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The bidirectional association between psychiatric disorders and sheltered homelessness

Published online by Cambridge University Press:  08 September 2023

Sandra Feodor Nilsson Open the ORCID record for Sandra Feodor Nilsson [Opens in a new window] ,
Theresa Wimberley Open the ORCID record for Theresa Wimberley [Opens in a new window] ,
Helene Speyer ,
Carsten Hjorthøj Open the ORCID record for Carsten Hjorthøj [Opens in a new window] ,
Seena Fazel Open the ORCID record for Seena Fazel [Opens in a new window] ,
Merete Nordentoft Open the ORCID record for Merete Nordentoft [Opens in a new window]  and
Thomas Munk Laursen Open the ORCID record for Thomas Munk Laursen [Opens in a new window]
Sandra Feodor Nilsson*
Affiliation:
Copenhagen Research Center for Mental Health – CORE, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark
Theresa Wimberley
Affiliation:
The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark iPSYCH – The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Aarhus, Denmark
Helene Speyer
Affiliation:
Copenhagen Research Center for Mental Health – CORE, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Carsten Hjorthøj
Affiliation:
Copenhagen Research Center for Mental Health – CORE, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
Seena Fazel
Affiliation:
Department of Psychiatry, University of Oxford, UK and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
Merete Nordentoft
Affiliation:
Copenhagen Research Center for Mental Health – CORE, Copenhagen University Hospital – Mental Health Services CPH, Copenhagen, Denmark iPSYCH – The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Aarhus, Denmark Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Thomas Munk Laursen
Affiliation:
The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
*
Corresponding author: Sandra Feodor Nilsson; Email: sandra.feodor.nilsson@regionh.dk
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Abstract

Background

Psychiatric disorders and homelessness are related, but temporal associations are unclear. We aimed to explore the overlap between hospital-based psychiatric disorders and sheltered homelessness.

Methods

This population-based cohort study was conducted using the Danish registers e.g., the Danish Homeless Register and the Danish National Patient Register. The study cohort included all individuals aged 15 years or older, living in Denmark at least one day during 2002–2021 (born 1984–2006). First psychiatric diagnosis was used to define psychiatric disorder and first homeless shelter contact to define homelessness. Adjusted incidence rate ratios (IRRs) and cumulative incidences were estimated.

Results

Among 1 530 325 individuals accounting for 16 787 562 person-years at risk aged 15–38 years, 11 433 (0.8%) had at least one homeless shelter contact. Among 1 406 410 individuals accounting for 14 131 060 person-years at risk, 210 730 had at least one psychiatric disorder. People with any psychiatric disorder had increased risk of sheltered homelessness relative to individuals with no psychiatric disorder [IRR 9.2, 95% confidence interval (CI) 8.8–9.6]. Ten years after first psychiatric disorder, 3.0% (95% CI 2.9–3.1) had at least one homeless shelter contact. Individuals experiencing homelessness had increased risk of any psychiatric disorder compared to individuals with no homeless shelter contact (IRR 7.0, 95% CI 6.7–7.4). Ten years after first homeless shelter contact, 47.1% (45.3–48.0) had received a hospital-based psychiatric diagnosis.

Conclusion

Strong bidirectional associations between psychiatric disorders and homelessness were identified. Health and social care professionals should be aware of and address these high risks of accumulated psychiatric and social problems.

Keywords

Health policyhomeless youthill-housed personsminority groupspsychiatrypublic healthsocial determinants of healthsubstance-related disorders
Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 4 , March 2024 , pp. 742 - 752
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Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

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