Homelessness and associated factors over a 13-year period among psychiatric in-patients in Berlin, Germany: routine data analysis

Abstract

Background Homeless patients in psychiatric hospitals are a scarcely studied and there is lack of knowledge about factors associated with homelessness and in-patient treatment. Aims To determine the change over time in the number of homeless psychiatric in-patients and to examine factors associated with homelessness. Method Retrospective data analysis of 1205 selected electronic patient files on psychiatric in-patient treatment in a university psychiatric hospital in Berlin, Germany. The rate of patients experiencing homelessness over a 13-year period (2008–2021) and the sociodemographic and clinical factors associated with homelessness are analysed over time. Results Our study revealed a 15.1% increase in the rate of homeless psychiatric in-patients over the 13-year period. Of the whole sample, 69.3% people lived in secure private housing, 15.5% were homeless and 15.1.% were housed in sociotherapeutic facilities. Homelessness was significantly associated with being male (OR = 1.76 (95% CI 1.12–2.76), born outside of Germany (OR = 2.22, 95% CI 1.47–3.34), lack of out-patient treatment (OR = 5.19, 95% CI 3.35–7.63), psychotic disorders (OR = 2.46, 95% CI 1.16–5.18), reaction to severe stress (OR = 4.19, 95% CI 1.71–10.24), personality disorders (OR = 4.98, 95% CI 1.92–12.91), drug dependency (OR = 3.47, 95% CI 1.5–8.0) and alcohol dependency (OR = 3.57, 95% CI 1.67–7.62). Conclusions The psychiatric care system is facing an increasing number of patients in precarious social situations. This should be considered in resource allocation planning in healthcare. Individual solutions for aftercare, along with supported housing, could counteract this trend.

Homeless people: a review of personality disorders

“…Fazel’s ( 8 ) systematic review and meta-regression analysis, drawing on data from 5684 homeless individuals, reported the prevalence of PD among the homeless in Western countries as 23.1% (CI 15.5%–30.8%). Similar data were observed in a population of 500 homeless patients in Portugal ( 13 ) and in Germany ( 14 ) both at 24%. While in Stockholm, a prevalence of 12% was reported in 1704 homeless patients receiving hospital care ( 15 ).…”

“…Homeless people with multiple diagnoses have greater mental health needs and worse general health determinants ( 9 , 13 ). A general synthesis of the prevalence of comorbid psychiatric disorders in homeless patients, according to reports reveals the following figures: psychotic disorders among 4.4%–57% ( 8 , 13 , 14 , 16 ); major depression among 11.4% ( 8 ); bipolar disorders among 11.4%–17.5% ( 8 , 16 ); alcohol dependence among 14.3%–37.9% ( 8 , 13 , 14 , 16 ); drug dependence among 14.3%–34% ( 8 , 13 , 14 , 16 ); acute stress reaction among 23%–24% ( 13 , 14 ); and anxiety disorder among 2.3% ( 16 ). These references are based on studies carried out in the USA, France, Japan, Portugal, and Germany.…”