Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Homeless Persons”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMed2002

Vulnerability factors for homelessness associated with substance dependence in a community sample of homeless adults.

We studied a community probability sample of 1185 homeless individuals to examine substance dependence in relationship to other personal and social vulnerabilities linked to homelessness, including sociodemographics, childhood/adolescent factors, prehomelessness factors, multiple episodes of homelessness, and the quality of shelter in their current episode of homelessness. These vulnerability factors were significantly concentrated in homeless individuals with lifetime and recent substance dependence, especially among those with both alcohol and drug dependence. In addition, the profiles of the homeless with alcohol dependence alone were distinct from those with drug dependence alone or both, with older age, more males, longer histories of homelessness, and significantly poorer quality shelter during the previous 30 days. Therefore, homeless individuals with substance dependence have many vulnerabilities beyond their substance dependence that should be dealt with in treatment or other service settings before lasting housing can be achieved.

Adult↗
PubMed1997

A diagnostic comparison of homeless and nonhomeless patients in an urban mental health clinic.

This study compared demographic and diagnostic characteristics of a sample of homeless outpatient mental health clinic attenders with a domiciled comparison group from the same clinic. Data on demographic variables and DSM-III-R psychiatric diagnoses were collected over a two-year period on a consecutive sample of 166 homeless and 117 nonhomeless clinic attenders. Data on demographics and psychiatric diagnoses of the homeless clinic attenders were further compared with data collected systematically from 900 homeless individuals in the same city. In the clinic, homeless subjects were more often members of ethnic minorities, and homeless women were significantly younger and better educated than their nonhomeless counterparts. Rates of schizophrenia, bipolar disorder, and somatization disorder were not significantly different between homeless and nonhomeless groups. Major depression was about four times as prevalent in nonhomeless men as in homeless men. Homeless men were significantly more likely than nonhomeless men to qualify for a diagnosis of alcohol use disorder, and homeless women were more likely than other women to qualify for a diagnosis of drug use disorder. Both homeless men and women were significantly more likely than their domiciled counterparts to meet criteria for antisocial personality disorder. Personality disorder other than antisocial was more prevalent in nonhomeless men than in homeless men. Combined rates of personality disorder were significantly higher among homeless than nonhomeless women, but not men. Homeless clinic attenders were demographically and diagnostically very similar to a general homeless population in the same city. The only diagnosis that was more prevalent in the homeless clinic than in the homeless community was antisocial personality disorder. We concluded that because of difference in diagnostic prevalence, homeless and nonhomeless individuals in mental health clinics need to be considered independently. Clinicians treating homeless outpatients may benefit from having special facility in diagnosis and management of antisocial personality disorder and substance abuse, along with expertise in other psychiatric disorders in this population.

Adult↗
PubMed2005

Injection drug use among homeless adults in the Southeast with severe mental illness.

This study examined injection drug use and HIV risk behaviors in a predominantly African American sample of homeless men with mental illness. Personal interviews focusing on injection drug use and sexual risk behaviors were completed with 240 homeless mentally ill men in two shelters in a southeastern city. Sixty-two (26%) of the 240 men injected drugs. Among the injection drug users (IDUs), most reported high-risk behaviors, including needle sharing (70%) and participation in shooting galleries (71%). Very few performed risk reduction activities (e.g., cleaning needles with bleach [19%] or using a needle exchange program [0%]). Within the preceding 6 months, most of the IDUs had had sex with women (51%) or men (8%) without a condom. This investigation reported a high lifetime occurrence of injection drug use in a sample of predominantly African American homeless men with mental illness. The IDUs reported intravenous drug use and sexual activities with great risk of HIV transmission and provided little evidence of risk-reduction efforts. These men are outside of most social service and health care systems but must be included in special programs to decrease the transmission of HIV.

Adult↗
PubMed2003

The New York-New York housing initiative and use of public shelters by persons with severe mental illness.

OBJECTIVE: The study examined changes in the use of shelters in New York City by mentally ill persons with a history of homelessness who received housing placements through the New York-New York (NY/NY) housing initiative between 1990 and 1999 and the impact of the initiative on the overall demand for shelter beds in the city. METHODS: Computerized service records on housing, shelter use, and health care services were linked to create an integrated data set for 3,167 persons who received NY/NY housing placements, which provided mental health services, and for a matched control group of persons with mental illness who used shelters but did not receive housing placements. Regression analyses were used to assess the relationships between shelter use and receipt of a placement. Differences in postplacement shelter use between NY/NY housing recipients and the matched control group were then examined at an individual level and a population level. RESULTS: Heavy users of the shelter system were more likely to be placed in NY/NY housing. In the two-year postplacement period, persons who received a NY/NY housing placement used, on average, 128.2 fewer shelter days than those in the control group. In 1996, the NY/NY housing initiative reduced the average nightly census in New York City shelters by an estimated 4.6 percent. CONCLUSIONS: Providing housing combined with mental health services is an effective approach to reducing shelter use among mentally ill persons who have a history of homelessness.

Adolescent↗
PubMed1998

Hospitalization costs associated with homelessness in New York City.

BACKGROUND: Homelessness is believed to be a cause of health problems and high medical costs, but data supporting this association have been difficult to obtain. We compared lengths of stay and reasons for hospital admission among homeless and other low-income persons in New York City to estimate the hospitalization costs associated with homelessness. METHODS: We obtained hospital-discharge data on 18,864 admissions of homeless adults to New York City's public general hospitals (excluding admissions for childbirth) and 383,986 nonmaternity admissions of other low-income adults to all general hospitals in New York City during 1992 and 1993. The differences in length of stay were adjusted for diagnosis-related group, principal diagnosis, selected coexisting illnesses, and demographic characteristics. RESULTS: Of the admissions of homeless people, 51.5 percent were for treatment of substance abuse or mental illness, as compared with 22.8 percent for the other low-income patients, and another 19.7 percent of the admissions of homeless people were for trauma, respiratory disorders, skin disorders, and infectious diseases (excluding the acquired immunodeficiency syndrome [AIDS]), many of which are potentially preventable medical conditions. For the homeless, 80.6 percent of the admissions involved either a principal or a secondary diagnosis of substance abuse or mental illness -- roughly twice the rates for the other patients. The homeless patients stayed 4.1 days, or 36 percent, longer per admission on average than the other patients, even after adjustments were made for differences in the rates of substance abuse and mental illness and other clinical and demographic characteristics. The costs of the additional days per discharge averaged $4,094 for psychiatric patients, $3,370 for patients with AIDS, and $2,414 for all types of patients. CONCLUSIONS: Homelessness is associated with substantial excess costs per hospital stay in New York City. Decisions to fund housing and supportive services for the homeless should take into account the potential of these services to reduce the high costs of hospitalization in this population.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection.

BACKGROUND: Case management (CM) coordinates care for persons with complex health care needs. It is not known whether CM is effective at improving biological outcomes among homeless and marginally housed persons with human immunodeficiency virus (HIV) infection. Our goal was to determine whether CM is associated with reduced acute medical care use and improved biological outcomes in homeless and marginally housed persons with HIV infection. METHODS: We conducted a prospective observational cohort study in a probability-based community sample of HIV-infected homeless and marginally housed adults in San Francisco, California. The primary independent variable was CM, defined as none or rare (any CM in 25% but 75%). The dependent variables were 3 self-reported health service use measures (receipt of primary care, emergency department visits and hospitalizations, and antiretroviral therapy adherence) and 2 biological measures (increase in CD4(+) cell count of >or=50% and geometric mean HIV load of or=50% improvements in CD4(+) cell count. CM was not associated with geometric HIV load <400 copies/mL when antiretroviral therapy adherence was included in the model. Study limitations include a lack of randomization. CONCLUSION: CM may be a successful method to improve adherence to antiretroviral therapy and biological outcomes among HIV-infected homeless and marginally housed adults.

Adult↗
PubMed2006

Gender differences in illicit substance use among middle-aged drug users with or at risk for HIV infection.

OBJECTIVE: The objective of the present study was to examine gender differences and other factors associated with current heroin and cocaine use among middle-aged drug users. METHODS: Baseline data were merged from 2 studies of men and of women with or at risk for HIV infection. Analysis was restricted to study participants who had ever used heroin or cocaine and who were 49-60 years of age at the time that they were interviewed. HIV-antibody status, drug-use history, and psychosocial and sociodemographic data were examined. Logistic regression models were used to assess factors independently associated with current heroin and cocaine use. RESULTS: Of 627 persons who ever used heroin and/or cocaine, 250 (39.9%) reported using these drugs within 6 months of the study interview conducted at baseline. Men were more likely to be using drugs currently, compared with women (42.3% vs. 28.2%; P = .007). In multivariate analysis, men, unemployed persons, and HIV-seronegative persons were more likely to be using heroin or cocaine at the time of the interview. In addition, current marijuana users, persons drinking alcohol on a daily basis, and persons who had been homeless in the 6 months before the interview were also more likely to be using these drugs. CONCLUSION: A relatively high proportion of middle-aged substance users with or at risk for HIV infection, especially men, may continue to use illicit drugs into the sixth decade of life. The differences noted between men and women who have used heroin and/or cocaine at some point in their lives suggest that special attention be given to aging and gender issues in framing HIV-prevention and drug-treatment programs.

Age Factors↗
PubMed2001

Provider assessment of adherence to HIV antiretroviral therapy.

BACKGROUND: Adherence assessment is an essential component of monitoring HIV antiretroviral therapy. Prior studies suggest that medical providers frequently estimate individual patient adherence inaccurately. OBJECTIVE: We compared provider estimates of nonadherence to antiretroviral therapy with unannounced pill counts and structured patient interviews to determine the accuracy of adherence information obtained by providers and patients. DESIGN, SETTING, AND PARTICIPANTS: Comparison of three adherence measures in homeless or marginally housed persons receiving HIV antiretroviral therapy (n = 45) and their providers (n = 35). MEASUREMENTS: Provider estimate of percentage of pills taken; three successive patient structured reports of number of doses missed in the last 3 days; and three successive unannounced pill counts. RESULTS: 13% (95% confidence interval [CI], 4%-22%) of patients were not following their regimen as directed. Provider-adherence estimate explained only 26% (95% CI, 6%-47%) of the variation in pill count adherence, whereas patient report explained 72% (95% CI, 52%-96%). The sensitivity and specificity of provider estimates of nonadherence, defined as <80% of pills taken by pill count, were 40% and 85%, respectively. The sensitivity and specificity of patient interview were 72% and 95%, respectively. CONCLUSIONS: Provider estimate of adherence was inaccurate whereas structured patient report was more closely related to pill count. Structured assessment over several short intervals may improve accuracy of adherence assessment in clinical practice.

Antiretroviral Therapy, Highly Active↗
PubMedDate not supplied

Striving for becoming at-home in the midst of dying.

Research interviews with 12 patients at an inpatient, free-standing hospice in Sweden were analyzed, using a phenomenological hermeneutic approach, to show the effects of individual nursing care as experienced by the guests. The findings revealed that the effects of, and reactions to, nursing care were inseparable from the hospice milieu and the patients' situation, which was interpreted as including the prospect of becoming homeless. Thus, the effects of hospice spirit (nursing care and milieu) as experienced by these hospice patients represented the contrasting possibilities of hindering--or contributing to--the prospect of becoming homeless. What the patients spoke about was either a consoling or a desolating hospice spirit. A consoling hospice spirit supports experiences of wholeness and communion, i.e., becoming at-home in the midst of dying, while a desolating hospice spirit results in feelings of alienation and fragmentation, i.e., feeling homeless. Considering the dying person to be a guest rather than a patient is an important component of Swedish hospice philosophy and supports the view of the dying person as an autonomous and dignified human being.

Adult↗
PubMed1988

Programs for the indigent: filling the cracks in healthcare.

Until the United States establishes a nationwide, long-term plan for care for the medically indigent, individual institutions and systems must try to fill the cracks through which the indigent are falling. The SSM Health Care System, St. Louis, is doing this through a number of efforts. At a May 1987 leadership conference, system members were asked to look into their communities, local institutions, and city and state governments to see what could be done to improve access to healthcare. In addition to standard policies of caring for all patients regardless of their ability to pay, individual institutions devised varied strategies to serve the indigent in their areas. The programs are aimed at the uninsured and underinsured, the farming and rural community, the urban poor, the homeless, the developmentally disabled, persons with AIDS, senior citizens, children, and the Hispanic community. At the corporate level, the system explores public policy issues and supports legislation for funding care for the indigent. System department and entities have also taken other action to aid indigent patients.

Catholicism↗
PubMedDate not supplied

Tuberculosis increasing in the United States.

Cases of active tuberculosis are increasing in the United States after years of decline. A provisional total of 23,720 cases was reported by the end of 1990. Case rates increased 4.4 percent between 1988 and 1989, and perhaps another 1 percent in 1990. Overall rate was 9.5 per 100,000 in 1989, with the Middle Atlantic and Pacific regions reporting the highest rates, 36 percent and 34 percent, respectively, above the U.S. total. The lowest rates were in the West North Central and Mountain regions. Rates continue to be higher among urbanites, minorities, the poor, the homeless, substance abusers and persons infected with HIV. Screening recommendations are outlined in an effort to reverse the growing rate of TB in this country.

Humans↗
PubMed1987

The urban homeless: estimating composition and size.

Although homelessness has been recognized as a serious and growing urban social problem, scientifically acceptable methods for estimating the composition and size of the homeless population have been lacking. A new research approach to estimating the size and composition of undomiciled urban populations is presented, and its utility is illustrated through a description of the literal homeless of Chicago. The homeless in the Chicago sample are unaffiliated persons living in extreme poverty, with high levels of physical and mental disability. Homelessness is interpreted as a manifestation of extreme poverty among persons without families in housing markets with declining stocks of inexpensive dwelling units suitable for single persons.

Chicago↗
PubMed2006

Homelessness among patients with schizophrenia in rural China: a 10-year cohort study.

OBJECTIVE: To explore the frequency and risk factors of homelessness among a previously identified cohort of patients with schizophrenia in rural China. METHOD: A 10-year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. RESULTS: Thirty-nine patients (7.8%) experienced homelessness during the follow-up period. The rate of homelessness was 0.9 per 100 person-years during the 10-year follow-up period. Four significant predictors of homelessness remained in the final logistic regression model: living in shabby or unstable house or shelter, positive family history of mental disorders, without income of the patient, and unmarried, divorced, or separated. Risk of homelessness increased substantially with exposure to multiple risk factors. CONCLUSION: Substantial numbers of homeless patients with schizophrenia are challenges for mental health care and public health. Appropriate community-based services, especially housing services, should be crucial for prevention of homelessness in patients with schizophrenia.

Adolescent↗
PubMed1994

Not all homeless women are alike: effects of motherhood and the presence of children.

Previous work suggests that the population of homeless women is a heterogeneous group, and that motherhood and the presence or absence of children define sub-groups that may be distinct. The current study is a systematic study of 300 homeless women (90% of whom were mothers) according to these suggested sub-groupings. Mothers whose children were with them, compared to other women, were younger and often unemployed and welfare dependent. Mothers without their children had higher rates of nonsubstance Axis I disorders (48%) and alcoholism (33%), and 72% had a lifetime psychiatric diagnosis. Homeless mothers whose children are not with them represent a deviant subgroup with more personal (and fewer social) vulnerabilities to homelessness and may represent a target population for focus of psychiatric treatment efforts. Mothers with their children may benefit more from increased attention to social services.

Adolescent↗
PubMed1977

[Social situation, orientation and personality aspects of juveniles without homes].

A group of homeless juveniles (N = 50) was compared to a group of rockers (N = 46) and a further group of "normal" non-rockers (N = 132) as regards social background, attitudes to others, intelligence, performance motivation and further personality variables such as aggression, extraversion, neuroticism and rigidity. Whereas no significant differences were found in respect of personality variables and attitudes, the homeless juveniles were in a far worse position than the rockers as regards social background: extremely low income, large families, overcrowded accomodation, high rate of alcoholism, delinquency and broken homes. They were less successful in school although they compared favourably with the other groups in those areas of intelligence covered by tests.

Adolescent↗
PubMed1995

Mental health service use among homeless and never-homeless men with schizophrenia.

OBJECTIVE: The study compared patterns of previous mental health service use among 100 homeless men with schizophrenia and 100 men with schizophrenia who had never been homeless and explored whether differences in use of services were related to severity of illness. METHODS: Subjects were recruited from shelters, clinics, and inpatient psychiatric programs in New York City. Clinical interviewers used standardized research instruments to collect data on psychiatric treatment history, mental health service use within the past 12 months, adequacy of discharge planning from the most recent psychiatric hospitalization, positive and negative-symptom levels, and presence of concurrent substance abuse and antisocial personality disorder. RESULTS AND CONCLUSIONS: Homeless subjects and never-homeless subjects had similar treatment histories and recent patterns of inpatient, outpatient, and emergency service use. However, the homeless men were more likely to have been discharged from their most recent psychiatric hospitalization against medical advice and to have less adequate discharge planning for living arrangements, aftercare, and finances. Inadequacies in discharge planning were most apparent among homeless men with triple disorders of schizophrenia, substance abuse, and antisocial personality disorder.

Adolescent↗
PubMed1989

Diagnostic patterns in hospital use by an urban homeless population.

Because patterns of disease and health care system usage by the homeless constitute a neglected area of research in the medical literature, we undertook a retrospective analysis of inpatient records on medically indigent adults, controlling for housing status, to add to the growing body of research in the area of homeless health care. Data on all 4,243 indigent patients admitted over 2 fiscal years (1985 and 1986) under the county medical services program of San Diego County, California, revealed 5.3% (226) to be homeless. The commonest major diagnostic category among the homeless discharges was "diseases and disorders of the skin, subcutaneous tissue, and breast," constituting 21.2% as compared with only 8.7% of the discharge diagnoses for housed indigent persons. Within this major diagnostic category, the predominant diagnosis-related group was cellulitis, accounting for 12.8% of diagnoses in the homeless and only 4.0% of discharge diagnoses in other medically indigent persons. A homeless housing status was also correlated with a higher percentage of discharges with the major diagnostic category of "substance use and substance-induced organic mental disorders" but was negatively correlated with that of "diseases and disorders of the circulatory system."

Delivery of Health Care↗
PubMed1996

The changing careers of patients with chronic mental illness: a study of sequential patterns in mental health service utilization.

The aim of this study was to describe patterns of service use over time by a group of persons with chronic mental illness who were homeless at the time of the index admission. Subjects were all persons admitted to Skid Row Mental Health Services in a recent year who had 25 or more previous admissions to any Los Angeles County Department of Mental Health service (N = 49). Sequences of type of service at each of the 25 admissions were compared with optimal matching and categorized with cluster analysis. Patients in earlier clusters had many inpatient admissions; those in later clusters had many admissions to outpatient, residential, and jail services. Service use by individuals in each cluster showed the same trends. However, there were also different patterns of service use for patients in cluster within the same tie frame. Analyzing multiple admissions sequentially helps to locate likely places to intervene in downward-spiraling careers.

Adolescent↗