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Randomized Controlled Trial
. 2017 Jul;62(7):473-481.
doi: 10.1177/0706743717694836. Epub 2017 Jan 1.

Effect of Housing First on Suicidal Behaviour: A Randomised Controlled Trial of Homeless Adults with Mental Disorders

Joshua P Aquin  1 , Leslie E Roos  2 , Jino Distasio  3 , Laurence Y Katz  4 , Jimmy Bourque  5 , James M Bolton  6 , Shay-Lee Bolton  6 , Jacquelyne Y Wong  4 , Dan Chateau  7   8 , Julian M Somers  9 , Murray W Enns  6 , Stephen W Hwang  10 , James C Frankish  11 , Jitender Sareen  6 ; At Home/Chez Soi Investigators
Affiliations
Randomized Controlled Trial

Effect of Housing First on Suicidal Behaviour: A Randomised Controlled Trial of Homeless Adults with Mental Disorders

Joshua P Aquin et al. Can J Psychiatry. 2017 Jul.

Abstract
in English, French

Objective: This study attempted to determine if Housing First (HF) decreased suicidal ideation and attempts compared to treatment as usual (TAU) amongst homeless persons with mental disorders, a population with a demonstrably high risk of suicidal behaviour.

Method: The At Home/Chez Soi project is an unblinded, randomised control trial conducted across 5 Canadian cities (Vancouver, Winnipeg, Toronto, Montreal, Moncton) from 2009 to 2013. Homeless adults with a diagnosed major mental health disorder were recruited through community agencies and randomised to HF ( n = 1265) and TAU ( n = 990). HF participants were provided with private housing units and received case management support services. TAU participants retained access to existing community supports. Past-month suicidal ideation was measured at baseline and 6, 12, 18, and 21/24 months. A history of suicide attempts was measured at baseline and the 21/24-month follow-up.

Results: Compared to baseline, there was an overall trend of decreased past-month suicidal ideation (estimate = -.57, SE = .05, P < 0.001), with no effect of treatment group (i.e., HF vs. TAU; estimate = -.04, SE = .06, P = 0.51). Furthermore, there was no effect of treatment status (estimate = -.10, SE = .16, P = 0.52) on prevalence of suicide attempts (HF = 11.9%, TAU = 10.5%) during the 2-year follow-up period.

Conclusion: This study failed to find evidence that HF is superior to TAU in reducing suicidal ideation and attempts. We suggest that HF interventions consider supplemental psychological treatments that have proven efficacy in reducing suicidal behaviour. It remains to be determined what kind of suicide prevention interventions (if any) are specifically effective in further reducing suicidal risk in a housing-first intervention.

Objectif:: Cette étude tentait de déterminer si l’approche Logement d’abord (LD) a diminué l’idéation suicidaire et les tentatives de suicide comparativement au Traitement habituel (TH) chez les personnes sans abri souffrant de troubles mentaux, une population ayant manifestement un risque élevé de comportement suicidaire.

Méthode:: Le projet At Home/Chez Soi est un essai randomisé contrôlé sans insu mené dans 5 villes canadiennes (Vancouver, Winnipeg, Toronto, Montréal, Moncton) de 2009 à 2013. Des adultes sans abri ayant reçu un diagnostic de trouble de santé mentale majeur ont été recrutés dans des organismes communautaires et randomisés à Logement d’abord (n = 1265) et au Traitement habituel (n = 990). Les participants à Logement d’abord ont reçu un logement privé et des services de soutien de la gestion des cas. Les participants au Traitement habituel ont conservé l’accès aux soutiens communautaires existants. L’idéation suicidaire du mois précédent a été mesurée au départ, puis à 6, 12, 18, et 21 mois sur 24. Les antécédents de tentatives de suicide ont été mesurés au départ puis au suivi de 21 mois sur 24.

Résultats:: Comparativement au départ, il y a eu une tendance générale à la diminution de l’idéation suicidaire du mois précédent (Estimation = –0,57; ET = 0,05; p < 0,001), sans effet du groupe de traitement (c.-à-d., Logement d’abord contre Traitement habituel; Estimation = –0,04; ET = 0,06; p = 0,51). En outre, il n’y avait pas d’effet du type de traitement (Estimation = –0,10; ET = 0,16, p = 0,52) sur la prévalence des tentatives de suicide (LD = 11,9 %, TH = 10,5 %) durant le suivi de deux ans.

Conclusion:: Cette étude n’a pas réussi à prouver que l’approche Logement d’abord est supérieure au Traitement habituel pour réduire l’idéation suicidaire et les tentatives de suicide. Nous suggérons que les interventions de Logement d’abord envisagent des traitements psychologiques supplémentaires qui se sont révélés efficaces pour réduire le comportement suicidaire. Il reste à déterminer quel type d’interventions de prévention du suicide (le cas échéant) sont particulièrement efficaces pour réduire davantage le risque de suicide dans une intervention de Logement d’abord.

Keywords: Housing First; community mental health services; homelessness; longitudinal study; randomised controlled trial; suicide.

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Figures

Figure 1.
Figure 1.
Flow of participants throughout the study (CONSORT). aParticipants were excluded from the study if they did not meet the study inclusion criteria with respect to (1) age, (2) homelessness status, and (3) the presence of a mental disorder based on the Mini International Neuropsychiatric Interview or (4) if they were currently served by an assertive community treatment (ACT) or intensive case management team or (5) lacked legal status in Canada. bThirty-four participants (29 in the intervention group, 5 in the usual care group) were excluded from the final analysis as per national trial protocol.
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