (CLEAR), Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada.
| | - Stephen W Hwang
- Centre for Research on Inner City Health, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. .,Division of General Internal Medicine, Department of Medicine, University of Toronto, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Katherine Rouleau
- Global Health Program, Department of Family and Community Medicine, University of Toronto, 263 McCaul Street, 3rd Floor, Toronto, Ontario, M5T 1W7, Canada. .,Department of Family and Community Medicine, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada.
| | - Carolyn Dewa
- Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, M5T 1R8, Canada. .,Centre for Research on Employment and Workplace Health (CREWH), Centre for Addiction and Mental Health, 455 Spadina Avenue, Suite 300, Toronto, Ontario, M5S 2G8, Canada.
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32
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Gaebel W, Zielasek J. Homeless and mentally ill--a mental healthcare challenge for Europe. Acta Psychiatr Scand 2015; 131:236-8. [PMID: 25645234 DOI: 10.1111/acps.12394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- W Gaebel
- Department of Psychiatry and Psychotherapy, LVR-Institute of Mental Health Care Research, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Stergiopoulos V, Cusi A, Bekele T, Skosireva A, Latimer E, Schütz C, Fernando I, Rourke SB. Neurocognitive impairment in a large sample of homeless adults with mental illness. Acta Psychiatr Scand 2015; 131:256-68. [PMID: 25604122 DOI: 10.1111/acps.12391] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study examines neurocognitive functioning in a large, well-characterized sample of homeless adults with mental illness and assesses demographic and clinical factors associated with neurocognitive performance. METHOD A total of 1500 homeless adults with mental illness enrolled in the At Home Chez Soi study completed neuropsychological measures assessing speed of information processing, memory, and executive functioning. Sociodemographic and clinical data were also collected. Linear regression analyses were conducted to examine factors associated with neurocognitive performance. RESULTS Approximately half of our sample met criteria for psychosis, major depressive disorder, and alcohol or substance use disorder, and nearly half had experienced severe traumatic brain injury. Overall, 72% of participants demonstrated cognitive impairment, including deficits in processing speed (48%), verbal learning (71%) and recall (67%), and executive functioning (38%). The overall statistical model explained 19.8% of the variance in the neurocognitive summary score, with reduced neurocognitive performance associated with older age, lower education, first language other than English or French, Black or Other ethnicity, and the presence of psychosis. CONCLUSION Homeless adults with mental illness experience impairment in multiple neuropsychological domains. Much of the variance in our sample's cognitive performance remains unexplained, highlighting the need for further research in the mechanisms underlying cognitive impairment in this population.
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Affiliation(s)
- V Stergiopoulos
- Center for Research on Inner City Health, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Abstract
Homeless people experience elevated rates of risk factors for cognitive impairment. We reviewed available peer-reviewed studies reporting data from objective measures of cognition in samples identified as homeless. Pooled sample-weighted estimates of global cognitive screening measures, full-scale intelligence quotient (IQ), and premorbid IQ were calculated, in addition to pooled sample characteristics, to understand the representativeness of available studies. A total of 24 unique studies were identified, with 2969 subjects. The pooled estimate for the frequency of cognitive impairment was 25%, and the mean full-scale IQ score was 85, 1 standard deviation below the mean of the normal population. Cognitive impairment was found to be common among homeless adults and may be a transdiagnostic problem that impedes rehabilitative efforts in this population. Comparatively little data are available about cognition in homeless women and unsheltered persons.
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35
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Saperstein AM, Lee S, Ronan EJ, Seeman RS, Medalia A. Cognitive deficit and mental health in homeless transition-age youth. Pediatrics 2014; 134:e138-45. [PMID: 24958581 PMCID: PMC4067643 DOI: 10.1542/peds.2013-4302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is increasing recognition of the cognitive consequences of socioeconomic adversity during childhood, which can impair learning and negatively affect social and emotional development. However, there is a paucity of research on cognitive functioning and mental health among transition-age homeless youth. This study aimed to address this knowledge gap by examining the prevalence and functional significance of cognitive impairment and mental health disorders in a sample of 18- to 22-year-old homeless youth. METHODS Participants (N = 73) were recruited from a vocational support program at Covenant House New York, a care agency for homeless youth. Assessments included diagnostic assessment for mental health disorders and evaluation of neurocognition and vocational outcomes. RESULTS Youth demonstrated histories of academic instability, academic achievement below expectation, and high rates of untreated psychiatric disorders, the most prominent of which were anxiety, substance use, and mood disorders. Of those who had a mental health diagnosis, more than half demonstrated cognitive deficits. Performance on measures of working memory and verbal memory was <70% of that of the age-matched normative population. Cognitive impairment was associated with a significant risk for making a wage insufficient for independent living. CONCLUSIONS These data confirm the need to focus on cognitive as well as emotional and physical health in transition-age youth. Comprehensive intervention at this later developmental stage has the potential to facilitate the acquisition of skills needed for academic, vocational, and independent living success in adulthood.
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Affiliation(s)
- Alice M. Saperstein
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; and,Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Seonjoo Lee
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; and
| | - Elizabeth J. Ronan
- Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Rachael S. Seeman
- Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
| | - Alice Medalia
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York; and,Division of Mental Health Service and Policy Research, New York State Psychiatric Institute, New York, New York
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Ennis N, Roy S, Topolovec-Vranic J. Memory impairment among people who are homeless: a systematic review. Memory 2014; 23:695-713. [PMID: 24912102 DOI: 10.1080/09658211.2014.921714] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cognitive impairment may interfere with an individual's ability to function independently in the community and may increase the risk of becoming and remaining homeless. The purpose of this study was to systematically review the literature on memory deficits among people who are homeless in order to gain a better understanding of its nature, causes and prevalence. Studies that measured memory functioning as an outcome among a sample of homeless persons were included. Data on sampling, outcome measures, facet of memory explored and prevalence of memory impairment were extracted from all selected research studies. Included studies were evaluated using a critical appraisal process targetted for reviewing prevalence studies. Eleven studies were included in the review. Verbal memory was the most commonly studied facet of memory. Potential contributing factors to memory deficits among persons who are homeless were explored in seven studies. Memory deficits were common among the samples of homeless persons studied. However, there was a great deal of variation in the methodology and quality of the included studies. Conceptualisations of "homelessness" also differed across studies. There is a need for more controlled research using validated neuropsychological tools to evaluate memory impairment among people who are homeless.
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Affiliation(s)
- Naomi Ennis
- a Head Injury Clinic , St. Michael's Hospital , Toronto , ON , Canada
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Brown RT, Kiely DK, Bharel M, Mitchell SL. Factors associated with geriatric syndromes in older homeless adults. J Health Care Poor Underserved 2014; 24:456-68. [PMID: 23728022 DOI: 10.1353/hpu.2013.0077] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although older homeless adults have high rates of geriatric syndromes, risk factors for these syndromes are not known. We used multivariable regression models to estimate the association of subject characteristics with the total number of geriatric syndromes in 250 homeless adults aged 50 years and older. Geriatric syndromes included falls, cognitive impairment, frailty, major depression, sensory impairment, and urinary incontinence. A higher total number of geriatric syndromes was associated with having less than a high school education, medical comorbidities (diabetes and arthritis), alcohol and drug use problems, and difficulty performing one or more activities of daily living. Clinicians who care for older homeless patients with these characteristics should consider screening them for geriatric syndromes. Moreover, this study identifies potentially modifiable risk factors associated with the total number of geriatric syndromes in older homeless adults. This knowledge may provide targets for clinical interventions to improve the health of older homeless patients.
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Affiliation(s)
- Rebecca T Brown
- San Francisco Veterans AffairsMedical Center, San Francisco, CA 94122, USA.
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Topolovec-Vranic J, Ennis N, Howatt M, Ouchterlony D, Michalak A, Masanic C, Colantonio A, Hwang SW, Kontos P, Stergiopoulos V, Cusimano MD. Traumatic brain injury among men in an urban homeless shelter: observational study of rates and mechanisms of injury. CMAJ Open 2014; 2:E69-76. [PMID: 25077132 PMCID: PMC4084748 DOI: 10.9778/cmajo.20130046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little empiric research has investigated the interrelationship between homelessness and traumatic brain injury. The objectives of this study were to determine the rate, mechanisms and associated outcomes of traumatic brain injury among men in an urban homeless shelter. METHODS We recruited participants from an urban men's shelter in Toronto, Ontario. Researchers administered the Brain Injury Screening Questionnaire, a semistructured interview screening tool for brain injury. Demographic information and detailed histories of brain injuries were obtained. Participants with positive and negative screening results were compared, and the rates and mechanisms of injury were analyzed by age group. RESULTS A total of 111 men (mean age 54.2 ± standard deviation 11.5 yr; range 27-81 yr) participated. Nearly half (50 [45%]) of the respondents had a positive screening result for traumatic brain injury. Of these, 73% (35/48) reported experiencing their first injury before adulthood (< 18 yr), and 87% (40/46) reported a first injury before the onset of homelessness. Among those with a positive screening result, 33 (66%) reported sustaining at least one traumatic brain injury by assault, 22 (44%) by sports or another recreational activity, 21 (42%) by motor vehicle collision and 21 (42%) by a fall. A positive screening result was significantly associated with a lifetime history of arrest or mental illness and a parental history of substance abuse. INTERPRETATION Multiple mechanisms contributed to high rates of traumatic brain injury within a sample of homeless men. Assault was the most common mechanism, with sports and recreation, motor vehicle collisions and falls also being reported frequently by the participants. Injury commonly predated the onset of homelessness, with most participants experiencing their first injury in childhood. Additional research is needed to understand the complex interactions among homelessness, traumatic brain injury, mental illness and substance use.
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Affiliation(s)
- Jane Topolovec-Vranic
- Trauma and Neurosurgery Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ont
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ont
| | - Naomi Ennis
- Head Injury Clinic, St. Michael’s Hospital, Toronto, Ont
| | | | | | | | - Cheryl Masanic
- Head Injury Clinic, St. Michael’s Hospital, Toronto, Ont
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ont
| | - Angela Colantonio
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ont
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ont
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Stephen W. Hwang
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ont
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ont
| | - Pia Kontos
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ont
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Vicky Stergiopoulos
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ont
- Department of Psychiatry, University of Toronto, Toronto, Ont
| | - Michael D. Cusimano
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
- Injury Prevention Research Office, Trauma and Neurosurgery Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ont
- Division of Neurosurgery, University of Toronto, Toronto, Ont
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Andersen J, Kot N, Ennis N, Colantonio A, Ouchterlony D, Cusimano MD, Topolovec-Vranic J. Traumatic brain injury and cognitive impairment in men who are homeless. Disabil Rehabil 2014; 36:2210-5. [DOI: 10.3109/09638288.2014.895870] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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40
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Topolovec-Vranic J, Ennis N, Ouchterlony D, Cusimano MD, Colantonio A, Hwang SW, Kontos P, Stergiopoulos V, Brenner L. Clarifying the link between traumatic brain injury and homelessness: Workshop proceedings. Brain Inj 2013; 27:1600-5. [DOI: 10.3109/02699052.2013.823666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lougheed DC, Farrell S. The Challenge of a “Triple Diagnosis”: Identifying and Serving Homeless Canadian Adults With a Dual Diagnosis. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2013. [DOI: 10.1111/jppi.12041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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42
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Topolovec-Vranic J, Ennis N, Colantonio A, Cusimano MD, Hwang SW, Kontos P, Ouchterlony D, Stergiopoulos V. Traumatic brain injury among people who are homeless: a systematic review. BMC Public Health 2012; 12:1059. [PMID: 23216886 PMCID: PMC3538158 DOI: 10.1186/1471-2458-12-1059] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/05/2012] [Indexed: 11/25/2022] Open
Abstract
Background Homelessness and poverty are important social problems, and reducing the prevalence of homelessness and the incidence of injury and illness among people who are homeless would have significant financial, societal, and individual implications. Recent research has identified high rates of traumatic brain injury (TBI) among this population, but to date there has not been a review of the literature on this topic. The objective of this systematic review was to review the current state of the literature on TBI and homelessness in order to identify knowledge gaps and direct future research. Methods A systematic literature search was conducted in PsycINFO (1887–2012), Embase (1947–2012), and MEDLINE/Pubmed (1966–2012) to identify all published research studies on TBI and homelessness. Data on setting, sampling, outcome measures, and rate of TBI were extracted from these studies. Results Eight research studies were identified. The rate of TBI among samples of persons who were homeless varied across studies, ranging from 8%-53%. Across the studies there was generally little information to adequately describe the research setting, sample sizes were small and consisted mainly of adult males, demographic information was not well described, and validated screening tools were rarely used. The methodological quality of the studies included was generally moderate and there was little information to illustrate that the studies were adequately powered or that study samples were representative of the source population. There was also an absence of qualitative studies in the literature. Conclusions The rate of TBI is higher among persons who are homeless as compared to the general population. Both descriptive and interventional studies of individuals who are homeless should include a psychometrically sound measure of history of TBI and related disability. Education of caregivers of persons who are at risk of becoming, or are homeless, should involve training on TBI. Dissemination of knowledge to key stakeholders such as people who are homeless, their families, and public policy makers is also advocated.
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Affiliation(s)
- Jane Topolovec-Vranic
- Trauma and Neurosurgery Program, Keenan Research Center of the Li Ka Shing Knowledge Institute, St, Michael's Hospital; Department of Occupational Science and Occupational Therapy, University of Toronto, 30 Bond Street, Bond 3-012, Toronto, ON M5B 1W8, Canada.
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Abstract
The impact of mental illness, comorbid substance abuse, and medication nonadherence, coupled with disjointed psychiatric and social services, conspires to a disproportionately high rate of psychiatric disorders among people who are homeless in the United States. This article reviews the prevalence of homeless among the mentally ill as well as the prevalence of mental illness among the homeless and details barriers in access to care and the solutions that have been attempted. The need and solutions to introduce a new generation of physicians and allied health care workers to the unique health care needs of the homeless population are highlighted.
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Affiliation(s)
- Adriana Foster
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Georgia Health Sciences University, 997 Saint Sebastian Way, Augusta, GA 30912, USA.
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Levitt AJ, Jost JJ, Mergl KA, Hannigan A, Degenova J, Chung SY. Impact of chronically street homeless tenants in congregate supportive housing. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2012; 82:413-20. [PMID: 22880979 DOI: 10.1111/j.1939-0025.2012.01164.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
New initiatives to house chronically street homeless (CSH) adults have led to increasing proportions of this population living in congregate supportive housing, but little is known about the impact of this shift on supportive housing programs. The present multisite, mixed-methods study examined service utilization and lease compliance among 52 chronically street homeless and 46 long-term shelter stayer (LTSS) adults during their first 12 months in congregate supportive housing. Quantitative analysis of administrative data revealed that CSH tenants used significantly more service resources than LTSS tenants, including more advocacy, escorting, and psychiatric treatment and more assistance with financial, housing, and mental and physical health issues. The 2 groups did not differ significantly on measures of lease compliance. Qualitative focus groups with CSH tenants, service provider staff, and property management staff all indicated that existing supportive housing services are suitable for this population, although some adjustments, additional resources, or both, may be indicated.
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Affiliation(s)
- A J Levitt
- Center for Urban Community Services, 198 E. 121st St., 5th floor, New York, NY 10035, USA.
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Geriatric syndromes in older homeless adults. J Gen Intern Med 2012; 27:16-22. [PMID: 21879368 PMCID: PMC3250555 DOI: 10.1007/s11606-011-1848-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/28/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND The average age of the US homeless population is increasing. Little is known about the prevalence of geriatric syndromes in older homeless adults. OBJECTIVE To determine the prevalence of common geriatric syndromes in a sample of older homeless adults, and to compare these prevalences to those reported in the general older population. DESIGN Cross-sectional. PARTICIPANTS Two hundred and forty-seven homeless adults aged 50-69 recruited from eight homeless shelters in Boston, MA. MAIN MEASURES Interviews and examinations for geriatric syndromes, including functional impairment, cognitive impairment, frailty, depression, hearing impairment, visual impairment, and urinary incontinence. The prevalences of these syndromes in the homeless cohort were compared to those reported in three population-based cohorts. KEY RESULTS The mean age of the homeless cohort was 56.0 years, and 19.8% were women. Thirty percent of subjects reported difficulty performing at least one activity of daily living, and 53.2% fell in the prior year. Cognitive impairment, defined as a Mini-Mental State Examination score <24, was present in 24.3% of participants; impaired executive function, defined as a Trail Making Test Part B duration >1.5 standard deviations above population-based norms, was present in 28.3% of participants. Sixteen percent of subjects met criteria for frailty, and 39.8% had major depression, defined as a score ≥10 on the Patient Health Questionnaire 9. Self-reported hearing and visual impairment was present among 29.7% and 30.0% of subjects, respectively. Urinary incontinence was reported by 49.8% of subjects. After multivariate adjustment for demographic characteristics, homeless adults were more likely to have functional impairment, frailty, depression, visual impairment and urinary incontinence compared to three population-based cohorts of older persons. CONCLUSIONS Geriatric syndromes that are potentially amenable to treatment are common in older homeless adults, and are experienced at higher rates than in the general older population.
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Abstract
This study compared the functional capacity and neurocognitive status of homeless and housed adults with schizophrenia or schizoaffective disorder and examined whether housing status is an independent predictor of functional capacity. We examined 30 homeless individuals and 21 housed controls and matched for diagnosis, sex, and age. The participants, recruited from an acute psychiatric inpatient unit, completed a measure of psychiatric symptom severity, a neuropsychological test battery, and a measure of functional capacity, the University of California-San Diego performance-based skills assessment (UPSA). There were no significant differences in performance on the neuropsychological test battery or the UPSA between housed and homeless participants. In a multivariate model, however, cognitive status and housing status were independent predictors of functional capacity, and homelessness was associated with an approximately 9-point lower score on the UPSA. This finding highlights the importance of neuropsychological screening and interventions that promote housing stability for patients with schizophrenia.
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Homelessness and neuropsychological impairment: preliminary analysis of adults entering outpatient psychiatric treatment. J Nerv Ment Dis 2010; 198:790-4. [PMID: 21048468 DOI: 10.1097/nmd.0b013e3181f97dff] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Homelessness has been associated with neuropsychological (NP) impairment, but few studies have adequately controlled for factors known to affect NP performance. We performed brief NP testing examining learning, recall, processing speed, executive functioning, and verbal fluency in 50 ever- and 22 never-homeless persons entering outpatient psychiatric treatment. Groups were matched a priori on key demographic, substance use, psychiatric, and premorbid intelligence quotient characteristics. Rates of NP impairment were high among both groups (46%-54%). There were no significant differences in global NP impairment. There were trends toward better levels of processing speed and executive functioning among never-homeless relative to ever-homeless. Among the ever-homeless group, NP test performance was unrelated to number of homelessness episodes (median 3). Findings confirm high prevalence of NP impairment among homeless individuals but provide little evidence for broad NP differences between ever- and never-homeless persons matched for coexisting conditions that have confounded interpretation of previous results in the literature.
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