Homelessness linked to previous health problems
Health problems associated with chronic homelessness have been well documented. These range from increased rates of infectious diseases, including pneumonia, tuberculosis and HIV, to long-term conditions such as cardiovascular disease and COPD. Mental health disorders are common in the homeless, as are smoking, alcohol misuse and illicit drug use.
This paper took the novel approach of assessing the health impact of becoming homeless. It also measured the effects of finding housing or remaining homeless, on the health of the participants.
The study surveyed 445 newly homeless respondents between the ages of 18 and 65 living in shelter care in New York City. Follow-up data were collected on 351 participants over 18 months. The investigation comprised baseline and follow-up interviews by trained interviewers in either English or Spanish. Mental health problems were recorded with reference to the DSM-IV criteria, and physical health data were gathered using a 36-item short health survey.
Slightly more than half of the baseline sample were men, with the majority of respondents belonging to minority ethnic groups. The mean age of participants was 36.9 years, and more that 85% were unemployed when they entered the shelter system. At 18 months 265 respondents had found housing and 86 remained homeless.
At the time they became homeless, the study participants had significantly higher rates of physical illness (including hypertension and diabetes), major depression and substance use disorders than participants in general population surveys.
It is intriguing to note that, despite becoming homeless, the survey group's health did not worsen; indeed in some areas it actually improved. The authors argue that this may represent regression to the mean, or may represent the quality of health services provided to those within the New York City shelter system, which includes case worker support in accessing the Medicaid system.
The group that remained homeless had higher morbidity rates and showed less improvement in their health than those who found housing.
The results highlight the active nature of the study participants' health problems before they became homeless. People with a high risk of homelessness may not fully access health services.
People struggling under the combined burdens of residential instability, poor social networks and significant physical and mental health problems are at risk of becoming homeless. It is possible that easy-to-access, high-quality medical and social services in the community may enable those living with poverty to improve their health status and avoid becoming homeless.
Schanzer B, Dominguez B, Shrout PE. Homelessness, Health Status and Health Care Use Am J Pub Health 2007;97: 464-469Reviewer
Dr Jez Thompson
Former GP, Clinical Director, Leeds Community Drug Services