Abstract
BackgroundSchizophrenia and other psychotic disorders constitute a huge global burden of disease and they are major contributors to disability as well as premature mortality among homeless people. This systematic review and meta-analysis aimed to estimate the pooled prevalence of schizophrenia and other psychotic disorders among homeless people.MethodsPubMed, Embase, and Scopus were searched to identify pertinent studies. We used a fixed- or random-effect meta-analysis to pool data from the included studies depending on the anticipated heterogeneity. A predesigned search strategy, as well as inclusion and exclusion criteria, were used. We also performed subgroup and sensitivity analysis and Cochran’s Q- and the I2 test was employed to compute heterogeneity. Egger’s test and visual inspection of the symmetry in funnel plots were used to assess publication bias.ResultsThirty-one studies involving 51,925 homeless people were included in the final analysis. The meta-analysis showed a remarkably higher prevalence of psychosis [21.21% (95% CI:13.73, 31.29), I2 = 99.43%], schizophrenia [10.29% (95%, CI: 6.44, 16.02), I2 = 98.76%], schizophreniform disorder [2.48% (95% CI: 6.16, 28.11), I2 = 88.84%] schizoaffective disorder [3.53% (95% CI: 1.33, 9.05), I2 = 31.63%,] as well as psychotic disorders not otherwise specified [9% (95% CI: 6.92, 11.62), I2 = 33.38%] among homeless people. The prevalence estimate of psychosis was higher in developing (29.16%) as compared to developed (18.80%) countries. Similarly, the prevalence of schizophrenia was highest in developing (22.15%) than developed (8.83%) countries.ConclusionThis systematic review and meta-analysis revealed that schizophrenia and other psychotic disorders are highly prevalent among homeless people, indicating an urgent need for studies to help develop better mechanisms of prevention, detection as well as treatment of those disorders among homeless people.
Highlights
Schizophrenia and other psychotic disorders constitute a huge global burden of disease and they are major contributors to disability as well as premature mortality among homeless people
There are previous systematic reviews on overall mental disorders and psychosis among homeless people, to our knowledge, this is the first systematic review and meta-analysis aimed to provide the pooled prevalence estimates of schizophrenia and other psychotic disorders among the homeless. we hypothesized that the prevalence of schizophrenia and other psychotic disorders are notably high among homeless people
Our analysis resulted in a remarkably higher prevalence of overall psychosis (21.21%), schizophrenia (10.29%), schizophreniform disorder (2.48%), schizoaffective disorder (3.53%), as well as psychotic disorders not otherwise specified (9%) among homeless people The findings of our meta-analysis highlighted that the prevalence of schizophrenia and other psychotic disorders were higher among homeless people as compared to the reported prevalence in the general population
Summary
Schizophrenia and other psychotic disorders constitute a huge global burden of disease and they are major contributors to disability as well as premature mortality among homeless people. As compared to the general population, homeless people suffer from a greater prevalence of psychiatric disorders including schizophrenia and other psychotic disorders [7, 8]. The reported magnitude of mental disorders among homeless people ranged from 25 to 50% across the studies [9,10,11]. Epidemiologic evidence from several studies has shown that schizophrenia and other psychotic disorders are among the most common psychiatric disorders among homeless people [7, 8, 16] and they are associated with a greater risk of comorbid physical disease, substance use, and disability as well as mortality from different causes [12,13,14, 16,17,18]. The impacts of psychotic disorders among homeless people could be severe and extensive, it negatively impacts the homeless person suffering from it, the family, relatives and other population [12, 15, 23, 24]
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