Medical complications of homelessness: a neglected side of men’s health

Abstract

Background Homelessness is an increasing societal and health issue associated with high rates of substance abuse and mental health disorders. Homeless people die more often and at a younger age than others. Aim To identify health needs and improve healthcare for homeless men. Methods A physician‐led clinic was established on‐site at the Mission Australia Centre in Sydney, incorporating: (i) liver screening, including portable fibroscan testing, and on‐site treatment of hepatitis C; (ii) a mental health clinic, staffed by a psychiatrist; and (iii) a nurse‐led clinic to follow up medical issues and deliver vaccinations. Patient data were recorded prospectively to determine what medical problems were encountered so as to drive future healthcare planning. Results A total of 257 men was assessed between November 2011 and December 2017. In that time, 561 men resided at the Centre. Of these 257 men who attended the clinic, 61% were <45 years old; 69% were current and 8% former smokers; 62% had a history of chronic alcoholic abuse and 66% other substance abuse; 64% had one or more of depression, anxiety, psychosis or another mental health disorder and 44% had metabolic syndrome features, 38% cardiovascular disease, 29% hepatitis C and 21% a respiratory disorder. Conclusion The main health needs of homeless men fall into the categories of mental health; cardiovascular, respiratory and metabolic disorders and addictions and hepatitis C. Establishing on‐site clinics at homeless shelters with expertise to address these issues will likely improve the well‐being of these men, reduce hospital admissions and prolong their lives.

Prevalence and Risk Factors of Metabolic Syndrome among the Homeless in Taipei City: A Cross-Sectional Study

“…Based on results, we found that the prevalence of MetS among the homeless in Taipei was 53%, those meeting four or more diagnostic conditions (DCs) accounted for 50% of the MetS patients, while patients meeting all five DCs accounted for 20%. Compared with the results of previous studies, the prevalence of MetS among the homeless in South Florida of US, Ireland, and Sydney of Australia was 29.5%, 22% and 44%, respectively [28][29][30]. Moreover, among the homeless patients with MetS in South Florida, the proportion meeting four DCs was only 7%, while the number of sample individuals meeting all five DCs was 0 [28].…”

“…The smoking rate among the homeless adults in Taipei was 56%, and the drinking rate was only 24%. Among the Sydney homeless adults, 69% smoked and 62% had a history of chronic alcohol abuse [30]. The smoking rate of Ireland homeless adults was 78%, and the drinking rate was 93% [29].…”

“…Scott et al (2013) examined 252 homeless adults in Ireland and found that 22% were patients with MetS, of which the smoking rate was 78%, the drinking rate was 93%, 90% had abdominal obesity, and the patients with MetS were significantly older than those without MetS [29]. A health survey of 257 homeless men in Sydney found that 44% had MetS, 69% were smokers, 62% had a history of chronic alcohol abuse, and 29% had hepatitis C [30]. Baggett et al (2018) pointed out that depression, anxiety, and a high smoking rate of 68%-80% were the main risk factors for MetS of the homeless [31].…”

Comparison of homeless clinic attenders with and without psychotic illness

“…Substance use among people with psychotic illness may be a consequence of homelessness among people with psychosis as much as a cause, from living in an environment where substances are freely available and peer pressure to participate is common (Teesson et al, 2000) and as a way of coping with the stress of not having a safe place to live. Complications of substance use among the homeless with psychotic illness include poor physical health (Brown et al, 2018;Nielssen et al, 2017) and increased mortality (Babidge et al, 2001). Continued substance use also acts as barrier to returning to stable accommodation for many patients, both due to the priority given to substance use over paying rent and because of the effect of daily intoxication on organisational skills and other aspects of social performance.…”

Depression Prevalence, Antidepressant Treatment Status, and Association with Sustained HIV Viral Suppression Among Adults Living with HIV in Care in the United States, 2009–2014

“…We constructed three models: (1) estimating the prevalence ratio of sustained viral suppression for those with any versus no depression, (2) estimating the prevalence ratio of sustained viral suppression for those with untreated depression or treated depression separately versus no depression, and (3) estimating the prevalence ratio of sustained viral suppression for those with treated versus untreated depression. Each model was adjusted for gender [30,31], race [31,32], homelessness [33,34], health insurance status [35,36], drug use [15,37], and time since HIV diagnosis [38,39]. In all multivariable analyses we included variables as potential confounders that were a priori and statistically determined to be significantly associated with any depression and sustained viral suppression (p ≤ 0.05).…”