BACKGROUND:
Homelessness
is associated with a very high prevalence of substance use and mental disorders
and elevated levels of acute health service use. Among the homeless, little is
known regarding the relative impact of specific mental disorders on healthcare
utilization. The aim of the present study was to examine the association
between different categories of diagnosed mental disorders with hospital admission
and length of stay (LOS) in a cohort of homeless adults in Vancouver, Canada.
METHODS:
Participants
were recruited as part of an experimental trial in which participants met
criteria for both homelessness and mental illness. Administrative data were obtained
(with separate consent) including comprehensive records of acute
hospitalizations during the 10 years prior to recruitment and while
participants where experiencing homelessness. Generalized Estimating Equations
were used to estimate the associations between outcome variables (acute
hospital admissions and LOS) and predictor variables (specific disorders).
RESULTS:
Among the
eligible sample (n = 433) 80 % were hospitalized, with an average of 6.0
hospital admissions and 71.4 days per person during the 10-year
observation period. Of a combined total 2601 admissions to hospital, 1982 were
psychiatric and 619 were non-psychiatric. Significant (p <0.001) independent
predictors of hospital admission and LOS included a diagnosis of schizophrenia
or bipolar disorder, as well as high (≥32 service contacts) non-psychiatric
medical service use in the community.
CONCLUSIONS:
Our
results demonstrate that specific mental disorders alongside high
non-psychiatric service use were significantly associated with hospital
admission and LOS. These findings suggest the importance of screening within
the homeless population to identify individuals who may be at risk for acute
illness and the implementation of services to promote recovery and prevent
repeated hospitalization.
Below: Acute hospitalization before recruitment for ‘At Home’ participants (n = 433)
Below: Hospital days before recruitment for ‘At Home’ participants (n = 433)
- 1Faculty of Health Sciences, Simon Fraser University, Simon Fraser University 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. arussoli@sfu.ca.
- 2Faculty of Health Sciences, Simon Fraser University, Simon Fraser University 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. akm_moniruzzaman@sfu.ca.
- 3Faculty of Health Sciences, Simon Fraser University, Simon Fraser University 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. spa16@sfu.ca.
- 4Faculty of Health Sciences, Simon Fraser University, Simon Fraser University 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. clauren@sfu.ca.
- 5Faculty of Health Sciences, Simon Fraser University, Simon Fraser University 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. jsomers@sfu.ca.
- BMC Health Serv Res. 2016 Feb 17;16(1):60. doi: 10.1186/s12913-016-1316-7.
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