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Meta-Analysis
. 2024 Jul 1;81(7):691-699.
doi: 10.1001/jamapsychiatry.2024.0426.

Prevalence of Mental Health Disorders Among Individuals Experiencing Homelessness: A Systematic Review and Meta-Analysis

Rebecca Barry  1   2 , Jennifer Anderson  1 , Lan Tran  1 , Anees Bahji  1   2   3 , Gina Dimitropoulos  1   2   4   5 , S Monty Ghosh  2   5   6 , Julia Kirkham  2   5   6 , Geoffrey Messier  7 , Scott B Patten  1   2   5   3 , Katherine Rittenbach  1 , Dallas Seitz  1   2   5
Affiliations
Meta-Analysis

Prevalence of Mental Health Disorders Among Individuals Experiencing Homelessness: A Systematic Review and Meta-Analysis

Rebecca Barry et al. JAMA Psychiatry. .

Abstract

Importance: Several factors may place people with mental health disorders, including substance use disorders, at increased risk of experiencing homelessness and experiencing homelessness may also increase the risk of developing mental health disorders. Meta-analyses examining the prevalence of mental health disorders among people experiencing homelessness globally are lacking.

Objective: To determine the current and lifetime prevalence of mental health disorders among people experiencing homelessness and identify associated factors.

Data sources: A systematic search of electronic databases (PubMed, MEDLINE, PsycInfo, Embase, Cochrane, CINAHL, and AMED) was conducted from inception to May 1, 2021.

Study selection: Studies investigating the prevalence of mental health disorders among people experiencing homelessness aged 18 years and older were included.

Data extraction and synthesis: Data extraction was completed using standardized forms in Covidence. All extracted data were reviewed for accuracy by consensus between 2 independent reviewers. Random-effects meta-analysis was used to estimate the prevalence (with 95% CIs) of mental health disorders in people experiencing homelessness. Subgroup analyses were performed by sex, study year, age group, region, risk of bias, and measurement method. Meta-regression was conducted to examine the association between mental health disorders and age, risk of bias, and study year.

Main outcomes and measures: Current and lifetime prevalence of mental health disorders among people experiencing homelessness.

Results: A total of 7729 citations were retrieved, with 291 undergoing full-text review and 85 included in the final review (N = 48 414 participants, 11 154 [23%] female and 37 260 [77%] male). The current prevalence of mental health disorders among people experiencing homelessness was 67% (95% CI, 55-77), and the lifetime prevalence was 77% (95% CI, 61-88). Male individuals exhibited a significantly higher lifetime prevalence of mental health disorders (86%; 95% CI, 74-92) compared to female individuals (69%; 95% CI, 48-84). The prevalence of several specific disorders were estimated, including any substance use disorder (44%), antisocial personality disorder (26%), major depression (19%), schizophrenia (7%), and bipolar disorder (8%).

Conclusions and relevance: The findings demonstrate that most people experiencing homelessness have mental health disorders, with higher prevalences than those observed in general community samples. Specific interventions are needed to support the mental health needs of this population, including close coordination of mental health, social, and housing services and policies to support people experiencing homelessness with mental disorders.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bahji reported having been awarded doctoral studies research funding from the Canadian Institutes of Health Research Fellowship and the University of Calgary Cumming School of Medicine, as well as research funding through the Calgary Health Trust. Dr Bahji receives a small honorarium for teaching undergraduate and postgraduate medical trainees in the Cumming School of Medicine at the University of Calgary. In addition, Dr Bahji is an unpaid member of the Canadian Network for Mood and Anxiety Treatments editorial committee, the International Society of Addiction Journal Editors, the Canadian Society of Addiction Medicine policy committee, and the Addiction Psychiatry section of the Canadian Psychiatric Association. Dr Bahji is also an unpaid associate editor of the Canadian Journal of Addiction and a mental health educator for TED-Ed, where he receives a small honorarium for supporting online educational content. Dr Rittenbach reported being employed by the Government of Alberta outside of the submitted work. Dr Seitz reported grants from Calgary Health Foundation during the conduct of the study as well as grants from University Health Foundation, Canadian Institutes of Health Research, Public Health Agency of Canada, Alzheimer’s Association, and Hotchkiss Brain Institute and honoraria for guideline development from Canadian Coalition for Seniors Mental Health outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Current Prevalence of Mental Health Disorders Among People Experiencing Homelessness
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References

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