Sixty-seven percent of people experiencing homelessness worldwide have a mental health disorder, according to a report published yesterday in JAMA Psychiatry. Additionally, the prevalence of mental health disorders among this population appears to be on the rise.

“The relationship between mental health disorders and homelessness is complex and bidirectional,” wrote Rebecca Barry, Ph.D., of the University of Calgary and colleagues. “[M]ental health disorders may lead to situations that result in homelessness, or homelessness may be a stressor contributing to the development or worsening of mental health disorder symptoms.”

Barry and colleagues combined data from 85 studies that investigated the current and/or lifetime prevalence of mental health disorders among adults aged 18 and older experiencing homelessness. The combined sample included 48,414 adults (77% male) from 19 countries—though about half the studies were from the U.S. or Canada.

The current prevalence of mental health disorders among people experiencing homelessness was 67%, while the lifetime prevalence was 77%. Additional findings included the following:

Males experiencing homelessness had a significantly higher lifetime prevalence of mental health disorders (86%) compared with females (69%).
Substance use disorders (including alcohol) were by far the most prevalent disorder identified, with a current prevalence of 44% and a lifetime prevalence of 56%.
Antisocial personality disorder was the second most common disorder, with a current prevalence of 26%, followed by major depression (19%), general mood disorders (18%), anxiety disorders (14%), psychotic disorders (14%), posttraumatic stress disorder (11%), bipolar disorder (8%), and schizophrenia (7%).
North America had the highest prevalence of mental disorders among people experiencing homelessness at 77% compared with Australia (47%), Asia (59%), and Europe (60%).

The authors also found that the prevalence of mental health disorders among people experiencing homelessness was higher in studies published after 2010 compared with those published earlier (76% vs 48%). They called this an important finding and posited that people with mental health disorders may be at increased risk of experiencing homelessness due to factors like housing affordability, limited access to care, low income, and problems reintegrating after receiving inpatient treatment.

“Conversely, the increase in prevalence could be the result of people experiencing homelessness being more likely to develop a mental health disorder due to stressors related to being unhoused, given the bidirectional relationship,” the authors continued. “Regardless, our finding that there is increasing prevalence of mental health disorders among people experiencing homelessness is concerning and effective strategies are needed to address the significant mental health needs of this population.”

For related information, see the Psychiatric News article “M.D.s Call for Community Resources Amid Plans to Force Homeless Into Care.”

(Image: Getty Images/iStock/Wirestock)

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