To carry out a preliminary assessment of the use of a psychiatric screening
tool in an urban homeless population, and to estimate the potential
prevalence of undiagnosed and (or) unmanaged mental illness in this
population.
Methods:
Participants (n = 166) were recruited from the Calgary
Drop-in and Rehab Centre to complete a questionnaire containing 6 modules
screening for common psychiatric disorders. Summary statistics were used in
the analysis.
Results:
Only 12 respondents (7%) screened negative on each of the 6 modules. The
screening process determined that 60.2% of the sample (n =
100) had probable mental illness but reported no history of psychiatric
diagnosis or treatment.
Conclusions:
A straightforward application of screening (in which screen-positive subjects
are referred for assessment) would be difficult in this population as most
will screen positive. The results highlight the tremendous burden of
psychiatric symptoms in this population.
WoodwardJEberleMKrauseDet alResearch project on homelessness in Greater Vancouver.
Vancouver (BC): The Greater
Vancouver Regional District;
2002.
2.
LairdG.Homelessness in a growth economy: Canada's 21st century
paradox. Calgary (AB):
Sheldon Chumir Foundation for Ethics in
Leadership; 2007.
3.
StroickSMHubacLRitcher-SalomonsS.Biennial count of homeless persons in Calgary.
Calgary (AB): The City of
Calgary; 2008.
4.
BurtMR. Helping America's homeless.
Washington (DC): Urban
Institute Press; 2001.
5.
KamienieckiGW. Prevalence of psychological distress
and psychiatric disorders among homeless youth in Australia: A comparative
review. Aust N Z J Psychiatry.
2001;35(3):352–358.
6.
KassFSilverJM. Neuropsychiatry and the
homeless. J Neuropsychiatry Clin Neurosci.
1990;2(1):
15–19.
7.
KovessVLazarusC. ManginThe prevalence of psychiatric disorders and use of care by
homeless people in Paris. Soc Psychiatry Psychiatr
Epidemiol.
1999;34(11):580–587.
8.
FischerPJBreakeyWR. The epidemiology of alcohol, drug,
and mental disorders among homeless persons. Am
Psychol.
1991;46(11):1115–1128.
9.
HeckertUAndradeLAlvesMJet alLifetime prevalence of mental disorders among homeless people in
a southeast city in Brazil. Eur Arch Psychiatry Clin
Neurosci.
1999;249(3):150–155.
10.
ScottJ.Homelessness and mental illness. Br J
Psychiatry.
1993;162:314–324.
11.
VazquezCMunozMSanzJ.Lifetime and 12-month prevalence of DSM-III-R mental disorders
among the homeless in Madrid: A European study using the
CIDI. Acta Psychiatr Scand.
1997;95(6):523–530.
12.
BenziesKRutherfordGWalshCet alHomeless shelter residents: Who are they and what are their needs
within a context of rapid economic growth?Scholarship Hum Serv.
2008;7(1):1–18.
13.
HwangSWWindrimPMSvobodaTJet alPhysician payment for the care of homeless
people. CMAJ.
2000;163(2):170–171.
14.
StarkLR. Barriers to health care for homeless
people. In: JahielRI, editor. Homelessness: A prevention-oriented
approach. Baltimore (MD):
Johns Hopkins University Press;
1992.
15.
KatzS JHoferTPManningWG. Physician use in Ontario and the
United States: The impact of socioeconomic status and health
status. Am J Public Health.
1996;86(4):520–524.
16.
GoreyKMHolowatyEJFehringerGet alAn international comparison of cancer survival: Toronto, Ontario,
and Detroit, Michigan, metropolitan areas. Am J
Public Health.
1997;87(7):1156–1163.
17.
KesslerRCFrankRGEdlundMet alDifferences in the use of psychiatric outpatient services between
the United States and Ontario. N Engl J
Med.
1997;336(8):551–557.
18.
WojtusikLWhiteMC. Health status, needs, and health care
barriers among the homeless. J Health Care Poor
Underserved.
1998;9(2):
140–152.
19.
BallFLHavassyBE. A survey of the problems and needs of
homeless consumers of acute psychiatric services.
Hosp Community Psychiatry.
1984;35(9):917–921.
20.
WoodD.Delivering health care to homeless persons. The diagnosis and management
of medical and mental health conditions. New York
(NY): Springer Publishing;
1992.
21.
PadgettDKStrueningELAndrewsHet alPredictors of emergency room use by homeless adults in New York
City: The influence of predisposing, enabling and need
factors. Soc Sci Med.
1995;41(4):547–556.
22.
PadgettDStrueningELAndrewsH.Factors affecting the use of medical, mental health, alcohol, and
drug treatment services by homeless adults. Med
Care.
1990;28(9):805–821.
23.
WasylenkiDAGoeringPNLemireDet alThe hostel outreach program: Assertive case management for
homeless mentally ill persons. Hosp Community
Psychiatry.
1993;44(9):848–853.
FerrariIRBrownKRowlandJet alCalgary Drop-in and Rehab Centre: A picture of the health of a homeless
individual. Calgary (AB):
Calgary Drop-In and Rehab Centre;
2006.
26.
SmartRGAdlafEM. Substance use and problems among
Toronto streetyouth. Br JAddict.
1991;86(8):999–1010.
27.
QuantzDFrankishJ.Homelessness research in the Greater Vancouver Regional District: An
agenda for moving forward. Vancouver
(BC): University of British
Columbia; 2002.
28.
SaundersJBAaslandOGBaborTFet alDevelopment of the Alcohol Use Disorders Identification Test
(AUDIT): WHO Collaborative Project on Early Detection of Persons with
Harmful Alcohol Consumption—II. Addiction.
1993;88(6):791–804.
29.
IsaacsonJHButlerRZacharekMet alScreening with the Alcohol use Disorders Identification Test
(AUDIT) in an inner-city population. J Gen Intern
Med.
1994;9(10):550–553.
30.
BohnMJBaborTFKranzlerHR. The Alcohol Use Disorders
Identification Test (AUDIT): Validation of a screening instrument for use in
medical settings. J Stud Alcohol.
1995;56(4):423–132.
31.
DaeppenJBYersinBLandryUet alReliability and validity of the Alcohol Use Disorders
Identification Test (AUDIT) imbedded within a general health risk screening
questionnaire: Results of a survey in 332 primary care
patients. Alcohol Clin Exp Res.
2000;24(5):659–665.
32.
VolkRJSteinbauerJRCantorSBet alThe Alcohol Use Disorders Identification Test (AUDIT) as a screen
for at-risk drinking in primary care patients of different racial/ethnic
backgrounds. Addiction.
1997;92(2):
197–206.
33.
ClaussenBAaslandOG. The Alcohol Use Disorders
Identification Test (AUDIT) in a routine health examination of long-term
unemployed. Addiction.
1993;88(3):363–368.
34.
SkinnerHAAllenBA. Does the computer make a difference?
Computerized versus face-to-face versus self-report assessment of alcohol,
drug, and tobacco use. J Consult Clin
Psychol.
1983;51(2):267–275.
35.
GavinDRRossHESkinnerHA. Diagnostic validity of the drug abuse
Screening test in the assessment of DSM-III drug disorders.
Br J Addict.
1989;84(3):301–307.
36.
KesslerRCAndrewsGColpeLJet alShort screening scales to monitor population prevalences and
trends in non-specific psychological distress.
Psychol Med.
2002;32(6):959–976.
37.
BrooksRTBeardJSteelZ.Factor structure and interpretation of the K10.
Psychol Assess.
2006;18(1):62–70.
38.
AndrewsGSladeT.Interpreting scores on the Kessler Psychological Distress Scale
(K10). Aust N Z J Public Health.
2001;25(6):494–497.
39.
HidesLLubmanDIDevlinHet alReliability and validity of the Kessler 10 and Patient Health
Questionnaire among injecting drug users. Aust N Z J
Psychiatry.
2007;41(2):
166–168.
40.
LishJDDime-MeenanSWhybrowPCet alThe National Depressive and Manic-Depressive Association (DMDA)
survey of bipolar members. J Affect Disord.
1994;31(4):281–294.
41.
HirschfeldRMWilliamsJBSpitzerRLet alDevelopment and Validation of a screening instrument for bipolar
spectrum disorder: The Mood Disorder Questionnaire.
Am J Psychiatry.
2000;157(11):1873–1875.
42.
HirschfeldRMHolzerCCalabreseJRet alValidity of the Mood Disorder Questionnaire: A general population
study. Am J Psychiatry.
2003;160(1):178–180.
43.
MillerCJKlugmanJBervDet alSensitivity and specificity of the Mood Disorder Questionnaire
for detecting bipolar disorder. J Affect
Disord.
2004;81(2):167–171.
44.
LoweBGrafeKZipfelSet alDiagnosing ICD-10 depressive episodes: Superior criterion
validity of the Patient Health Questionnaire.
Psychother Psychosom.
2004;73(6):386–390.
45.
LoweBKroenkeKHerzogWet alMeasuring depression outcome with a brief self-report instrument:
Sensitivity to change of the Patient Health Questionnaire
(PHQ-9). J Affect Disord.
2004;81(1):61–66.
JenkinsRLewisGBebbingtonPet alThe National Psychiatric Morbidity Surveys of Great
Britain—initial findings from the household survey.
Int Rev Psychiatry.
2003;15(1–2):29–42.
48.
JohnsLCCannonMSingletonNet alPrevalence and correlates of self-reported psychotic symptoms in
the British population. Br J Psychiatry.
2004;185:298–305.
49.
Statistics CanadaCanadian Community Health Survey, Cycle 1.2—mental health and
well-being. Ottawa (ON):
Statistics Canada;
2003.
50.
SalizeHJHorstADillmann-LangeCet alNeeds for mental health care and service provision in single
homeless people. Soc Psychiatry Psychiatr
Epidemiol.
2001;36(4):207–216.
51.
SunSIrestigRBurstromBet alHealth-related quality of life (EQ-5D) among homeless persons
compared to a general population sample in Stockholm County,
2006. Scand J Public Health.
2012;40(2):115–125.
52.
McGlashanTHJohannessenJO. Early detection and intervention with
schizophrenia: Rationale. Schizophr Bull.
1996;22(2):201–222.
53.
WilsonJMGJungnerG.Principles and practice of screening for disease.
Geneva (CH): World Health
Organization; 1968.
54.
FirstMBWilliamsJBWSpitzerRLet alStructured Clinical Interview for DSM-IV-TR Axis I disorders, clinical
trials versions (SCID-CT). New York
(NY): Biometrics Research, New York State
Psychiatric Institute; 2007.
55.
LinnLSGelbergLLeakeB.Substance abuse and mental health status of homeless and
domiciled low-income users of a medical clinic. Hosp
Community Psychiatry.
1990;41(3):306–310.
56.
DesaiRALiu-MaresWDauseyDJet alSuicidal ideation and suicide attempts in a sample of homeless
people with mental illness. J Nerv Ment
Dis.
2003;191(6):365–371.
57.
FazelSKhoslaVDollHet alThe prevalence of mental disorders among the homeless in western
countries: Systematic review and meta-regression analysis.
PLoS Med.
2008;5(12):e225.
58.
FichterMQuadfliegN.Alcoholism in homeless men in the mid-nineties: Results from the
Bavarian Public Health Study on homelessness. Eur
Arch Psychiatry Clin Neurosci.
1999;249(1):34–44.
59.
KoegelPBurnamMAFarrRK. The prevalence of specific
psychiatric disorders among homeless individuals in the inner city of Los
Angeles. Arch Gen Psychiatry.
1988;45(12):
1085–1092.
60.
SusserEMooreRLinkB.Risk factors for homelessness. Epidemiol
Rev.
1993;15(2):546–556.
61.
GelbergLLinnLS. Psychological distress among homeless
adults. J Nerv Ment Dis.
1989;177(5):291–295.
62.
WongYL. Tracking change in psychological
distress among homeless adults: An examination of the effect of housing
status. Health Soc Work.
2002;27(4):262–273.
63.
FrankishCJHwangSWQuantzD.Homelessness and health in Canada: Research lessons and
priorities. Can J Public Health.
2005;96(Suppl
2):S23–S29.
64.
RegierDAFarmerMERaeDSet alComorbidity of mental disorders with alcohol and other drug
abuse. Results from the Epidemiologic Catchment Area (ECA)
Study. JAMA.
1990;264(19):2511–2518.
65.
WilesNJZammitSBebbingtonPet alSelf-reported psychotic symptoms in the general population:
Results from the longitudinal study of the British National Psychiatric
Morbidity Survey. Br J Psychiatry.
2006;188:519–526.
66.
RokachA.The loneliness of youth homelessness. Int
J Adolesc Youth. 2006;
13(1–2):
113–126.
67.
MunozMPanaderoSSantosEPet alRole of stressful life events in homelessness: An intragroup
analysis. Am J Community Psychol.
2005;35(1–2):35–47.
68.
PadgettDKSmithBTHenwoodBFet alLife course adversity in the lives of formerly homeless persons
with serious mental illness: Context and meaning. Am
J Orthopsychiatry.
2012;82(3):421–130.
69.
TsaiJRosenheckRA. Smoking among chronically homeless
adults: Prevalence and correlates. Psychiatr
Serv. 2012;63(6):
569–576.
70.
FichterMMQuadfliegN.Course of alcoholism in homeless men in Munich, Germany: Results
from a prospective longitudinal study based on a representative
sample. Subst Use Misuse.
2003;38(3–6):395–127.
71.
JohnsLCNazrooJYBebbingtonPet alOccurrence of hallucinatory experiences in a community sample and
ethnic variations. Br J Psychiatry.
2002;180:174–178.
72.
FolsomDJesteDV. Schizophrenia in homeless persons: A
systematic review of the literature. Acta Psychiatr
Scand.
2002;105(6):404–413.
73.
BoninJPFournierLBlaisR.Predictors of mental health service utilization by people using
resources for homeless people in Canada. Psychiatr
Serv.
2007;58(7):936–941.
74.
DrapeauABoyerRDialloFB. Discrepancies between survey and
administrative data on the use of mental health services in the general
population: Findings from a study conducted in Quebec.
BMC Public Health.
2011;11:837.
75.
BachrachLLTalbottJAMeyersonAT. The chronic psychiatric patient as a
“difficult” patient: A conceptual analysis. New Dir
Ment Health Serv.
1987;(33):35–50.
76.
GoldfingerSMHopkinJTSurberRW. Treatment resisters or system
resisters? Toward a better service system for acute care
recidivists. New Dir Ment Health Serv.
1984;(21):17–27.
77.
GelbergLGallagherTCAndersenRMet alCompeting priorities as a barrier to medical care among homeless
adults in Los Angeles. Am J Public Health.
1997;87(2):217–220.
78.
JoyceDPLimbosM.Identification of cognitive impairment and mental illness in
elderly homeless men: Before and after access to primary health
care. Can Fam Physician.
2009;55(11):1110–1111.e6.
79.
ColdwellCMBenderWS. The effectiveness of assertive
community treatment for homeless populations with severe mental illness: A
meta-analysis. Am J Psychiatry.
2007;164(3):393–399.
80.
LehmanAFDixonLBKernanEet alA randomized trial of assertive community treatment for homeless
persons with severe mental illness. Arch Gen
Psychiatry.
1997;54(11):
1038–1043.
81.
O'FlahertyBWWuT.Homeless shelters for single adults: Why does their population
change?Soc Serv Rev.
2008;82(3):511–550.
82.
RandallGBrownS.Helping rough sleepers off the streets. London
(GB): Office of the Deputy Prime
Minister; 2002.
