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. 2014 Aug 20:12:138.
doi: 10.1186/s12916-014-0138-x.

Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia

Abebaw Fekadu, Charlotte Hanlon, Emebet Gebre-Eyesus, Melkamu Agedew, Haddis Solomon, Solomon Teferra, Tsehaysina Gebre-Eyesus, Yonas Baheretibeb, Girmay Medhin, Teshome Shibre, Abraham Workneh, Teketel Tegegn, Alehegn Ketema, Philip Timms, Graham Thornicroft, Martin Prince

Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia

Abebaw Fekadu et al. BMC Med. .

Abstract

Background: The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia.

Methods: A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule.

Results: We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness.

Conclusion: Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.

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Figures

Figure 1
Figure 1
A young woman with a 2-year history of street homelessness related to a schizophrenic illness that started while she was in college. (A) The woman on a street in Addis Ababa packing up her belongings just before admission for treatment; (B) the same woman with some of the clinical team in Amanuel Hospital before she left the hospital. Written informed consent was obtained from the patient for publication of this study and any accompanying images. A copy of the written consent is available for review by the Editor of this Journal. Photo by Abebaw Fekadu.
Figure 2
Figure 2
Flow diagram of assessments for psychosis of street homeless individuals, Addis Ababa, Ethiopia.
Figure 3
Figure 3
Profile of symptoms and observed behaviours of street homeless with psychosis.
Figure 4
Figure 4
Unmet needs of street homeless people with psychosis, Addis Ababa, Ethiopia.
See this image and copyright information in PMC

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