Neurocognitive impairment in a large sample of homeless adults with mental illness

Abstract

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.

Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study

“…Previous studies suggest an association between cognitive impairment and psychiatric disease, substance use, and TBI in homeless adults (Andersen et al, 2014; Seidman et al, 1997; Stergiopoulos et al, 2015). An analysis of a large sample of homeless adults in Canada who had severe mental illness and a mean age of 41 determined that age, education level, speaking a primary language other than English or French, and a history of psychosis explained 20% of the variance in a composite cognitive score.…”

“…However, the majority of these studies relied on samples either recruited from shelter environments, which may not be representative of the homeless population overall, (Burra et al, 2009; Spence et al, 2004) or from specific populations (e.g., persons with mental health conditions) (Bousman et al, 2010; Seidman et al, 1997; Stergiopoulos et al, 2015). Most studies of cognitive function in homeless adults have used global tests of cognition (e.g., Modified Mini Mental Status Exam [MMSE]) (Burra et al, 2009; Depp et al, 2015).…”

Home is where hearth is

“…Homelessness in this commentary will be defined as a lack of customary regular access to a conventional dwelling unit (1). In the paper by Stergiopoulos et al (2) in this issue, among 1500 homeless people, nearly half were either depressed or had substance use disorders and half had traumatic brain injury. This reflects one of two things: firstly, whether drift hypothesis postulated by Faris and Dunham over 70 years ago (3) where those with schizophrenia migrate to inner cities still holds true or not but, more importantly, this study reflects the failure of the society and the profession in looking after those who are vulnerable due to a number of reasons.…”

“…The rate of mental illness in the homeless population is about 50%, and an additional 25% suffer from a comorbidity of mental illness and substance use problems (2). Rates seem to vary greatly locally and it was recommended to use local surveys and harmonized definitions of homelessness across countries (3).…”

“…While there are structured programmes with efficiency in improving recovery by providing housing and social security, for example, 'Housing First', by and also by Busch-Geertsema (4, 5), the issue of access to mental health care is still open. Reviews showed that case management, assertive community treatment and critical time interventions were effective models of healthcare delivery including the improvement of symptoms of mental disorders, reducing substance use, decreasing psychiatric hospitalizations and increasing outpatient contacts (2,6). A specific review about homeless young people showed that for this special population, the evidence base was small, and it was concluded that more methodologically sound research was needed to determine which specific interventions were beneficial (7).…”