Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings

Krausz, Reinhard Michael; Clarkson, Adam F.; Strehlau, Verena; Torchalla, Iris; Li, Kathy; Schuetz, Christian

doi:10.1007/s00127-012-0649-8

Cited by 105 publications

(102 citation statements)

References 24 publications

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“…Notably, the rate of reported comorbid substance use and psychiatric illness is upwards of 50% (Fazel et al, 2014;Krausz et al 2013). These individuals also experience greater severity of psychiatric illness when compared to persons of low socioeconomic status with stable housing (Eyrich-Garg et al 2008).…”

Section: Chapter 1 General Introductionmentioning

confidence: 99%

Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

et al. 2017

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Homeless and marginally housed individuals constitute a socially impoverished population characterized by high rates of multimorbid illness that includes polysubstance use, viral infection, and psychiatric illness. Their extensive exposure to risk factors is associated with numerous poor outcomes, yet little is known about structural brain integrity and its association with neurocognition in this population. In Study 1, we conducted a cluster analysis to re-construct three previously derived subgroups with distinct neurocognitive profiles in a large sample of socially marginalized persons (N = 299). Cluster 1 (n = 87) was characterized as highest functioning overall, whereas Cluster 3 (n = 103) was the lowest functioning neurocognitively, with a relative strength in decision-making. Cluster 2 (n = 109) fell intermediate to the other subgroups, with a relative weakness in decision-making. Next, we examined the association between complementary fronto-temporal cortical brain measures (gyrification, cortical thickness) and neurocognitive profiles using multinomial logistic regression. Chi-square tests and ANOVAs differentiated subgroups on proxy measures of neurodevelopment and acquired brain insult/risk exposure. We found that greater frontal and temporal gyrification and more proxies of aberrant neurodevelopment were associated with Cluster 3 (lowest functioning subgroup). Further, age moderated the association between orbitofrontal cortical thickness and neurocognition, with positive associations in older adults, and negative associations in younger adults. Finally, greater acquired brain insult/risk exposure was associated with the cluster characterized by selective decisionmaking impairment (Cluster 2), and the higher functioning cluster (Cluster 1). In Study 2, we examined the association between white matter integrity and neurocognitive profiles using multinomial logistic regression and Tract-based Spatial Statistics. We found significantly lower fractional anisotropy (FA), with corresponding increased axial and radial diffusivity (AD, RD) in widespread and bilateral brain regions of Cluster 3.Differences in RD were more prominent compared to AD. Altogether, our findings highlight the unique pathways to neurocognitive impairment in a heterogeneous population and help to clarify the vulnerabilities confronted by different subgroups.

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Section: Chapter 1 General Introductionmentioning

confidence: 99%

Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

et al. 2017

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“…Recruitment and procedures have been described in detail elsewhere. 5 The interview assessed: demographic information; childhood sexual abuse, 6 adult sexual abuse, current sexual risk-taking behaviours and sexually transmissible infections (STIs). We calculated a summary score for factors that compromise sexual health: childhood and adult sexual abuse, sex work and unprotected sex with more than one partner, resulting in scores of 0 to 4.…”

Section: Methodsmentioning

confidence: 99%

Sexual health, vulnerabilities and risk behaviours among homeless adults

et al. 2014

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Sexual health variablesTotal sample Women % (n) Men % (n) P-value % (n) 95% CI Abstract. It is well known that homeless individuals are at risk for a variety of health problems, including sexually transmissible infections. Optimisation of health services for the homeless requires knowledge of their sexual health. The sexual health and sexual vulnerability factors of 500 homeless adults (196 women) were assessed in a cross-sectional survey in three Canadian cities. Our data indicate that a significant proportion of individuals and more women than men reported multiple experiences that compromise their sexual health exponentially. These findings may inform health policies related to sexuality to foster positive sexual health outcomes for all people, including marginalised populations.

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“…Associations between different factors can be explored; however, causal inferences cannot be drawn from the results due to the survey's cross-sectional design. 55 While the 2014 SLCDC-MA was developed to be nationally representative, the generalizability of the data to the entire Canadian population may be restricted due to the exclusion of the territories and some populations known to be at risk for mental illness, such as Aboriginal peoples 51,52 living on reserves or Crown lands, the homeless, 56 institutionalized patients, 57 and prison residents. 58 The study sample is also limited to Canadians who sought care and received a mood and/or an anxiety disorder diagnosis.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

The 2014 Survey on Living with Chronic Diseases in Canada on Mood and Anxiety Disorders: a methodological overview

O’Donnell

Cheung

Bennett

et al. 2016

Health Promot Chronic Dis Prev Can

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Introduction: There is a paucity of information about the impact of mood and anxiety disorders on Canadians and the approaches used to manage them. To address this gap, the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component (SLCDC-MA) was developed. The purpose of this paper is to describe the methodology of the 2014 SLCDC-MA and examine the sociodemographic characteristics of the final sample.

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Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings

Abstract: Improving the mental health state of the homeless will require significant capacity for mental health and concurrent disorder programming that is tailored to the community it intends to serve. Demographic features of the population may help in directing assessments of need.

Cited by 105 publications

References 24 publications

Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

Structural brain markers are differentially associated with neurocognitive profiles in socially marginalized people with multimorbid illness.

Sexual health, vulnerabilities and risk behaviours among homeless adults

The 2014 Survey on Living with Chronic Diseases in Canada on Mood and Anxiety Disorders: a methodological overview

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