Mental illness among 500 people living homeless and referred for psychiatric evaluation in Lisbon, Portugal

Abstract

Background Our goal was to identify the demographic profile of the people living homeless with mental illness in Lisboa, Portugal, and their relationship with the national healthcare system. We also tried to understand which factors contribute to the number and duration of psychiatric admissions among these homeless people. Methods We used a cross-sectional design, collecting data for 4 years among homeless people, in Lisboa, Portugal, that were referred as possible psychiatric patients to Centro Hospitalar Psiquiátrico de Lisboa (CHPL). In total, we collected data from 500 homeless people, then crosschecked these people in our CHPL hospital electronic database and obtained 467 patient matches. Results The most common psychiatric diagnosis in our sample was drug abuse (34%), followed by alcohol abuse (33%), personality disorder (24%), and acute stress reaction (23%). Sixty-two percent of our patients had multiple diagnoses, a subgroup with longer follow-ups, more psychiatric hospitalizations, and longer psychiatric hospitalizations. The prevalence of psychotic disorders was high: organic psychosis (17%), schizophrenia (15%), psychosis not otherwise specified (14%), and schizoaffective disorder (11%), that combined altogether were present in more than half (57%) of our homeless patients. Conclusion The people living homeless with multiple diagnoses have higher mental health needs and worse determinants of general health. An ongoing effort is needed to identify and address this subgroup of homeless people with mental illness to improve their treatment and outcomes.

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 ).…”

“…A substantial number of psychiatric disorders are well documented in homeless populations ( 13 ). Homeless people with multiple diagnoses have greater mental health needs and worse general health determinants ( 9 , 13 ).…”

“…A substantial number of psychiatric disorders are well documented in homeless populations ( 13 ). 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 ).…”

Schizoaffective disorder in homeless patients: A systematic review

“…At that time, authors suggested that further studies were needed for a better understanding of schizoaffective disorder among the homeless population (Nardacci et al, 1993). In more recent European studies, of 500 homeless people, the prevalence of schizoaffective disorder was 11% (Monteiro Fernandes et al, 2021), and the homeless with schizoaffective disorder had a statistically significant longer follow-ups, a higher median of psychiatric hospitalizations, and a higher median duration of total psychiatric hospitalizations (Ayano et al, 2019). Therefore, following the scarce existence of literature regarding the topic (Fazel et al, 2008), the authors propose to do a review aiming to study the relation between schizoaffective disorder and homelessness.…”

Personality and attachment in the homeless: A systematic review

“…Bento and Barreto (2002) have been working with homeless people with mental illness, with different organizations, for a large number of years that altogether surpass the fifty years mark. To this day, they provide scientific literature regarding mental illness of homeless people, contributing to Portuguese studies (Monteiro Fernandes et al, 2022) and European guidelines (Barreto et al, 2019). Bento and Barreto (2002) could easily be considered our charismatic leaders who could bring people together and who held on to a vision, two of a kind of that homelessness needed champion especially in nonhousing agencies such as the health authority (Pannel & Parry, 1999).…”