Morbidity and housing status 10 years after shelter use—follow-up of homeless men in Helsinki, Finland (original) (raw)
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The Lancet, 2011
The increased mortality of homeless people compared with non-homeless people might be linked to psychiatric disorders. However, homeless people are, because of their insufficient accommodation, difficult to sample and monitor, which has limited previous studies. We aimed to assess registered psychiatric disorders, mortality, and predictors of mortality in the homeless shelter population in Denmark. We did a nationwide, prospective, register-based cohort study of homeless people aged 16 years and older who were registered in the Danish Homeless Register between Jan 1, 1999, and Dec 31, 2009. We calculated the proportion of registered psychiatric disorders, overall and cause-specific standardised mortality ratio (SMR), and life expectancy. Hazard ratios (HRs) were used to assess predictors of death. 32,711 homeless people (23,040 men and 9671 women) were included in the study population. 14,381 men (62·4%) and 5632 women (58·2%) had registered psychiatric disorders, and 11,286 men (49·0%) and 3564 women (36·9%) had a substance abuse diagnosis. During the study period, 3839 men (16·7%) and 951 women (9·8%) died. The overall SMR for men was 5·6 (95% CI 5·4-5·8) and for women was 6·7 (6·2-7·1), and external causes accounted for 1161 (27·9%) of 4161 deaths for which information on the cause was available. Remaining life expectancy at age 15-24 years was 21·6 years (95% CI 21·2-22·1) and 17·4 years (16·4-18·5) lower for homeless men and women, respectively, than the general population. Registered substance abuse disorder was associated with the highest mortality risk compared with no psychiatric contact registered (adjusted HR 1·4, 95% CI 1·3-1·5 for men; 1·7, 1·4-2·1 for women). Health problems are extensive in the homeless shelter population and there is an urgent need for more sustained efforts to reduce the high morbidity and mortality, especially from external causes. Register data is an important resource to supplement existing knowledge on homeless people with more valid and detailed information. The Danish Council for Independent Research.
The Determinants of Length of Homeless Shelter Stays: Evidence-Based Regression Analyses
International Journal of Public Health, 2022
Objective: To identify determinants that contribute to the length of homeless shelter stay.Methods: We utilized a unique dataset from the Homeless Management Information Systems from Boston, Massachusetts, United States, which contains 44,197 shelter stays for 17,070 adults between Jan. 2014 and May 2018.Results: Our statistical analyses and regression model analyses show that factors that contribute to the length of a homeless shelter stay include being female, senior, disability, being Hispanic, or being Asian or Black African. A significant fraction of homeless shelter stays (76%) are experienced by individuals with at least one of three disabilities: physical disability, mental health issues, or substance use disorder. Recidivism also contributes to longer homeless shelter stays.Conclusion: The results suggest possible program and policy implications. Several factors that contribute to longer homeless shelter stay, such as gender, age, disability, race, and ethnicity, may have f...
Mortality and causes of death among homeless in Finland: a 10-year follow-up study
Journal of Epidemiology and Community Health, 2017
Background: Homelessness is associated with increased mortality, and some predictors of mortality have been previously identified. We examined the overall and cause-specific mortality among homeless men in Helsinki and the associations of social background and health service use with mortality. Methods: To assess cause-specific mortality in a competing risks framework, we performed a registerbased, case–control study of 617 homeless men and an age-matched control group of 1240 men from the general population that were followed for 10 years between 2004 and 2014. Cox proportional hazards model was used to calculate HR for death and a competing risks model to calculate sub-HRs (sHR) for cause-specific death. Results: During the follow-up, 45.0% of the homeless died compared with 10.5% of controls (HR 5.38, 95% CI 4.39 to 6.59). The risk of death was particularly elevated for the homeless aged≤50 years (HR 10.3, 95% CI 7.0 to 15.2). External causes caused 34% of the deaths (sHR 11.2, 95% CI 6.8 to 18.2), but also deaths from medical causes were common (sHR 3.6, 95% CI 2.9 to 4.6). Age and somatic hospitalisation were significant predictors of death both among homeless and controls. Educational attainment, marital status, employment and psychiatric hospitalisation were significant predictors of mortality among the controls, but not among the homeless. Conclusions: Homelessness is associated with a fivefold mortality compared with the controls, and especially homeless aged ≤50 years have an increased risk of death. Being homeless eliminates the protective effects of marriage, employment and education on mortality risk.
Shelters for the Homeless: Learning from Research
ing and food. Moreover, some organizations offer emergency housing services while refusing to be associated with shelters. For example, in many cities, one may find shelters that serve both abused women and homeless families, while in Quebec the network of shelters for women who are victims of domestic violence are largely independent of those for homeless people. It would probably be more appropriate to use the term emergency housing measures . However, the larger shelters remain the best-known representatives of the services available to homeless people, as they are frequently mentioned in the media, particularly in crisis situations, when they are often overcrowded.
Examining the health status of homeless adults entering permanent supportive housing
Journal of Public Health, 2017
Background Permanent supportive housing (PSH) has been recognized as an effective intervention and the national policy for addressing chronic homelessness in the United States. Due to an aging cohort of homeless adults and prioritizing those who are most vulnerable for housing, the health status of those entering PSH is likely worse than those previously reported in the literature. Methods This report examined the self-reported health and health conditions of a sample of 421 homeless adults entering PSH between 2014 and 2016. The average age of our sample was 54 years old. Results Overall, 90% reported two or more chronic conditions (either physical or mental), 68% reported at least two chronic physical health conditions and 56% indicated at least two chronic mental health conditions. Describing their health status, 57% reported fair, poor or very poor health. Conclusions These findings suggest that access to housing will not easily remedy the well-documented premature mortality amo...
ABSTRACT The researcher investigated the homeless phenomenon including chronic homelessness. The investigation considered structural, social and individual factors that might act together to produce homelessness and or chronic homelessness (Gonzalez, No date). The United States Department of Housing and Urban Development [HUD] definition of chronic homelessness is an unaccompanied homeless individual who has a disabling condition and has been continuously homeless for a year or more or has had at least four episodes of homelessness in the past three years. To be considered chronically homeless, persons must have been sleeping in a place not meant for human habitation or living on the street(Homeless Planning Council of Delaware, 2005).The purpose of the study was to analyze factors that enable single males at one shelter to be chronically homeless. The research was a qualitative research study. The qualitative methodology emphasized participation in the lives of those studied so that the researcher can share as well as better understand a particular phenomenon. This qualitative research was all about exploring issues, understanding phenomenon, and answering questions.
Journal of Urban Health: Bulletin of the New York Academy of Medicine, 2002
The experience of homelessness is considered one of the most important social determinants of health. When people are forced to live without stable shelter, they are exposed to a number of risk factors for poor health and well-being, including harsh living environments, violence and unsafe conditions, drugs and alcohol, reduced access to health care, and existing or new physical and behavioral health issues. The daily struggles of being homeless-safety, food, shelter, clothing-limits or prevents individuals' capacity to focus on their physical and behavioral health care needs. This paper reviews the current state of homelessness in Colorado, explores the connection between homelessness and health, and identifies promising strategies that Colorado communities are using or may use to end homelessness, improve the health of their communities, and promote health equity. It is important to recognize the cyclical nature of homelessness. In examining the relationship between homelessness and health, some health problems may cause or contribute to homelessness, while other health problems are a consequence of homelessness. In either case, homelessness often complicates existing health problems. This paper primarily focuses on how health problems result from homelessness and how homelessness may exacerbate health issues specific to mental health, Substance Use Disorder (SUD), chronic disease, and violence. What is Homelessness? The U.S. Department of Housing and Urban Development (HUD), guided by the McKinney-Vento Act and the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act 1 , provides a definition for homelessness that includes four broad categories: 1. "People who are living in a place not meant for human habitation, in emergency shelter, in transitional housing, or are exiting an institution where they temporarily resided. 2. People who are losing their primary nighttime residence, which may include a motel or hotel or a doubled-up situation, within 14 days and lack resources or support networks to remain in housing. 3. Families with children or unaccompanied youth who are unstably housed and likely to continue in that state. 2 4. People who are fleeing or attempting to flee domestic violence, have no other residence, and lack the resources or support networks to obtain other permanent housing." 3 Researchers also define the extent or severity of homelessness using chronic homelessness, intermittent homelessness, and crisis or transitional homelessness. The causes of homelessness are complex and include factors that cross the social-ecological model and require an examination of interaction between the individual, relational, community, and societal levels. These include: 1 The HEARTH Act updates the McKinney-Vento Act by including people at imminent risk of becoming homeless and by providing a formal definition of chronic homelessness. 2 This is a new category of homelessness, and it applies to families with children or unaccompanied youth who have not had a lease or ownership interest in a housing unit in the last 60 or more days, have had two or more moves in the last 60 days, and who are likely to continue to be unstably housed because of disability or multiple barriers to employment.
Journal of Planning Literature
As governments and service agencies across the world grapple with chronic rates of homelessness and housing instability, there is a growing need to understand the value that providing secure, stable housing brings to the lives of people who are homeless and the broader community. The complex nature of homelessness is revealed across a variety of academic fields including planning, pharmacology, urban affairs, housing policy, nutrition, psychiatry, sociology, public health, urban health, and criminology. We undertook a scoping review according to PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis) that mapped the breadth and scale of the evidence-base and identified themes and gaps. We identified 476 reports and after excluding duplicates and ones that did not relate to our criteria, were left with 100 studies from eight countries. Each of them identified benefits and/or changes that occurred when people experiencing homelessness or housing insecurity transit...