Ethnographic research suggests the homeless population may be evolving over recent decades. Changes in rates of psychiatric disorders could have profound service implications for this population. Lacking longitudinal data to track these rates, the next best means of examining this problem is to compare available data sets from separate epidemiologic studies using identical or similar sampling strategies (the purpose of this presentation). Three relevant data sets collected in three consecutive decades in St. Louis are the Epidemiological Catchment Area (ECA) residential data obtained in 1981-2 (N=150 lifetime homeless) and data from two homeless population epidemiologic studies in 1989-90 (N=900) and 2000-01 (N=400). The Diagnostic Interview Schedule (DIS) or the Composite International Diagnostic Interview/Substance Abuse Module (CIDI/SAM) (2000-01 sample, substance-related diagnoses only) provided lifetime psychiatric diagnoses in all three samples. Significant increases in rates over the last two decades were found for alcohol and drug use disorder, major depression, and bipolar disorder, with modest increases in schizophrenia. Antisocial personality disorder rates held relatively steady across time. Psychiatric disorders among the homeless appear to be generally increasing. The findings support the need for increasing opportunities and access for mental illness and substance abuse treatment for homeless populations. Methodological limitations include variation in: 1) homelessness definition (current vs. lifetime), 2) changing diagnostic criteria (DSM III to III-R to IV), 3) sampling locations and procedures (ECA sample only), and 4) instrumentation (CIDI for substance abuse in most recent sample).
Learning Objectives: 1. To describe changes in prevalence rates of psychiatric disorders in the homeless population over time. 2. To explain possible factors contributing to these changes. 3. To discuss the impact of these changes on current service needs in this population.
Keywords: Homeless, Psychiatric Epidemiology
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.