Abstract

Little is known about the medical conditions and medication use of individuals who are homeless and have mental health problems. This study used secondary data (N = 933) from a mental health clinic serving homeless adults. Primary outcomes were the number and types of self-reported medical conditions and medications. About half (52.60%) of participants were taking one or more medications (mean = 1.67; SD = 2.30), most commonly antidepressants, antipsychotics, and anticonvulsants. Most frequently reported medical conditions were headaches/migraines, hypertension, and arthritis with a mean of 3.09 (SD = 2.74) conditions. Age and sex were significant predictors of the number of medical conditions. Age and the length of time homeless were significant predictors of the number of medications taken. Results suggest that those who are older and have been homeless longer appear to be increased risk for health problems and may need more medications to manage these conditions.

Introduction

Persons who are homeless and struggle with psychiatric disorders often have multiple comorbid medical problems, which can lead to poor quality of life and make the treatment of their psychiatric disorder more complex. Compared to the general population, those experiencing homelessness tend to have worse overall health status, suffer from higher rates of both chronic and acute disease, and may be managing multiple chronic health conditions (Fazel et al. 2014; Lebrun-Harris et al. 2013; Schanzer et al. 2007; Sun et al. 2012). In a recent study of over 25,000 people experiencing homelessness, about one-fourth of those who were unsheltered reported having a chronic medical illness other than a mental illness (Montgomery et al. 2016). Others have found higher rates of co-morbidity with the largest numbers among veterans (Schinka et al. 2016; Weber et al. 2013). Chronic medical conditions frequently reported among individuals who lack housing include cardiovascular disease, diabetes, skin disorders, dental and periodontal disease, HIV/AIDS, sexually transmitted infections, chronic obstructive pulmonary disease, and tuberculosis (Victor 1997; Hwang 2001; Barnes et al. 1996; Jones et al. 2009; Allen et al. 1994; Zolopa et al. 1994; Culhane et al. 2001). Other commonly reported chronic health conditions among the homeless include hearing and vision difficulty, arthritis, and podiatric problems (Goss et al. 2003; Wiersma et al. 2010; Padgett and Struening 1992).

The burden of managing a mental illness and one or more physical health problems can be challenging and can lead to increased mortality (Pascual et al. 2008; Beijer and Andreasson 2010; Fazel et al. 2008; Nordentoft and Wandall-Holm 2003; Hwang et al. 1998; Barrow et al. 1999; Babidge et al. 2001; Beijer et al. 2011; Nielsen et al. 2011). Morbidity and mortality are concerns for the homeless, particularly as the number of older adults who are homeless increases (Davidson 2016). Others have found that the mortality rate for homeless adults is almost 4 times higher than the general population (Hibbs et al. 1994). Life expectancy is lowest for single homeless adults (64.2 years for males and 69.6 years for females) as compared to adults in families (67.2 years for males and 70 years for females) with some suggestion that obtaining housing may reduce mortality (Metraux et al. 2011). Females and those who have been homeless for more than five years may have increased risk of mortality (Montgomery et al. 2016). The problems associated with a medical condition itself are often further complicated by the stressors and vulnerabilities associated with homelessness. For example, homeless individuals with cardiovascular disease may have elevated traditional and non-traditional risk factors that cause difficulties in diagnosing and managing the disease that can lead to increased mortality; programs tailored to the homeless population may be an effective means to address these disparities (Baggett et al. 2018).

Read the full article at: https://link.springer.com/article/10.1007/s10597-020-00552-4

From “Community Mental Health Journal” by Elizabeth Mayfield Arnold, Charles R. Strenth, Luke P. Hedrick, Robert C. Paterson, Julian Curiel, Amira E. Joseph, Thomas W. Brown, and James N. Kimball.