Subscribe to RSS
DOI: 10.1055/s-0042-111742
Psychische Krankheit und subjektive Gesundheit bei Wohnungslosen in Zürich
Erste Prävalenzdaten aus der SchweizMental Disorder and Self-Rated Health Among Homeless People in ZurichFirst Epidemiological Data from SwitzerlandPublication History
Publication Date:
14 September 2016 (online)
Zusammenfassung
Anliegen Untersuchung der psychiatrischen Morbidität und der subjektiven Gesundheit (self-rated health, SRH) bei Wohnungslosen in der Stadt Zürich.
Methode Querschnittsstudie bei Wohnungslosen (n = 338) in Zürich und Vergleich der SRH mit jener der Allgemeinbevölkerung (n = 21 597).
Ergebnisse Bei 96 % der Wohnungslosen lag mindestens eine psychiatrische Diagnose vor, am häufigsten Drogen- oder Alkoholabhängigkeit. Wohnungslose bewerteten ihre Gesundheit signifikant schlechter als die Allgemeinbevölkerung.
Schlussfolgerungen Auch in Zürich sind Wohnungslose weit häufiger von psychischer Krankheit betroffen als die Allgemeinbevölkerung. Die SRH ist ein Indikator für die effektive Gesundheit und ist mit der Inanspruchnahme medizinischer Leistungen assoziiert.
Abstract
Objective This study aims to assess psychiatric morbidity and self-rated health (SRH) of homeless people in Zurich, Switzerland.
Methods Cross-sectional study of N = 338 homeless people, assessement of psychiatric disorders (ICD-10), level of functioning (GAF, HoNOS), self-rated health. Comparison of SRH among homeless people with a sample of Zurich (N = 956) and Swiss (N = 21 579) population.
Results 96 % of the homeless people had at least one psychiatric disorder, most of them drug- (60.9 %) or alcohol-dependence (41.5 %). Homeless people had a far lower SRH than the Zurich population. Higher impairment in HoNOS was associated with lower levels of SRH. Low SRH was associated with help care seeking (OR = 1.9, p < 0.001) and medication (OR = 1.5, p = 0.006).
Conclusions The prevalence of psychiatric disorders is far higher among homeless people compared to the general population in Zurich. Implications for providing help at the intersection of social and health care are discussed.
-
Literatur
- 1 Fazel S, Khosla V, Doll H. et al. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med 2008; 5: e225
- 2 Kellinghaus C, Eikelmann B, Ohrmann P. et al. Wohnungslos und psychisch krank. Überblick über den Forschungsstand und eigene Ergebnisse zu einer doppelt benachteiligten Randgruppe. Fortschr Neurol Psychiatr 1999; 67: 108-121
- 3 Fichter MM, Quadflieg N. Prevalence of mental illness in homeless men in Munich, Germany: results from a representative sample. Acta Psychiatr Scand 2001; 103: 94-104
- 4 Salize HJ, Horst A, Dillmann-Lange C. et al. Wie beurteilen psychisch kranke Wohnungslose ihre Lebensqualität?. Psychiat Prax 2001; 28: 75-80
- 5 Längle G, Egerter B, Albrecht F. et al. Prevalence of mental illness among homeless men in the community – approach to a full census in a southern German university town. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 382-390
- 6 Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet 2014; 384: 1529-1540
- 7 Bhui K, Shanahan L, Harding G. Homelessness and mental illness: a literature review and a qualitative study of perceptions of the adequacy of care. Int J Soc Psychiatry 2006; 52: 152-165
- 8 Nusselder WJ, Slockers MT, Krol L. et al. Mortality and life expectancy in homeless men and women in Rotterdam: 2001 – 2010. PLoS One 2013; 8: e73979
- 9 Susser E, Struening EL, Conover S. Psychiatric problems in homeless men. Lifetime psychosis, substance use, and current distress in new arrivals at New York City shelters. Arch Gen Psychiatry 1989; 46: 845-850
- 10 Cohen CI, Thompson KS. Homeless mentally ill or mentally ill homeless?. Am J Psychiatry 1992; 149: 816-823
- 11 Rössler W, Salize HJ, Biechele U. Psychisch kranke Wohnsitzlose – Die vergessene Minderheit. Psychiat Prax 1994; 21: 173-178
- 12 Hwang SW, Burns T. Health interventions for people who are homeless. Lancet 2014; 384: 1541-1547
- 13 Organisation for Economic Co-operation and Development (OECD). Health Data 2014. Im Internet: www.oecd.org (Stand: 05.02.2016)
- 14 Jaeger M, Briner D, Kawohl W. et al. Psychosocial functioning of individuals with schizophrenia in community housing facilities and the psychiatric hospital in Zurich. Psychiatry Res 2015; 230: 413-418
- 15 Canavan R, Barry MM, Matanov A. et al. Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities. BMC Health Serv Res 2012; 12: 222
- 16 Coldwell CM, Bender WS. The effectiveness of assertive community treatment for homeless populations with severe mental illness: a meta-analysis. Am J Psychiatry 2007; 164: 393-399
- 17 Nelson G, Aubry T, Lafrance A. A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. Am J Orthopsychiatry 2007; 77: 350-361
- 18 O’Campo P, Kirst M, Schaefer-McDaniel N. et al. Community-based services for homeless adults experiencing concurrent mental health and substance use disorders: a realist approach to synthesizing evidence. J Urban Health 2009; 86: 965-989
- 19 Briner D, Erlinger U. Aufsuchende Hilfen. In: Rössler W, Kawohl W. Hrsg. Soziale Psychiatrie. Stuttgart: Kohlhammer; 2013: 162-171
- 20 Schuz B, Wurm S, Schollgen I. et al. What do people include when they self-rate their health? Differential associations according to health status in community-dwelling older adults. Qual Life Res 2011; 20: 1573-1580
- 21 Larsson D, Hemmingsson T, Allebeck P. et al. Self-rated health and mortality among young men: what is the relation and how may it be explained?. Scand J Public Health 2002; 30: 259-266
- 22 DeSalvo KB, Fan VS, McDonell MB. et al. Predicting mortality and healthcare utilization with a single question. Health Serv Res 2005; 40: 1234-1246
- 23 Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 1997; 38: 21-37
- 24 Fleishman JA, Zuvekas SH. Global self-rated mental health: associations with other mental health measures and with role functioning. Med Care 2007; 45: 602-609
- 25 Ahmad F, Jhajj AK, Stewart DE. et al. Single item measures of self-rated mental health: a scoping review. BMC Health Serv Res 2014; 14: 398
- 26 Levinson D, Kaplan G. What does Self Rated Mental Health Represent. J Public Health Res 2014; 3: 287
- 27 Burns RA, Sargent-Cox K, Mitchell P. et al. An examination of the effects of intra and inter-individual changes in wellbeing and mental health on self-rated health in a population study of middle and older-aged adults. Soc Psychiatry Psychiatr Epidemiol 2014; 49: 1849-1858
- 28 Scott J. Homelessness and mental illness. Br J Psychiatry 1993; 162: 314-324
- 29 Sheehan DV, Lecrubier Y, Sheehan KH. et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 (Suppl. 20) 22-33
- 30 Wittchen H-U, Wunderlich U, Gruschwitz S. et al. SKID I. Strukturiertes Klinisches Interview für DSM-IV. Achse I: Psychische Störungen. Interviewheft und Beurteilungsheft. Eine deutschsprachige, erweiterte Bearb. d. amerikanischen Originalversion des SKID I. Göttingen: Hogrefe; 1997
- 31 Andreas S, Harfst T, Rabung S. et al. The validity of the German version of the Health of the Nation Outcome Scales (HoNOS-D): a clinician-rating for the differential assessment of the severity of mental disorders. Int J Methods Psychiatr Res 2010; 19: 50-62
- 32 Theodoridou A, Jaeger M, Ketteler D. et al. The concurrent validity and sensitivity of change of the German version of the health of the nation outcome scales in a psychiatric inpatient setting. Psychopathology 2011; 44: 391-397
- 33 APA. Diagnostic and Statistical manual of mental disorders DSM-IV. Washington, DC: American Psychiatric Association; 1994
- 34 Andreani T. Schweizerische Gesundheitsbefragung. Neuchâtel: Bundesamt für Statistik; 2014
- 35 Reinking DP, Wolf JR, Kroon H. High prevalence of mental disorders and addiction problems among the homeless in Utrecht. Ned Tijdschr Geneeskd 2001; 145: 1161-1166
- 36 Meller I, Fichter M, Quadflieg N. et al. Die Inanspruchnahme medizinischer und psychosozialer Dienste durch psychisch erkrankte Obdachlose. Ergebnisse einer epidemiologischen Studie. Nervenarzt 2000; 71: 543-551
- 37 Salize HJ, Arnold M, Uber E. et al. Verbesserung der psychiatrischen Behandlungsprävalenz bei Risikopersonen vor dem Abrutschen in die Wohnungslosigkeit. Psychiat Prax
- 38 Burns T, Catty J, Wright C. De-constructing home-based care for mental illness: can one identify the effective ingredients?. Acta Psychiatr Scand Suppl 2006; 429: 33-35
- 39 Leisse M, Kallert TW. Deinstitutionalization, housing situation and subjective satisfaction of schizophrenic patients. Psychiat Prax 2001; 28: 10-17
- 40 Salize HJ, Dillmann-Lange C, Kentner-Figura B. et al. Drohende Wohnungslosigkeit und psychische Gefährdung. Prävalenz und Einflussfaktoren bei Risikopopulationen. Nervenarzt 2006; 77: 1345-1354
- 41 Salize HJ, Werner A, Jacke CO. Service provision for mentally disordered homeless people. Curr Opin Psychiatry 2013; 26: 355-361
- 42 Steinhart I, Wienberg G. Das Funktionale Basismodell für die gemeindepsychiatrische Versorgung schwer psychisch kranker Menschen – Mindeststandard für Behandlung und Teilhabe. Psychiat Prax 2016; 43: 65-68
- 43 Trabert G. Medizinische Versorgung für wohnungslose Menschen – individuelles Recht und soziale Pflicht statt Exklusion. Gesundheitswesen 2016; 78: 107-112
- 44 Torchalla I, Albrecht F, Buchkremer G. et al. Wohnungslose Frauen mit psychischer Erkrankung – eine Feldstudie. Psychiat Prax 2004; 31: 228-235