Differential patterns of mental disorders among the homeless in Madrid (Spain) and Los Angeles (USA)

Abstract

In this paper we compare rates of mental disorders (major depression, dysthymia, cognitive impairment, and schizophrenia) among homeless people in Madrid and Los Angeles (LA) and examine the ordering of the onset of both conditions (i.e., homelessness and mental disorders). In the Madrid study, 262 homeless persons were interviewed using the CIDI. In the LA study, 1563 homeless persons were interviewed with the DIS. To make an item-by-item comparison, we companied the databases from both studies to submit a single database to statistical analyses. Results showed no significant differences in DSM-III-R life-time prevalence rates of mental disorders between both samples. However, the Madrid sample showed higher 12-month prevalence rates of dysthymia and cognitive impairment as compared to the LA sample. Most subjects across both cities first experienced symptoms of their mental disorders before first becoming homeless. The only significant difference was that all of the depressed adults in Madrid experienced depression prior to first becoming homeless, whereas this was the case for only 59.1% of LA depressed homeless people. We discuss the reasons for these cultural differences and their implications for cross-national public health research and intervention.

Time Perspective, Depression, and Substance Misuse Among the Homeless

“…Nevertheless, the self-reported high levels of depression among our homeless sample are consistent with other studies reporting a high incidence of clinical depression using standardised diagnostic criteria in this population (e.g., Muñoz et al, 1998).…”

“…Among the homeless, there is ample evidence of depression. One large survey of homeless people, in Madrid and Los Angeles found rates of 14.9% and 17.5%, respectively (Muñoz, Vázquez, Koegel, Sanz & Burnam, 1998). Therefore, it is important to consider levels of concurrent depression when examining time orientation among the homeless.…”

A Typology of Mentally Disordered Users of Resources for Homeless People: Towards Better Planning of Mental Health Services

“…Focusing specifically on homeless persons with mental illness, identified with the use of Diagnosis Interview Schedule (DIS; Robins et al 1981), and with the use of Ward's hierarchical aggregates model, Shepherd identified nine stable profiles in the sample (N = 6,180): malingerers, those with depression and alcoholism, symptom minimizers, psychotic avoiders, service avoiders, newly homeless, local ethnic minorities, women with children, and healthy families. While this study shed further light on the heterogeneity among homeless mentally ill people, it is unclear whether it was representative of the general homeless population, since it included clientele of a special program (ACCESS) and revealed significantly more psychotic disorders than other studies (e.g., Fournier 2001;Munoz et al 1998). The study also included a large African-American population-a distinct difference from Canada's homeless population (Fournier 2001;Goering et al 2002).…”

Safe Living: The Impact of Unstable Housing Conditions on HIV Risk Reduction Among Female Drug Users

“…Unstable housing conditions have been associated with poor physical health, mental illness, and drug use (Gelberg 1990;Nyamathi et al 2000;Nyamathi, Leake and Gelberg 2000). In addition, individuals with unstable housing conditions are reported to be disproportionately affected by the HIV/AIDS epidemic (Munoz et al 1998;Robertson et al 2004;Zolopa et al 1994).…”