Abstract
Psychiatric patients are at increased risk of adverse life events, such as being incarcerated and homelessness in their life course. Using data from a cross-sectional multicenter study of 2,475 patients selected from 26 mental health services in Brazil, we examined the association of sociodemographic, clinical, behavioral, and adverse life characteristics with history of homelessness, incarceration or their co-occurrence during lifetime. Odds ratios were obtained by multinomial logistic regression models. The prevalence of homelessness, incarceration and co-occurrence of these two conditions were 8.6%, 16.4%, and 9.4%, respectively. Lower income, living in unstable condition, intellectual disability, and cigarette smoking were associated with homelessness. Being male, lower schooling, sex under effect of alcohol or drugs, and multiple sex partners were associated with incarceration. Psychiatric hospitalizations, substance use, and history of sexually transmitted diseases, and sexual, physical, or verbal violence were associated with co-occurrence of both conditions. Our findings suggest that incarceration and homelessness are very prevalent and correlated in psychiatric patients in Brazil. Many of the associated factors are potentially modifiable, and may act synergistically requiring integrated care.
Highlights
Individuals with mental illness are potentially vulnerable to a higher risk of several health conditions and they often live under disadvantage social contexts with increased risk of adverse life events, including being incarcerated and having episodes of homelessness in their life course[1,2]
Two hundred and twelve (8.6%) participants had a history of homelessness only; 405(16.4%) of incarceration only, and the co-occurrence of homelessness and incarceration were reported by 232(9.4%) participants
The association of sociodemographic, clinical, behavioral, and adverse life characteristics with the events studied indicated a high proportion of patients who experienced homelessness (8.6%), incarceration (16.4%) and the co-occurrence of homelessness and incarceration (9,4%) in their lifetime
Summary
Individuals with mental illness are potentially vulnerable to a higher risk of several health conditions and they often live under disadvantage social contexts with increased risk of adverse life events, including being incarcerated and having episodes of homelessness in their life course[1,2]. A national survey in the USA (N=6,953) reported high prevalence of mental illness, substance abuse, previous arrests, and prior episodes of homelessness among jail inmates[4]. Various authors indicate that approximately 50%80% among homeless people have a history of mental illness, suffer from substance use disorders, and have histories of previous incarceration[5,6,7,8,9,10]. Incarceration and homelessness share many factors and this intertwined relationship poses those with history of both conditions at the greatest risk of suffering from mental health issues and substance abuse[12]
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