1
|
Brettel P, Beier E, Maun A, Jung P. [Health Service Utilization by Homeless Persons: Analysis of the Role of Enabling Factors, Pain and Gender using the Gelberg-Andersen Model]. DAS GESUNDHEITSWESEN 2022; 84:1080-1091. [PMID: 34729720 DOI: 10.1055/a-1633-3537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The aim of the study was to find factors that influence health service utilization by homeless people. In a field study, a sample of 51 homeless men and 47 homeless women in the German county of Baden-Württemberg participated in face-to-face-interviews with a questionnaire designed for this study. Analyses were performed using multiple logistic regression models. Variables were organized using the Gelberg-Andersen Behavioral Model for Vulnerable Populations. Satisfied subsistence needs (OR 1.33, 95%-CI [1.03-1.72] regarding utilization of vaccinations), a stable source of primary care (OR 12.2 [1.81-82] regarding utilization of early detection examinations; quasi-complete separation regarding use of GP services) social networks (OR 2.9 [1.13-7.5] regarding utilisation of early detection examinations; OR 0.63 [0.41-0.98] regarding emergency department visits) and technological ressources (OR 2.2 [1.13-4.4] regarding use of GP services) had a positive influence on the pattern of health service utilization. Pain was correlated with more emergency department visits (OR 1.72 [1.22-2.4]) and hospitalizations (OR 1.66 [1.19-2.3]). The results showed differences between homeless men and women. The factors of influence found in this study should be addressed in the care of homeless persons. Integration of social care into the regular health care system is necessary for early detection and treatment of complex social and medical needs of vulnerable populations. This requires interprofessional approaches in medical education and training focussing on the situation of vulnerable populations and on social determinants of health.
Collapse
Affiliation(s)
- Paul Brettel
- Institut für Allgemeinmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Elena Beier
- Institut für Allgemeinmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Andy Maun
- Institut für Allgemeinmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Petra Jung
- Institut für Allgemeinmedizin, Universitätsklinikum Freiburg, Freiburg, Deutschland
| |
Collapse
|
2
|
Haussleiter IS, Lehmann I, Ueberberg B, Heinz J, Zielasek J, Gouzoulis-Mayfrank E, Juckel G. Homelessness among psychiatric inpatients in North Rhine-Westphalia: a retrospective routine data analysis. BMC Psychiatry 2022; 22:132. [PMID: 35183140 PMCID: PMC8857834 DOI: 10.1186/s12888-022-03786-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Within the last five years the number of homeless persons in Germany has more than doubled, with many suffering from mental illnesses that require treatment. Whether the mental illness itself led to losing shelter or whether the state of being homeless increased the likelihood of developing symptoms of a mental disorder remains unclear. The current study assessed the interaction of homelessness and mental illness from a care provider perspective. METHODS We conducted a retrospective analysis of inpatient routine data from 20 psychiatric hospitals in North Rhine-Westphalia (NRW), Germany, over a period of four years (N = 366,767 inpatient treatment cases). Patients were considered "homeless" if they had no fixed unique address. RESULTS About 2.4% of the analyzed cohort was classified as homeless, with increasing tendency over the study period (+14% from 2016 to 2019). The percentage of homeless patients varied broadly between the hospitals (0.2-6.3%). Homeless patients were more often male and on average eight years younger than patients with a fixed address. Homeless patients experienced more involuntary measures (admission and restraint), had a shorter course of treatment and were more often discharged within one day. Every second homeless case was diagnosed with a substance use disorder and every third homeless case with a psychotic disorder, whereas affective disorders were diagnosed less frequently in this group. Psychiatric comorbidity occurred more often in homeless patients whereas somatic diseases did not. CONCLUSIONS Multiple patient-related sociodemographic and local factors are associated with homelessness of psychiatric inpatients. In addition, clinical factors differ between homeless and non-homeless patients, pointing to more severe mental illness and treatment complications (e.g., coercive measures) in homeless persons. Thus, homelessness of psychiatric inpatients can imply special challenges that need to be considered by healthcare providers and politicians, with the goal of optimizing mental and social care and the mental health outcomes of homeless persons.
Collapse
Affiliation(s)
- Ida Sibylle Haussleiter
- LWL Research Institute for Mental Health, Ruhr University Bochum, LWL University Hospital, Bochum, Germany. .,Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Alexandrinenstrasse 1, 44791, Bochum, Germany.
| | - Isabell Lehmann
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - Bianca Ueberberg
- grid.5570.70000 0004 0490 981XLWL Research Institute for Mental Health, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Josephine Heinz
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - Jürgen Zielasek
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,grid.411327.20000 0001 2176 9917Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR Institute for Healthcare Research, LVR Institute for Research and Education, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,LVR Clinics Cologne, Cologne, Germany
| | - Georg Juckel
- grid.5570.70000 0004 0490 981XLWL Research Institute for Mental Health, Ruhr University Bochum, LWL University Hospital, Bochum, Germany ,grid.5570.70000 0004 0490 981XDepartment of Psychiatry, Ruhr University Bochum, LWL University Hospital, Alexandrinenstrasse 1, 44791 Bochum, Germany
| |
Collapse
|
3
|
Schreiter S, Heidrich S, Zulauf J, Saathoff U, Brückner A, Majic T, Rössler W, Schouler-Ocak M, Krausz MR, Bermpohl F, Bäuml J, Gutwinski S. Housing situation and healthcare for patients in a psychiatric centre in Berlin, Germany: a cross-sectional patient survey. BMJ Open 2019; 9:e032576. [PMID: 31888930 PMCID: PMC6937056 DOI: 10.1136/bmjopen-2019-032576] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine the housing situation among people seeking psychiatric treatment in relation to morbidity and service utilisation. DESIGN Cross-sectional patient survey. SETTING Psychiatric centre with a defined catchment area in Berlin, Germany, March-September 2016. PARTICIPANTS 540 psychiatric inpatients including day clinics (43.2% of all admitted patients in the study period (n=1251)). MAIN OUTCOME MEASURES Housing status 30 days prior the interview as well as influencing variables including service use, psychiatric morbidity and sociodemographic variables. RESULTS In our survey, 327 participants (68.7%) currently rented or owned an own apartment; 62 (13.0%) reported to be homeless (living on the street or in shelters for homeless or refugees); 87 (18.3%) were accommodated in sociotherapeutic facilities. Participants without an own apartment were more likely to be male and younger and to have a lower level of education. Homeless participants were diagnosed with a substance use disorder significantly more often (74.2%). Psychotic disorders were the highest among homeless participants (29.0%). Concerning service use, we did neither find a lower utilisation of ambulatory services nor a higher utilisation of hospital-based care among homeless participants. CONCLUSIONS Our findings underline the need for effective housing for people with mental illness. Despite many sociotherapeutic facilities, a concerning number of people with mental illness is living in homelessness. Especially early interventions addressing substance use might prevent future homelessness.
Collapse
Affiliation(s)
- Stefanie Schreiter
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sascha Heidrich
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jamie Zulauf
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ute Saathoff
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anne Brückner
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tomislav Majic
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany
| | - Wulf Rössler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Universität Zürich, Zurich, Switzerland
| | - Meryam Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany
| | - Michael R Krausz
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany
| | - Josef Bäuml
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany
| |
Collapse
|