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Jones AA, Cho LL, Gicas KM, Procyshyn RM, Vila-Rodriguez F, Stubbs JL, Leonova O, Buchanan T, Thornton AE, Lang DJ, MacEwan GW, Panenka WJ, Barr AM, Field TS, Honer WG. Multilayer depressive symptom networks in adults with bodily pain living in precarious housing or homelessness. Eur Arch Psychiatry Clin Neurosci 2024; 274:643-653. [PMID: 37610500 DOI: 10.1007/s00406-023-01664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023]
Abstract
Housing insecurity is associated with co-occurring depression and pain interfering with daily activities. Network analysis of depressive symptoms along with associated risk or protective exposures may identify potential targets for intervention in patients with co-occurring bodily pain. In a community-based sample of adults (n = 408) living in precarious housing or homelessness in Vancouver, Canada, depressive symptoms were measured by the Beck Depression Inventory; bodily pain and impact were assessed with the 36-item Short Form Health Survey. Network and bootstrap permutation analyses were used to compare depressive symptoms endorsed by Low versus Moderate-to-Severe (Mod + Pain) groups. Multilayer networks estimated the effects of risk and protective factors. The overall sample was comprised of 78% men, mean age 40.7 years, with 53% opioid use disorder and 14% major depressive disorder. The Mod + Pain group was characterized by multiple types of pain, more persistent pain, more severe depressive symptoms and a higher rate of suicidal ideation. Global network connectivity did not differ between the two pain groups. Suicidal ideation was a network hub only in the Mod + Pain group, with high centrality and a direct association with exposure to lifetime trauma. Antidepressant medications had limited impact on suicidal ideation. Guilt and increased feelings of failure represented symptoms from two other communities of network nodes, and completed the shortest pathway from trauma exposure through suicidal ideation, to the non-prescribed opioid exposure node. Interventions targeting these risk factors and symptoms could affect the progression of depression among precariously housed patients.
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Affiliation(s)
- Andrea A Jones
- Division of Neurology, Department of Medicine, University of British Columbia, 8219-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Thalia S Field
- Division of Neurology, Department of Medicine, University of British Columbia, 8219-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Zanini L, Picano C, Spitoni GF. The Iowa Gambling Task: Men and Women Perform Differently. A Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-024-09637-3. [PMID: 38462590 DOI: 10.1007/s11065-024-09637-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
The Iowa Gambling Task (IGT) was designed to assess decision-making under conditions of complexity and uncertainty; it is currently one of the most widely used tests to assess decision-making in both experimental and clinical settings. In the original version of the task, participants are given a loan of play money and four decks of cards and are asked to maximize profits. Although any single card unpredictably yields wins/losses, variations in frequency and size of gains/losses ultimately make two decks more advantageous in the long term. Several studies have previously suggested that there may be a sex-related difference in IGT performance. Thus, the present study aimed to explore and quantify sex differences in IGT performance by pooling the results of 110 studies. The meta-analysis revealed that males tend to perform better than females on the classic 100-trial IGT (UMD = 3.381; p < 0.001). Furthermore, the significant heterogeneity observed suggests high variability in the results obtained by individual studies. Results were not affected by publication bias or other moderators. Factors that may contribute to differences in male and female performance are discussed, such as functional sex-related asymmetries in the ventromedial prefrontal cortex and amygdala, as well as differences in sensitivity to wins/losses.
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Affiliation(s)
- Ludovica Zanini
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli, 1, Rome, Italy.
| | - Chiara Picano
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Grazia Fernanda Spitoni
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via degli Apuli, 1, Rome, Italy
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
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Blumberg MJ, Petersson AM, Jones PW, Jones AA, Panenka WJ, Leonova O, Vila-Rodriguez F, Lang DJ, Barr AM, MacEwan GW, Buchanan T, Honer WG, Gicas KM. Differential sensitivity of intraindividual variability dispersion and global cognition in the prediction of functional outcomes and mortality in precariously housed and homeless adults. Clin Neuropsychol 2024:1-24. [PMID: 38444068 DOI: 10.1080/13854046.2024.2325167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To examine cognitive intraindividual variability (IIV) dispersion as a predictor of everyday functioning and mortality in persons who are homeless or precariously housed. METHOD Participants were 407 community-dwelling adults, followed for up to 13 years. Neurocognition was assessed at baseline and IIV dispersion was derived using a battery of standardized tests. Functional outcomes (social, physical) were obtained at baseline and last follow-up. Mortality was confirmed with Coroner's reports and hospital records (N = 103 deaths). Linear regressions were used to predict current social and physical functioning from IIV dispersion. Repeated measures Analysis of Covariance were used to predict long-term change in functioning. Cox regression models examined the relation between IIV dispersion and mortality. Covariates included global cognition (i.e. mean-level performance), age, education, and physical comorbidities. RESULTS Higher IIV dispersion predicted poorer current physical functioning (B = -0.46 p = .010), while higher global cognition predicted better current (B = 0.21, p = .015) and change in social functioning over a period of up to 13 years (F = 4.23, p = .040). Global cognition, but not IIV dispersion, predicted mortality in individuals under 55 years old (HR = 0.50, p = .013). CONCLUSIONS Our findings suggest that indices of neurocognitive functioning (i.e. IIV dispersion and global cognition) may be differentially related to discrete dimensions of functional outcomes in an at-risk population. IIV dispersion may be a complimentary marker of emergent physical health dysfunction in precariously housed adults and may be best used in conjunction with traditional neuropsychological indices.
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Affiliation(s)
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Canada
- Department of Psychology, University of the Fraser Valley, Abbotsford, Canada
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Wallace C, Smirl JD, Adhikari SP, Jones KE, Rieger M, Rothlander K, van Donkelaar P. Neurovascular coupling is altered in women who have a history of brain injury from intimate partner violence: a preliminary study. Front Glob Womens Health 2024; 5:1344880. [PMID: 38495125 PMCID: PMC10940333 DOI: 10.3389/fgwh.2024.1344880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Intimate partner violence (IPV) is a global health crisis with 30% of women over the age of 15 experiencing at least one event in their lifetime. Brain injury (BI) due to head impacts and/or strangulation is a common but understudied part of this experience. Previous research has shown BI from other injury mechanisms can disrupt neurovascular coupling (NVC). To gain further insight into whether similar changes occur in this population, we assessed NVC responses in women with a history of IPV-BI. Methods NVC responses were measured for the middle and posterior cerebral arteries (MCA, PCA) using transcranial Doppler ultrasound while participants performed a complex visual search task. The lifetime history of previous exposure to IPV-BI was captured using the Brain Injury Severity Assessment (BISA) along with measures of post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and demographic information. Initial analyses of NVC metrics were completed comparing participants who scored low vs. high on the BISA or did or did not experience non-fatal strangulation followed by a stepwise multiple regression to examine the impact of PTSD, anxiety, and depression on the relationship between the NVC metrics and IPV-BI. Results Baseline and peak cerebral blood velocity were higher and the percentage increase was lower in the PCA in the low compared to the high BISA group whereas no differences between the groups were apparent in the MCA. In addition, those participants who had been strangled had a lower initial slope and area under the curve in the PCA than those who had not experienced strangulation. Finally, the stepwise multiple regression demonstrated the percentage increase in the PCA was significantly related to the BISA score and both depression and anxiety significantly contributed to different components of the NVC response. Conclusions This preliminary study demonstrated that a lifetime history of IPV-BI leads to subtle but significant disruptions to NVC responses which are modulated by comorbid depression and anxiety. Future studies should examine cerebrovascular function at the acute and subacute stages after IPV episodes to shed additional light on this experience and its outcomes.
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Affiliation(s)
- Colin Wallace
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Department of Kinesiology, Okanagan College, Penticton, BC, Canada
| | - Jonathan D. Smirl
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Shambhu P. Adhikari
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - K. Elisabeth Jones
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Matt Rieger
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Krystal Rothlander
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
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5
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Gicas KM, Benitah K, Thornton AE, Petersson AM, Jones PW, Stubbs JL, Jones AA, Panenka WJ, Lang DJ, Leonova O, Vila-Rodriguez F, Barr AM, Buchanan T, Su W, Vertinsky AT, Rauscher A, MacEwan GW, Honer WG. Using serial position effects to investigate memory dysfunction in homeless and precariously housed persons. Clin Neuropsychol 2023; 37:1710-1727. [PMID: 36790121 DOI: 10.1080/13854046.2023.2178513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
Background: Homeless and precariously housed persons exhibit significant memory impairment, but the component processes underlying memory dysfunction have not been explored. We examined the serial position profile (i.e., primacy and recency effects) of verbal memory and its neuroanatomical correlates to identify the nature of memory difficulties in a large cohort of homeless and precariously housed adults. Method: The sample included 227 community-dwelling homeless and precariously housed adults. Serial position scores (primacy, middle, recency) were computed using the Hopkins Verbal Learning Test-Revised. Paired sample t-tests were used to compare percent recall from each word list region. Age-adjusted correlations assessed associations between serial position scores and other cognitive domains (attention, processing speed, executive functioning). Regression analyses were conducted to examine regional brain volumes of interest (hippocampus, entorhinal cortex, dorsolateral prefrontal cortex [DLPFC]) and their differential associations with serial position scores. Results: The serial position profile was characterized by a diminished recency effect in relation to the primacy effect. Serial position scores positively correlated with sustained attention and cognitive control. Larger hippocampal volume was associated with better primacy item recall. DLPFC volume was not associated with serial position recall after adjustment for false discovery rate. There were no associations between regional brain volumes and recency item recall. Conclusion: Our results suggest that commonly reported memory difficulties in homeless and precariously housed adults are likely secondary to a core deficit in executive control due to compromised frontal lobe functioning. These findings have implications for cognitive rehabilitation in this complex and vulnerable group.
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Affiliation(s)
| | - Katie Benitah
- Department of Psychology, York University, Toronto, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Andrea A Jones
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Alexander Rauscher
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada
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6
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Cho LL, Jones AA, Gao C, Leonova O, Vila-Rodriguez F, Buchanan T, Lang DJ, MacEwan GW, Procyshyn RM, Panenka WJ, Barr AM, Thornton AE, Gicas KM, Honer WG, Barbic SP. Rasch analysis of the beck depression inventory in a homeless and precariously housed sample. Psychiatry Res 2023; 326:115331. [PMID: 37437487 DOI: 10.1016/j.psychres.2023.115331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
The approach to analysis of and interpretation of findings from the Beck Depression Inventory (BDI), a self-report questionnaire, depends on sample characteristics. To extend work using conventional BDI scoring, the BDI's suitability in assessing symptom severity in a homeless and precariously housed sample was examined using Rasch analysis. Participants (n=478) recruited from an impoverished neighbourhood in Vancouver, Canada, completed the BDI. Rasch analysis using the partial credit model was done, and the structural validity, unidimensionality, and reliability of the BDI were studied. A receiver operating characteristic curve determined a Rasch cut-off score consistent with clinical depression, and Rasch scores were correlated with raw scores. Good fit to the Rasch model was observed after rescoring all items and removing Item 19 (Weight Loss), and unidimensionality and reliability were satisfactory. Item 9 (Suicidal Wishes) represented the most severe symptom. Rasch-based scores detected clinical depression with moderate sensitivity and specificity, and were positively correlated with conventional scores. The BDI in a community-based sample of homeless and precariously housed adults satisfied Rasch model expectations in a 20-item format, and is suitable for assessing symptom severity. Future research on depression in similar samples may reveal more information on using specific symptoms to determine clinical significance.
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Affiliation(s)
- Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chloe Gao
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna J Lang
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Skye P Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada.
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Russolillo A, Moniruzzaman A, Carter M, Raudzus J, Somers JM. Association of homelessness and psychiatric hospital readmission-a retrospective cohort study 2016-2020. BMC Psychiatry 2023; 23:459. [PMID: 37353747 PMCID: PMC10288711 DOI: 10.1186/s12888-023-04945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND A large proportion of adult psychiatric inpatients experience homelessness and are often discharged to unstable accommodation or the street. It is unclear whether homelessness impacts psychiatric hospital readmission. Our primary objective was to examine the association between homelessness and risk for 30-day and 90-day readmission following discharge from a psychiatric unit at a single urban hospital. METHODS A retrospective cohort study involving health administrative data among individuals (n = 3907) in Vancouver, Canada with an acute psychiatric admission between January 2016 and December 2020. Participants were followed from the date of index admission until censoring (December 30, 2020). Homelessness was measured at index admission and treated as a time-varying exposure. Adjusted Hazard Ratios (aHRs) of acute readmission (30-day and 90-day) for psychiatric and substance use disorders were estimated using multivariable Cox proportional hazards regression. RESULTS The cohort comprised 3907 individuals who were predominantly male (61.89%) with a severe mental illness (70.92%), substance use disorder (20.45%) and mean age of 40.66 (SD, 14.33). A total of 686 (17.56%) individuals were homeless at their index hospitalization averaging 19.13 (21.53) days in hospital. After adjusting for covariates, patients experiencing homelessness had a 2.04 (1.65, 2.51) increased rate of 30-day readmission and 1.65 (1.24, 2.19) increased rate of 90-day readmission during the observation period. CONCLUSIONS Homelessness was significantly associated with increased 30-day and 90-day readmission rates in a large comprehensive sample of adults with mental illness and substance use disorders. Interventions to reduce homelessness are urgently needed. QUESTION Is homelessness associated with risk for 30-day and 90-day psychiatric hospital readmission? FINDINGS In this retrospective cohort study of 3907 individuals, homelessness at discharge was associated with increased 30-day and 90-day psychiatric readmission. MEANING Housing status is an important risk factor for hospital readmission. High-quality interventions focused on housing supports have the potential to reduce psychiatric readmission.
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Affiliation(s)
- Angela Russolillo
- Department of Psychiatry, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, BC, V6Z 1Y6, Vancouver, Canada.
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, BC, V6B 5K3, Vancouver, Canada.
| | - Akm Moniruzzaman
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, BC, V6B 5K3, Vancouver, Canada
| | - Michelle Carter
- Department of Psychiatry, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, BC, V6Z 1Y6, Vancouver, Canada
| | - Julia Raudzus
- Department of Psychiatry, St. Paul's Hospital, Providence Health Care, 1081 Burrard Street, BC, V6Z 1Y6, Vancouver, Canada
| | - Julian M Somers
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, 515 West Hastings Street, BC, V6B 5K3, Vancouver, Canada
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Bates AT, Tse-Agha L, Agha A, Nunez JJ, Boyda HN, Jones AA, Barr AM, Honer WG, Vila-Rodriguez F. Reduction in Substance-Related Composite Harm Scores Through Street Soccer. Cureus 2023; 15:e39650. [PMID: 37388606 PMCID: PMC10306313 DOI: 10.7759/cureus.39650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction Street soccer makes the sport accessible to people affected by homelessness or precarious housing. There is overwhelming evidence that exercise improves physical and mental health. In addition, sport facilitates positive peer pressure that leads to beneficial life changes. Method To examine participants' accounts of the effects of street soccer in a sample of socially disadvantaged players from Western Canada, we collected 73 cross-sectional self-reports of life changes via a questionnaire. The questionnaire included questions on social, mental, and physical health, including substance use. This allowed the calculation of a modified composite harm score. Results Participants reported improved physical (46% of participants) and mental (43% of participants) health, reduced cigarette (50% of smokers), alcohol (45% of users), cannabis (42% of users), and other non-prescribed drug use, increased number of friends (88% of participants), improved housing (60% of participants), increased income (19% of participants), increased community medical supports (40% of participants), and decreased conflicts with police (47% of those with prior recent conflict). Perceived reductions in substance use were supported by significant changes in composite harm score. Conclusion Street soccer appears to promote improved physical, mental, and social health among people affected by homelessness or precarious housing, with reduction in substance use likely to be a key factor. This work builds upon past qualitative research showing the benefits of street soccer and supports future research which may help elucidate the mechanisms by which street soccer has beneficial effects.
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Affiliation(s)
- Alan T Bates
- Psychiatry, The University of British Columbia, Vancouver, CAN
- Psychiatry, BC Cancer, Vancouver, CAN
| | | | - Arun Agha
- Palliative Medicine, Queen's University, Kingston, CAN
| | - John-Jose Nunez
- Psychiatry, The University of British Columbia, Vancouver, CAN
| | - Heidi N Boyda
- Pharmacology and Therapeutics, The University of British Columbia, Vancouver, CAN
| | - Andrea A Jones
- Neurology, The University of British Columbia, Vancouver, CAN
| | - Alasdair M Barr
- Pharmacology and Therapeutics, The University of British Columbia, Vancouver, CAN
| | - William G Honer
- Psychiatry, The University of British Columbia, Vancouver, CAN
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Chevreau G, Coll M, Barbot F, Castillo MC, Vallat-Azouvi C. Neuropsychological functioning of homeless people in Paris: An exploratory study. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-12. [PMID: 36803262 DOI: 10.1080/23279095.2023.2175321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Homelessness is a multifactorial issue, influenced by structural and individual factors. These factors include health status, which has been reported to be poorer among people experiencing homelessness. Although the somatic and mental health of homeless individuals has already been studied in France, to our knowledge, no research has been conducted on neuropsychological functioning in this country. Studies out with France have identified cognitive impairments as highly prevalent among homeless people, and these impairments are likely affected by local structural factors, such as healthcare access. Therefore, we conducted an exploratory study in Paris to evaluate cognition and associated factors in homeless adults. The second objective was to identify methodological specificities to consider in a future larger-scale study and for the application of the outcomes. For this exploratory phase, 14 individuals were recruited from specific services and were interviewed regarding their social, neurological, and psychiatric history, before completing a set of cognitive tests. The results showed a high diversity of profiles in terms of demographic characteristics, including being a migrant and/or illiterate. A high proportion of participants had signs of traumatic brain injury, anxiety, depressive disorders, and post-traumatic stress disorders. Most cognitive scores were in the low average of normative data. No statistical association was found between identified risk factors and cognitive performance. Future studies should consider the sociodemographic specificities of the homeless population and design appropriate measurement tools to improve the understanding of neuropsychological profiles.
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Affiliation(s)
- Gaëtan Chevreau
- Laboratoire Psychopathologie et Processus de Changement, Université Paris 8 Vincennes-Saint-Denis, Paris, France
| | | | - Frédéric Barbot
- Centre d'Investigation Clinique (Inserm CIC 1429), Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Paris, France
| | - Marie-Carmen Castillo
- Laboratoire Psychopathologie et Processus de Changement, Université Paris 8 Vincennes-Saint-Denis, Paris, France
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10
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Fearn-Smith EM, Scanlan JN, Hancock N. Exploring and Mapping Screening Tools for Cognitive Impairment and Traumatic Brain Injury in the Homelessness Context: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3440. [PMID: 36834133 PMCID: PMC9966671 DOI: 10.3390/ijerph20043440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Cognitive impairment is common amongst people experiencing homelessness, yet cognitive screening and the collection of history of brain injury rarely features in homelessness service delivery practice. The purpose of this research was to scope and map strategies for screening for the potential presence of cognitive impairment or brain injury amongst people experiencing homelessness and identify instruments that could be administered by homelessness service staff to facilitate referral for formal diagnosis and appropriate support. A search was conducted across five databases, followed by a hand search from relevant systematic reviews. A total of 108 publications were included for analysis. Described in the literature were 151 instruments for measuring cognitive function and 8 instruments screening for history of brain injury. Tools that were described in more than two publications, screening for the potential presence of cognitive impairment or history of brain injury, were included for analysis. Of those regularly described, only three instruments measuring cognitive function and three measuring history of brain injury (all of which focused on traumatic brain injury (TBI)) may be administered by non-specialist assessors. The Trail Making Test (TMT) and the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) are both potentially viable tools for supporting the identification of a likely cognitive impairment or TBI history in the homelessness service context. Further population-specific research and implementation science research is required to maximise the potential for practice application success.
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Affiliation(s)
- Erin M. Fearn-Smith
- Faculty of Medicine and Health, Centre for Disability Research and Policy, The University of Sydney, Camperdown, NSW 2050, Australia
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11
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Stubbs JL, Jones AA, Wolfman D, Chan RCY, Vila-Rodriguez F, Vertinsky AT, Heran MK, Su W, Lang DJ, Field TS, Gicas KM, Woodward ML, Thornton AE, Barr AM, Leonova O, MacEwan W, Rauscher A, Honer WG, Panenka WJ. Differential age-associated brain atrophy and white matter changes among homeless and precariously housed individuals compared with the general population. BMJ Neurol Open 2023; 5:e000349. [PMID: 36660541 PMCID: PMC9843194 DOI: 10.1136/bmjno-2022-000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
Background Homeless or precariously housed individuals live with poor health and experience premature mortality compared with the general population, yet little is known about age-related brain changes among these individuals. We evaluated whether MRI measures of brain structure are differentially associated with age and selected risk factors among individuals who are homeless or precariously housed compared with a general population sample. Methods We compared T1-weighted and diffusion tensor imaging measures of brain macrostructure and white matter microstructure in a well-characterised sample of 312 precariously housed participants with a publicly available dataset of 382 participants recruited from the general population. We used piecewise and multiple linear regression to examine differential associations between MRI measures and between the samples, and to explore associations with risk factors in the precariously housed sample. Results Compared with the general population sample, older age in the precariously housed sample was associated with more whole-brain atrophy (β=-0.20, p=0.0029), lower whole-brain fractional anisotropy (β=-0.32, p<0.0001) and higher whole-brain mean diffusivity (β=0.69, p<0.0001). Several MRI measures had non-linear associations with age, with further adverse changes after age 35-40 in the precariously housed sample. History of traumatic brain injury, stimulant dependence and heroin dependence was associated with more atrophy or alterations in white matter diffusivity in the precariously housed sample. Conclusions Older age is associated with adverse MRI measures of brain structure among homeless and precariously housed individuals compared with the general population. Education, improvements in care provision and policy may help to reduce the health disparities experienced by these individuals.
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Affiliation(s)
- Jacob L Stubbs
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Andrea A Jones
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Wolfman
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Ryan C Y Chan
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver, BC, Canada
| | | | - Manraj K Heran
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | | | - Melissa L Woodward
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada,Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada
| | - William MacEwan
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada,British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, BC, Canada
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12
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Gicas KM, Mejia-Lancheros C, Nisenbaum R, Wang R, Hwang SW, Stergiopoulos V. Cognitive determinants of community functioning and quality of life in homeless adults with mental illness: 6-year follow-up from the At Home/Chez Soi Study Toronto site. Psychol Med 2023; 53:362-370. [PMID: 33926584 DOI: 10.1017/s0033291721001550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High rates of physical and mental health comorbidities are associated with functional impairment among persons who are homeless. Cognitive dysfunction is common, but how it contributes to various functional outcomes in this population has not been well investigated. This study examines how cognition covaries with community functioning and subjective quality of life over a 6-year period while accounting for the effects of risk and protective factors. METHODS Participants were 349 homeless adults (mean age = 39.8) recruited from the Toronto site of the At Home/Chez Soi study, a large Canadian randomized control trial of Housing First. Participants completed up to four clinical evaluations over 6 years. Factor scores were created to index verbal learning and memory (vLM) and processing speed-cognitive flexibility (PSCF). The primary outcomes were community functioning and subjective quality of life. Risk factors included lifetime homelessness, mental health diagnoses, medical comorbidity, and childhood adversity. Linear mixed-effects models were conducted to examine cognition-functional outcome associations over time, with resilience as a moderator. RESULTS Better vLM (b = 0.787, p = 0.010) and PSCF (b = 1.66, p < 0.001) were associated with better community functioning, but not with quality of life. Resilience conferred a protective effect on subjective quality of life (b = 1.45, p = 0.011) but did not moderate outcomes. CONCLUSIONS Our findings suggest a need to consider the unique determinants of community functioning and quality of life among homeless adults. Cognition should be prioritized as a key intervention target within existing service delivery models to optimize long-term functional outcomes.
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Affiliation(s)
- K M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - C Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - R Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - S W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - V Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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13
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Jones AA, Gicas KM, Mostafavi S, Woodward ML, Leonova O, Vila-Rodriguez F, Procyshyn RM, Cheng A, Buchanan T, Lang DJ, MacEwan GW, Panenka WJ, Barr AM, Thornton AE, Honer WG. Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness. Psychol Med 2022; 52:2559-2569. [PMID: 33455593 DOI: 10.1017/s0033291720004444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality. METHOD The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models. RESULTS Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55. CONCLUSIONS Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.
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Affiliation(s)
- Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Sara Mostafavi
- Department of Statistics, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Melissa L Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Cheng
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Photo elicitation to explore health and social exclusion with rooming house residents in Ottawa, Canada. Health Place 2022; 77:102866. [PMID: 35932596 DOI: 10.1016/j.healthplace.2022.102866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
Abstract
Little is known about how rooming house residents perceive how housing influences their health, despite higher morbidity and premature death compared to other Canadians. The social exclusion framework of the Social Knowledge Exchange Network (SEKN) conceptualized by Popay et al. (2008) was used to investigate how rooming houses are linked to health among ten rooming house residents from six rooming houses in Ottawa, Ontario, Canada. Study activities included taking photos to show how living in a rooming house affects health, a community walk-about with the principal investigator, a focus group, and individual interviews. Thematic analysis revealed two broad themes: Housing is Health Care, and Just Managing Today. Findings suggest that structural inequalities and siloed care contribute to the health of rooming house residents, including the balance between poverty and desire to maintain housing, and how residents cope with this stress. If health care providers want to help alleviate the disparities in rooming house residents' health, they need to broaden the lens through which health is conceptualized.
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15
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Cheng AYT, Stubbs JL, Barr AM, Gicas KM, Su W, Thornton AE, Lang DJ, Hamzah Y, Leonova O, MacEwan WG, Rauscher A, Honer WG, Panenka WJ. Risk factors for hippocampal cavities in a marginally housed population. Hippocampus 2022; 32:567-576. [PMID: 35702814 DOI: 10.1002/hipo.23450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/01/2022] [Accepted: 05/11/2022] [Indexed: 12/25/2022]
Abstract
Cavities in the hippocampus are morphological variants of uncertain significance. Aberrant neurodevelopment along with vascular and inflammatory etiologies have been proposed. We sought to characterize these cavities and their potential risk factors in a marginally housed population, with high rates of viral infection, addiction, and mental illness. (1) The volume of hippocampal cavities (HCavs) is greater in this highly multimorbid population compared to the general population. (2) Conventional vascular risk factors such as greater age and systolic blood pressure are associated with higher HCav volume. (3) Nonprescribed substance-related risk factors such as stimulant use or dependence, and smoking are associated with increased HCav volume independent of vascular risk factors. This is a retrospective analysis of an ongoing prospective study. We analyzed baseline data, including medical history, physical exam, psychiatric diagnosis, and MRI from a total of 375 participants. Hippocampal cavities were defined as spaces isointense to CSF on T1 MRI sequences, bounded on all sides by hippocampal tissue, with a volume of at least 1 mm3 . Risk factors were evaluated using negative binomial multiple regression. Stimulant use was reported by 87.3% of participants, with stimulant dependence diagnosed in 83.3% of participants. Prevalence of cavities was 71.6%, with a mean total bilateral HCav volume of 13.89 mm3 . On average, a 1 mmHg greater systolic blood pressure was associated with a 2.17% greater total HCav volume (95% CI = [0.57%, 3.79%], p = .0076), while each cigarette smoked per day trended toward a 2.69% greater total HCav volume (95% CI = [-0.87%, 5.54%], p = .058). A diagnosis of stimulant dependence was associated with a 95.6% greater total HCav volume (95% CI = [5.39%, 263.19%], p = .0335). Hypertension and diagnosis of stimulant dependence were associated with a greater total volume of HCav.
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Affiliation(s)
- Alex Y T Cheng
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yasmin Hamzah
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,British Columbia Neuropsychiatry Program, Vancouver, British Columbia, Canada
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16
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Stubbs JL, Thornton AE, Gicas KM, O'Connor TA, Livingston EM, Lu HY, Mehta AK, Lang DJ, Vertinsky AT, Field TS, Heran MK, Leonova O, Sahota CS, Buchanan T, Barr AM, MacEwan GW, Rauscher A, Honer WG, Panenka WJ. Characterizing Traumatic Brain Injury and Its Association with Losing Stable Housing in a Community-based Sample. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:207-215. [PMID: 33719613 PMCID: PMC8935598 DOI: 10.1177/07067437211000665] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) is increasingly recognized as a common and impactful health determinant in homeless and precariously housed populations. We sought to describe the history of TBI in a precariously housed sample and evaluate how TBI was associated with the initial loss and lifetime duration of homelessness and precarious housing. METHOD We characterized the prevalence, mechanisms, and sex difference of lifetime TBI in a precariously housed sample. We also examined the impact of TBI severity and timing on becoming and staying homeless or precariously housed; 285 precariously housed participants completed the Brain Injury Screening Questionnaire in addition to other health assessments. RESULTS A history of TBI was reported in 82.1% of the sample, with 64.6% reporting > 1 TBI, and 21.4% reporting a moderate or severe TBI. Assault was the most common mechanism of injury overall, and females reported significantly more traumatic brain injuries due to physical abuse than males (adjusted OR = 1.26, 95% CI = 1.14 to 1.39, P < 0.0001). The first moderate or severe TBI was significantly closer to the first experience of homelessness (b = 2.79, P = 0.003) and precarious housing (b = 2.69, P < 0.0001) than was the first mild TBI. In participants who received their first TBI prior to becoming homeless or precariously housed, traumatic brain injuries more proximal to the initial loss of stable housing were associated with a longer lifetime duration of homelessness (RR = 1.04, 95% CI = 1.02 to 1.06, P < 0.0001) and precarious housing (RR = 1.03, 95% CI = 1.01 to 1.04, P < 0.0001). CONCLUSIONS These findings demonstrate the high prevalence of TBI in this vulnerable population, and that aspects of TBI severity and timing are associated with the loss and lifetime duration of stable housing.
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Affiliation(s)
- Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, York University, Toronto, Ontario, Canada
| | - Tiffany A O'Connor
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Emily M Livingston
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Henri Y Lu
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amiti K Mehta
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexandra T Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Manraj K Heran
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charanveer S Sahota
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada.,British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Pain, opioid use, depressive symptoms, and mortality in adults living in precarious housing or homelessness. Pain 2022; 163:2213-2223. [DOI: 10.1097/j.pain.0000000000002619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
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18
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O'Connor TA, Panenka WJ, Livingston EM, Stubbs JL, Askew J, Sahota CS, Feldman SJ, Buchanan T, Xu L, Hu XJ, Lang DJ, Woodward ML, Thornton WL, Gicas KM, Vertinsky AT, Heran MK, Su W, MacEwan GW, Barr AM, Honer WG, Thornton AE. Traumatic brain injury in precariously housed persons: Incidence and risks. EClinicalMedicine 2022; 44:101277. [PMID: 35252825 PMCID: PMC8888336 DOI: 10.1016/j.eclinm.2022.101277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/19/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Homeless and precarious housed persons are particularly prone to traumatic brain injuries (TBIs), but existent incidence rates are hampered by poor case acquisition. We rigorously documented TBIs in precariously housed persons transitioning in and out of homelessness. METHODS Between December 2016 and May 2018, 326 precariously housed participants enrolled in a longitudinal study in Vancouver, Canada were assessed monthly for TBI occurrences after education on sequelae. Over one participant-year, 2433 TBI screenings were acquired for 326 person-years and variables associated with odds of incident TBI were evaluated. FINDINGS One hundred participants acquired 175 TBIs, yielding an observed incidence proportion of 30·7% and event proportion of 53·7%. Of the injured, 61% reported one TBI and 39% reported multiple injuries. Acute intoxication was present for more than half of the TBI events assessed. Additionally, 9·7% of TBI events occurred in the context of a drug overdose. Common injury mechanisms were falls (45·1%), assaults (25·1%), and hitting one's head on an object (13·1%). In this community-based but non-randomly recruited sample, exploratory analyses identified factors associated with odds of an incident TBI over one year of follow-up, including: schizophrenia disorders (odds ratio (OR) = 0·43, 95% confidence interval (CI) 0·19, 0·94), role functioning (OR = 0·69, 95% CI 0·52, 0·91), opioid dependence (OR = 2·17, 95% CI 1·27, 3·72) and those reporting past TBIs (OR = 1·99, 95% CI 1·13, 3·52). INTERPRETATION Given the ubiquity of TBIs revealed in this precariously housed sample, we identify an underappreciated and urgent healthcare priority. Several factors modified the odds of incident TBI, which can facilitate investigations into targeted prevention efforts. FUNDING Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, William and Ada Isabelle Steel Research Fund, Simon Fraser University Vice-President Research Undergraduate Student Research Award and Simon Fraser University Psychology Department Research Grant.
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Affiliation(s)
- Tiffany A. O'Connor
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
| | - William J. Panenka
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Emily M. Livingston
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
| | - Jacob L. Stubbs
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Julia Askew
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Charanveer S. Sahota
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
| | | | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Linwan Xu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - X. Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - Donna J. Lang
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L. Woodward
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Kristina M. Gicas
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | | | - Manraj K. Heran
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - G. William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
- Correspondence to: Allen E. Thornton, Human Neuropsychology Laboratory, Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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19
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Cho LL, Jones AA, Barbic S, Leonova O, Vila-Rodriguez F, Buchanan T, Lang DJ, William MacEwan G, Procyshyn RM, Panenka WJ, Barr AM, Thornton AE, Gicas KM, Honer WG. Psychometric properties and correlates of the Beck Depression Inventory in a community-based and homeless or precariously housed sample. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Maldonado-Rodriguez N, Crocker CV, Taylor E, Jones KE, Rothlander K, Smirl J, Wallace C, van Donkelaar P. Characterization of Cognitive-Motor Function in Women Who Have Experienced Intimate Partner Violence-Related Brain Injury. J Neurotrauma 2021; 38:2723-2730. [PMID: 34036801 DOI: 10.1089/neu.2021.0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intimate partner violence (IPV) affects at least one in three women worldwide, and up to 92% report symptoms consistent with brain injury (BI). Although a handful of studies have examined different aspects of brain structure and function in this population, none has characterized potential deficits in cognitive-motor function. This knowledge gap was addressed in the current study by having participants who had experienced IPV complete the bimanual Object Hit & Avoid (OHA) task in a Kinesiological Instrument for Normal and Altered Reaching Movement (KINARM) End-Point Laboratory. BI load, post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and history of abuse were also assessed. A stepwise multiple regression was undertaken to explore the relationship between BI load and task performance while accounting for comorbid psychopathologies. Results demonstrated that BI load accounted for a significant amount of variability in the number of targets hit and the average hand speed. PTSD, anxiety, and depression also contributed significantly to the variability in these measures as well as to the number and proportion of distractor hits, and the object processing rate. Taken together, these findings suggest that IPV-related BI, as well as comorbid PTSD, anxiety, and depression, disrupt the processing required to quickly and accurately hit targets while avoiding distractors. This pattern of results reflects the complex interaction between the physical injuries induced by the episodes of IPV and the resulting impacts that these experiences have on mental health.
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Affiliation(s)
- Naomi Maldonado-Rodriguez
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Clara Val Crocker
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Edward Taylor
- School of Social Work, University of British Columbia, Kelowna, British Columbia, Canada
| | - K Elisabeth Jones
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Krystal Rothlander
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Jon Smirl
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Colin Wallace
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
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21
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Baitz HA, Jones PW, Campbell DA, Jones AA, Gicas KM, Giesbrecht CJ, Loken Thornton W, Barone CC, Wang NY, Panenka WJ, Lang DJ, Vila-Rodriguez F, Leonova O, Barr AM, Procyshyn RM, Buchanan T, Rauscher A, MacEwan GW, Honer WG, Thornton AE. Component Processes of Decision Making in a Community Sample of Precariously Housed Persons: Associations With Learning and Memory, and Health-Risk Behaviors. Front Psychol 2021; 12:571423. [PMID: 34276459 PMCID: PMC8285095 DOI: 10.3389/fpsyg.2021.571423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 02/16/2021] [Indexed: 11/30/2022] Open
Abstract
The Iowa Gambling Task (IGT) is a widely used measure of decision making, but its value in signifying behaviors associated with adverse, "real-world" consequences has not been consistently demonstrated in persons who are precariously housed or homeless. Studies evaluating the ecological validity of the IGT have primarily relied on traditional IGT scores. However, computational modeling derives underlying component processes of the IGT, which capture specific facets of decision making that may be more closely related to engagement in behaviors associated with negative consequences. This study employed the Prospect Valence Learning (PVL) model to decompose IGT performance into component processes in 294 precariously housed community residents with substance use disorders. Results revealed a predominant focus on gains and a lack of sensitivity to losses in these vulnerable community residents. Hypothesized associations were not detected between component processes and self-reported health-risk behaviors. These findings provide insight into the processes underlying decision making in a vulnerable substance-using population and highlight the challenge of linking specific decision making processes to "real-world" behaviors.
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Affiliation(s)
- Heather A. Baitz
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Paul W. Jones
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - David A. Campbell
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
- School of Mathematics and Statistics, Carleton University, Ottawa, ON, Canada
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Kristina M. Gicas
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Chantelle J. Giesbrecht
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | | | | | - Nena Y. Wang
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Donna J. Lang
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - G. William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services, Research Institute, Vancouver, BC, Canada
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22
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Krausz RM, Wong JSH, Westenberg JN, Choi F, Schütz CG, Jang KL. Canada's Response to the Dual Public Health Crises: A Cautionary Tale. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:349-353. [PMID: 33567889 PMCID: PMC8044624 DOI: 10.1177/0706743721993634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Reinhard M Krausz
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - James S H Wong
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Jean N Westenberg
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Fiona Choi
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian G Schütz
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry L Jang
- Department of Psychiatry, 8166University of British Columbia, Vancouver, British Columbia, Canada
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23
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Gicas KM, Cheng A, Panenka WJ, Kim DD, Yau JC, Procyshyn RM, Stubbs JL, Jones AA, Bains S, Thornton AE, Lang DJ, Vertinsky AT, Rauscher A, Honer WG, Barr AM. Differential effects of cannabis exposure during early versus later adolescence on the expression of psychosis in homeless and precariously housed adults. Prog Neuropsychopharmacol Biol Psychiatry 2021; 106:110084. [PMID: 32890696 DOI: 10.1016/j.pnpbp.2020.110084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/16/2020] [Accepted: 08/26/2020] [Indexed: 12/20/2022]
Abstract
Longitudinal studies of cannabis exposure during early adolescence in the general population frequently report an increased risk of subsequently developing psychotic symptoms or a psychotic illness. However, there is a dearth of knowledge about the effects of early cannabis exposure on psychosis in homeless and precariously housed adults, who represent a population afflicted with high rates of psychosis. The aim of the present study was to examine how early cannabis exposure (by age 15) compared to later first use (after age 15) affected the expression of adult psychosis in this population. Secondary measures of psychopathology, drug use, cognition and brain structure were also collected. 437 subjects were recruited from single room occupancy hotels in the urban setting of the Downtown Eastside of Vancouver, Canada. Psychiatric diagnoses were determined, and psychotic symptom severity was measured with the 5-factor PANSS. Participants completed a battery of neurocognitive tests, and brain structure was assessed using structural and diffusion tensor imaging MRI scans. Results indicated that early cannabis exposure was associated with an increased risk (OR = 1.09, p < .05) of developing substance induced psychosis, whereas later first use increased risk (OR = 2.19, p < .01) of developing schizophrenia or schizoaffective disorder. There was no group difference in neurocognitive function, although differences were observed in the lateral orbitofrontal cortex and white matter tract diffusivity. These findings indicate that early cannabis exposure in this population may increase the risk of developing drug associated psychoses, which could potentially be mediated in part through altered neurodevelopmental brain changes.
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Affiliation(s)
| | - Alex Cheng
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jade C Yau
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Simran Bains
- Department of Medicine, Imperial College London, United Kingdom
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alexandra T Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alex Rauscher
- Department of Radiology, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, 2176 Health Sciences Mall, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
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24
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Gutwinski S, Westerbarkey E, Schouler-Ocak M, Moran JK, Schreiter S. Housing Satisfaction of Psychiatric Patients in Different Forms of Housing-A Cross-Sectional Study in Berlin, Germany. Front Psychiatry 2021; 12:652565. [PMID: 34168576 PMCID: PMC8218992 DOI: 10.3389/fpsyt.2021.652565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 12/28/2022] Open
Abstract
The growing social problem of homelessness and precarious housing situations has negative effects on psychological outcomes and quality of life (QoL) for mentally ill people. Despite a large body of research on QoL among homeless mentally ill people, research on housing satisfaction as a specific QoL domain and important outcome variable for treatment interventions is scarce. The purpose of this cross-sectional study is to investigate housing satisfaction among psychiatric patients in various housing situations. Out of 1,251 patients that were treated in the targeted facilities during the admission period, 540 agreed to participate (43.2%). 123 participants were excluded from the analysis due to missing data, resulting in a sample of N = 417. Housing satisfaction data was assessed in a subjective screening and differences in satisfaction levels between housing status groups were analyzed. As hypothesized, more normative housing situations reported higher housing satisfaction. Homeless participants and those living in socio-therapeutic facilities were associated with more psychological and physical distress resulting from their housing situation than domiciled and flat-sharing participants. Problems of reducing homelessness and improving housing support are highlighted, as well as opportunities for improving support, particularly in therapeutic facilities.
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Affiliation(s)
- Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany
| | - Ella Westerbarkey
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany
| | - Meryam Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany
| | - James K Moran
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany
| | - Stefanie Schreiter
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Berlin, Germany
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25
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Lewinson T, Carrion IV. "They don't know who they have in here": Sense of community in budget hotels. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:2552-2570. [PMID: 32939757 DOI: 10.1002/jcop.22448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
The purpose of this study was to understand older residents descriptions of socio-spatial guest interactions and sense of community in budget hotels. Due to financial vulnerability, some people move into budget hotels when other housing options are unavailable. Little is known about how older residents perceive other hotel guests who frequent the commercial establishment and how a mix of various consumer interactions can potentially influence health. Theoretically framing this inquiry with sense of community constructs, we conducted a secondary data analysis of 20 interviews with residents aged 50 and older. Through thematic analysis strategies, we identified temporal and socio-spatial interactions of hotel guests, then discussed sense of community based on these insider/outsider relationships. We conclude with research, policy, and practice implications of our findings.
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Affiliation(s)
- Terri Lewinson
- School of Social Work, Georgia State University, Atlanta, Georgia, USA
| | - Iraida V Carrion
- School of Social Work, University of South Florida, Tampa, Florida, USA
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26
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Zhou LW, Panenka WJ, Al-Momen G, Gicas KM, Thornton AE, Jones AA, Woodward M, Heran MKS, Vertinsky AT, Su W, Barr AM, MacEwan GW, Lang DJ, Rauscher A, Honer WG, Field TS. Cerebral Small Vessel Disease, Risk Factors, and Cognition in Tenants of Precarious Housing. Stroke 2020; 51:3271-3278. [PMID: 33019899 DOI: 10.1161/strokeaha.120.030446] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE We aim to describe the burden, characteristics, and cognitive associations of cerebral small vessel disease in a Canadian sample living with multimorbidity in precarious housing. METHODS Participants received T1, T2-fluid-attenuated inversion recovery, and susceptibility-weighted imaging 3T magnetic resonance imaging sequences and comprehensive clinical, laboratory, and cognitive assessments. Cerebral small vessel disease burden was characterized using a modified Small Vessel Disease (mSVD) score. One point each was given for moderate-severe white matter hyperintensities, ≥1 cerebral microbleeds, and ≥1 lacune. Multivariable regression explored associations between mSVD score, risk factors, and cognitive performance. RESULTS Median age of the 228 participants (77% male) was 44.7 years (range, 23.3-63.2). In n=188 participants with consistent good quality magnetic resonance imaging sequences, mSVD scores were 0 (n=127, 68%), 1 (n=50, 27%), and 2 (n=11, 6%). Overall, one-third had an mSVD ≥1 n=61 (32%); this proportion was unchanged when adding participants with missing sequences n=72/228 (32%). The most prevalent feature was white matter hyperintensities 53/218 (24%) then cerebral microbleed 16/191 (8%) and lacunes 16/228 (7%). Older age (odds ratio, 1.10 [95% CI, 1.05-1.15], P<0.001), higher diastolic blood pressure (odds ratio, 1.05 [95% CI, 1.01-1.09], P=0.008), and a history of injection drug use (odds ratio, 3.13 [95% CI, 1.07-9.16], P=0.037) had significant independent associations with a mSVD score of ≥1 in multivariable analysis. mSVD ≥1 was associated with lower performance on tests of verbal memory, sustained attention, and decision-making, contributing 4% to 5% of the variance in each cognitive domain. CONCLUSIONS The 32% prevalence of cerebral small vessel disease in this young, socially marginalized cohort was higher than expected for age and was associated with poorer cognitive performance.
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Affiliation(s)
- Lily W Zhou
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - William J Panenka
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Ghadeer Al-Momen
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Kristina M Gicas
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Allen E Thornton
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Andrea A Jones
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Melissa Woodward
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Manraj K S Heran
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - A Talia Vertinsky
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Wayne Su
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Alasdair M Barr
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - G William MacEwan
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Donna J Lang
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Alexander Rauscher
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - William G Honer
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
| | - Thalia S Field
- Division of Neurology (L.W.Z., A.A.J., T.S.F.), University of British Columbia (UBC), Vancouver, Canada.,Department of Psychiatry (W.J.P., M.W., W.S., G.W.M., W.G.H.), University of British Columbia (UBC), Vancouver, Canada.,Department of Radiology (M.K.S.H., A.T.V., D.J.L.), University of British Columbia (UBC), Vancouver, Canada.,Department of Paediatrics (A.R.), University of British Columbia (UBC), Vancouver, Canada.,Department of Anesthesia, Pharmacology & Therapeutics (A.M.B.), University of British Columbia (UBC), Vancouver, Canada.,Department of Neurology, King Fahad medical city, Riyadh, Saudi Arabia (G.A.-M.).,Department of Psychology, York University, Toronto, Canada (K.M.G.).,Department of Psychology, Simon Fraser University, Burnaby, Canada (A.E.T.).,BC Provincial Neuropsychiatry program, Vancouver, Canada (W.J.P.).,BC Mental Health and Substance Use Services Research Institute, Vancouver, Canada (W.J.P., M.W., W.G.H.)
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Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada. PLoS Med 2020; 17:e1003172. [PMID: 32628679 PMCID: PMC7337288 DOI: 10.1371/journal.pmed.1003172] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The "trimorbidity" of substance use disorder and mental and physical illness is associated with living in precarious housing or homelessness. The extent to which substance use increases risk of psychosis and both contribute to mortality needs investigation in longitudinal studies. METHODS AND FINDINGS A community-based sample of 437 adults (330 men, mean [SD] age 40.6 [11.2] years) living in Vancouver, Canada, completed baseline assessments between November 2008 and October 2015. Follow-up was monthly for a median 6.3 years (interquartile range 3.1-8.6). Use of tobacco, alcohol, cannabis, cocaine, methamphetamine, and opioids was assessed by interview and urine drug screen; severity of psychosis was also assessed. Mortality (up to November 15, 2018) was assessed from coroner's reports and hospital records. Using data from monthly visits (mean 9.8, SD 3.6) over the first year after study entry, mixed-effects logistic regression analysis examined relationships between risk factors and psychotic features. A past history of psychotic disorder was common (60.9%). Nonprescribed substance use included tobacco (89.0%), alcohol (77.5%), cocaine (73.2%), cannabis (72.8%), opioids (51.0%), and methamphetamine (46.5%). During the same year, 79.3% of participants reported psychotic features at least once. Greater risk was associated with number of days using methamphetamine (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.05-1.24, p = 0.001), alcohol (aOR 1.09, 95% CI 1.01-1.18, p = 0.04), and cannabis (aOR 1.08, 95% CI 1.02-1.14, p = 0.008), adjusted for demographic factors and history of past psychotic disorder. Greater exposure to concurrent month trauma was associated with increased odds of psychosis (adjusted model aOR 1.54, 95% CI 1.19-2.00, p = 0.001). There was no evidence for interactions or reverse associations between psychotic features and time-varying risk factors. During 2,481 total person years of observation, 79 participants died (18.1%). Causes of death were physical illness (40.5%), accidental overdose (35.4%), trauma (5.1%), suicide (1.3%), and unknown (17.7%). A multivariable Cox proportional hazard model indicated baseline alcohol dependence (adjusted hazard ratio [aHR] 1.83, 95% CI 1.09-3.07, p = 0.02), and evidence of hepatic fibrosis (aHR 1.81, 95% CI 1.08-3.03, p = 0.02) were risk factors for mortality. Among those under age 55 years, a history of a psychotic disorder was a risk factor for mortality (aHR 2.38, 95% CI 1.03-5.51, p = 0.04, adjusted for alcohol dependence at baseline, human immunodeficiency virus [HIV], and hepatic fibrosis). The primary study limitation concerns generalizability: conclusions from a community-based, diagnostically heterogeneous sample may not apply to specific diagnostic groups in a clinical setting. Because one-third of participants grew up in foster care or were adopted, useful family history information was not obtainable. CONCLUSIONS In this study, we found methamphetamine, alcohol, and cannabis use were associated with higher risk for psychotic features, as were a past history of psychotic disorder, and experiencing traumatic events. We found that alcohol dependence, hepatic fibrosis, and, only among participants <55 years of age, history of a psychotic disorder were associated with greater risk for mortality. Modifiable risk factors in people living in precarious housing or homelessness can be a focus for interventions.
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Jones PW, Thornton AE, Jones AA, Knerich VM, Lang DJ, Woodward ML, Panenka WJ, Su W, Barr AM, Buchanan T, Honer WG, Gicas KM. Amygdala Nuclei Volumes Are Selectively Associated With Social Network Size in Homeless and Precariously Housed Persons. Front Behav Neurosci 2020; 14:97. [PMID: 32612516 PMCID: PMC7309349 DOI: 10.3389/fnbeh.2020.00097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The amygdala is a brain region comprised of a group of functionally distinct nuclei that play a central role in social behavior. In homeless and precariously housed individuals, high rates of multimorbidity, and structural aspects of the environment may dysregulate social functioning. This study examined the neurobiological substrates of social connection in homeless and precariously housed persons by examining associations between amygdala nuclei volumes and social network size. Methods: Sixty participants (mean age 43.6 years; 73.3% male) were enrolled from an ongoing study of homeless and precariously housed adults in Vancouver, Canada. Social network size was assessed using the Arizona Social Support Interview Schedule. Amygdala nuclei volumes were extracted from anatomic T1-weighted MRI data. The central and basolateral amygdala nuclei were selected as they are implicated in anxiety-related and social behaviors. The hippocampus was included as a control brain region. Multivariable regression analysis investigated the relationship between amygdala nuclei volumes and social network size. Results: After controlling for age, sex, and total brain volume, individuals with the larger amygdala and central nucleus volumes had a larger network size. This association was not observed for the basolateral amygdala complex, though subsequent analysis found the basal and accessory basal nuclei of the basolateral amygdala were significantly associated with social network size. No association was found for the lateral amygdala nucleus or hippocampus. Conclusions: These findings suggest that select amygdala nuclei may be differentially involved in the social connections of persons with multimorbid illness and social marginalization.
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Affiliation(s)
- Paul W. Jones
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Verena M. Knerich
- Department of Computer Science, Ludwig Maximilians University, Munich, Germany
| | - Donna J. Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L. Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kristina M. Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Psychology, York University, Toronto, ON, Canada
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29
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Conway B, Truong D, Wuerth K. COVID-19 in homeless populations: unique challenges and opportunities. Future Virol 2020. [PMCID: PMC7319497 DOI: 10.2217/fvl-2020-0156] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Brian Conway
- Vancouver Infectious Diseases Centre, 201-1200 Burrard St, Vancouver, BC V6Z 2C7, Canada
| | - David Truong
- Vancouver Infectious Diseases Centre, 201-1200 Burrard St, Vancouver, BC V6Z 2C7, Canada
| | - Kelli Wuerth
- Vancouver Infectious Diseases Centre, 201-1200 Burrard St, Vancouver, BC V6Z 2C7, Canada
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30
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Stubbs JL, Thornton AE, Silverberg ND, Sevick JM, Barr AM, Honer WG, Panenka WJ. Traumatic Brain Injury: An Underappreciated Determinant of Health in Individuals Who are Homeless or Precariously Housed. World Neurosurg 2020; 137:474-475. [PMID: 32365435 DOI: 10.1016/j.wneu.2020.02.133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychology, Simon Fraser University, Vancouver, BC, Canada
| | - Noah D Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Jessica M Sevick
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; British Columbia Neuropsychiatry Program, Vancouver, BC, Canada
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31
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Gicas KM, Jones AA, Thornton AE, Petersson A, Livingston E, Waclawik K, Panenka WJ, Barr AM, Lang DJ, Vila-Rodriguez F, Leonova O, Procyshyn RM, Buchanan T, MacEwan GW, Honer WG. Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study. BJPsych Open 2020; 6:e21. [PMID: 32043436 PMCID: PMC7176832 DOI: 10.1192/bjo.2020.3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Homeless and precariously housed individuals experience a high burden of comorbid illnesses, and excess mortality. Cross-sectional studies report a high rate of cognitive impairment. Long-term trajectories have not been well investigated in this group. AIMS To longitudinally assess risks for premature and/or accelerated cognitive ageing, and the relationship with early mortality in homeless and precariously housed people. METHOD This is a 9-year community-based study of 375 homeless and precariously housed individuals from Vancouver, Canada. Annual cognitive testing assessed verbal learning and memory, and inhibitory control. Linear mixed-effects models examined associations between clinical risk factors (traumatic brain injury, psychotic disorders, viral exposure, alcohol dependence) and cognitive change over 9 years. Cox regression models examined the association between cognition and mortality. RESULTS Traumatic brain injury and alcohol dependence were associated with decline in verbal memory. Inhibitory control declined, independent of risk factors and to a greater extent in those who died during the study. Better inhibitory control was associated with a 6.6% lower risk of mortality at study entry, with a 0.3% greater effect for each year of life. For each one-point increase in the Charlson Comorbidity Index score at study entry, the risk of mortality was 9.9% higher, and was consistent across age. Adjusting for comorbidities, inhibitory control remained a significant predictor of mortality. CONCLUSIONS Findings raise the possibility of a premature onset, and accelerated trajectory, of cognitive ageing in this group of homeless and precariously housed people. Traumatic brain injury, alcohol dependence and cognition could be treatment priorities.
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Affiliation(s)
- Kristina M Gicas
- Department of Psychology, York University, Toronto, Canada.,Department of Psychiatry, University of British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Canada
| | | | - Anna Petersson
- Department of Psychology, Simon Fraser University, Canada
| | | | | | | | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Canada
| | | | - William G Honer
- Department of Psychiatry, University of British Columbia; and British Columbia Mental Health and Substance Use Services Research Institute, Canada
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32
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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.
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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
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33
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Stubbs JL, Thornton AE, Sevick JM, Silverberg ND, Barr AM, Honer WG, Panenka WJ. Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis. LANCET PUBLIC HEALTH 2019; 5:e19-e32. [PMID: 31806487 DOI: 10.1016/s2468-2667(19)30188-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Homelessness is a global public health concern, and traumatic brain injury (TBI) could represent an underappreciated factor in the health trajectories of homeless and marginally housed individuals. We aimed to evaluate the lifetime prevalence of TBI in this population, and to summarise findings on TBI incidence and the association between TBI and health-related or functioning-related outcomes. METHODS For this systematic review and meta-analysis, we searched without date restrictions for original research studies in English that reported data on the prevalence or incidence of TBI, or the association between TBI and one or more health-related or function-related outcome measures. Studies were included if they had a group or clearly identifiable subgroup of individuals who were homeless, marginally housed, or seeking services for homeless people. With use of random-effects models, we calculated pooled estimates of the lifetime prevalence of any severity of TBI and the lifetime prevalence of moderate or severe TBI. We used meta-regression and subgroup analysis to evaluate potential moderators of prevalence estimates and the leave-one-out method for sensitivity analyses. We then summarised findings from all studies that evaluated TBI incidence and the association between TBI and health-related or functioning-related outcomes. All statistical analyses were done using R version 3.5.1. The study is registered with PROSPERO, number CRD42019119678. FINDINGS Of 463 potentially eligible studies identified by the search, 38 studies were included in the systematic review and 22 studies were included in the meta-analysis. The lifetime prevalence of any severity of TBI in homeless and marginally housed individuals (18 studies, n=9702 individuals) was 53·1% (95% CI 46·4-59·7; I2=97%) and the lifetime prevalence of moderate or severe TBI (nine studies, n=5787) was 22·5% (13·5-35·0; I2=99%). The method used to ascertain TBI history, the age of the sample, and the sample size significantly moderated estimated lifetime prevalence of any severity of TBI. TBI was consistently associated with poorer self-reported physical and mental health, higher suicidality and suicide risk, memory concerns, and increased health service use and criminal justice system involvement. INTERPRETATION The lifetime prevalence of TBI is high among homeless and marginally housed individuals, and a history of TBI is associated with poorer health and general functioning. Health-care providers and public health officials should have an increased awareness of the burden of TBI in this population. Prospective and longitudinal studies are needed to better understand how the health of this population is affected by TBI. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada.
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Jessica M Sevick
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Noah D Silverberg
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada; British Columbia Provincial Neuropsychiatry Program, Vancouver, BC, Canada
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A comparison of regional brain volumes and white matter connectivity in subjects with stimulant induced psychosis versus schizophrenia. Psychopharmacology (Berl) 2019; 236:3385-3399. [PMID: 31230145 DOI: 10.1007/s00213-019-05298-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/05/2019] [Indexed: 12/31/2022]
Abstract
RATIONALE Schizophrenia and stimulant-induced psychosis (SIP) represent two different forms of psychotic disorder, with different etiologies. While many of the symptoms of psychosis are common to both disorders, there have been few direct comparisons between these conditions, especially when controlling for stimulant use in individuals with schizophrenia. OBJECTIVES We directly compared both psychotic disorders with a comprehensive battery of clinical, neurocognitive and neuroanatomical measures. This included one group with SIP (and concurrent stimulant dependence) and two groups with schizophrenia (either with or without concurrent stimulant dependence). METHODS Ninety-six participants were recruited from a marginalized urban population, which included 39 with SIP (and concurrent stimulant dependence), 18 with schizophrenia (without stimulant dependence), and 39 with schizophrenia (with concurrent stimulant dependence). All subjects had extensive clinical and neurocognitive evaluations, complemented with structural MRI including diffusion tensor imaging (DTI) sequences to determine regional brain volumes and white matter connectivity. RESULTS Both positive and negative symptoms were greater in the SZ-dependent group than the other two. Neurocognitive function was broadly similar. The structural brain imaging revealed lateralized changes to the left parietal/temporal lobe, in which regional volumes were smaller in the SZ-dependent than the SZ-non-dependent group. DTI analysis indicated extensive decreases in fractional anisotropy, with parallel increases in radial diffusivity, in the SIP group compared to the SZ-dependent group. CONCLUSIONS These findings reveal both similarities and differences between SIP and schizophrenia. Furthermore, schizophrenia with concurrent stimulant dependence may be associated with a different clinical and neuroanatomical profile as compared to schizophrenia alone.
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Magee C, Norena M, Hubley AM, Palepu A, Hwang SW, Nisenbaum R, Karim ME, Gadermann A. Longitudinal Associations between Perceived Quality of Living Spaces and Health-Related Quality of Life among Homeless and Vulnerably Housed Individuals Living in Three Canadian Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234808. [PMID: 31795464 PMCID: PMC6926800 DOI: 10.3390/ijerph16234808] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/15/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023]
Abstract
The objective of this study was to examine longitudinal associations between perceived quality of living spaces and mental and physical health-related quality of life (HRQoL) among homeless and vulnerably housed individuals living in three Canadian cities. The Health and Housing in Transition (HHiT) study was a prospective cohort study conducted between 2009 and 2013 of N = 1190 individuals who were homeless and vulnerably housed at baseline. Perceived quality of living spaces (based on rated comfort, safety, spaciousness, privacy, friendliness and overall quality) and both mental and physical HRQoL were assessed at baseline and at four annual follow up points. Generalized estimating equation (GEE) analyses were used to examine associations between perceived quality of living spaces and both mental and physical HRQoL over the four-year study period, controlling for time-varying housing status, health and socio-demographic variables. The results showed that higher perceived quality of living spaces was positively associated with mental (b = 0.42; 95% CI 0.38—0.47) and physical (b = 0.11; 95% CI 0.07—0.15) HRQoL over the four-year study period. Findings indicate that policies aimed at increasing HRQoL in this population should prioritize improving their experienced quality of living spaces.
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Affiliation(s)
- Carly Magee
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.E.K.); (A.G.)
- Human Early Learning Partnership, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6T 1Z3, Canada; (M.N.); (A.P.)
| | - Anita M. Hubley
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6T 1Z3, Canada; (M.N.); (A.P.)
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1A6, Canada; (S.W.H.); (R.N.)
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B 1A6, Canada; (S.W.H.); (R.N.)
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON M5B 1A6, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.E.K.); (A.G.)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6T 1Z3, Canada; (M.N.); (A.P.)
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (M.E.K.); (A.G.)
- Human Early Learning Partnership, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6T 1Z3, Canada; (M.N.); (A.P.)
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Barbic SP, Chan N, Rangi A, Bradley J, Pattison R, Brockmeyer K, Leznoff S, Smolski Y, Toor G, Bray B, Leon A, Jenkins M, Mathias S. Health provider and service-user experiences of sensory modulation rooms in an acute inpatient psychiatry setting. PLoS One 2019; 14:e0225238. [PMID: 31751373 PMCID: PMC6874072 DOI: 10.1371/journal.pone.0225238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sensory modulation rooms (SMRs) are therapeutic spaces that use sensory modulation concepts and strategies to assist service users to self-regulate and modulate arousal levels. SMRs are increasingly being explored as strength-based and person-centered adjuncts to care for people receiving inpatient psychiatry services. The aim of this study is to understand health provider and inpatient service user perceptions on the use of SMRs on acute psychiatric units. METHODS We conducted semi-structured interviews with ten service users and nine health providers (four occupational therapists and five nurses) regarding their experiences of the SMRs located on three acute inpatient units in a large urban tertiary care hospital. We audio recorded and transcribed the focus groups and used thematic analysis to analyze the data. RESULTS Our results suggested four common themes amongst health provider and service user experiences of sensory modulation rooms: (1) service user empowerment through self-management, (2) emotional regulation, (3) an alternative to current practices, and (4) health provider and service user education. CONCLUSION Our study supports the ecological utility of SMRs as person-centred adjunct therapeutic space viewed positively by both service users and health providers. This understanding of SMRs is critical for future service design, research and policy aimed at improving the service user experience and care for this population. Future research is needed to validate the experience of the SMRs with other patient groups and health providers.
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Affiliation(s)
- Skye P Barbic
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada.,Providence Health Care, Vancouver, British Columbia, Canada.,Department of Psychiatry, UBC, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Foundry, Vancouver, British Columbia, Canada
| | - Nicole Chan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Amanpreet Rangi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - James Bradley
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Rachal Pattison
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | | | - Sandy Leznoff
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Yojo Smolski
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Gagan Toor
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Blaine Bray
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Adelena Leon
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Malcolm Jenkins
- Providence Health Care, Vancouver, British Columbia, Canada.,Foundry, Vancouver, British Columbia, Canada
| | - Steve Mathias
- Providence Health Care, Vancouver, British Columbia, Canada.,Department of Psychiatry, UBC, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Foundry, Vancouver, British Columbia, Canada.,Department of Psychiatry, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Yau JC, Yu SM, Panenka WJ, Pearce H, Gicas KM, Procyshyn RM, MacCallum C, Honer WG, Barr AM. Characterization of mental health in cannabis dispensary users, using structured clinical interviews and standardized assessment instruments. BMC Psychiatry 2019; 19:335. [PMID: 31675939 PMCID: PMC6825348 DOI: 10.1186/s12888-019-2324-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cannabis is commonly used for its medical properties. In particular, cannabis is purported to have beneficial effects on a wide range of neuropsychiatric conditions. Studies assessing mental health in cannabis dispensary users typically evaluate symptoms using self-report check lists, which provide limited information about symptom severity, and whether subjects meet criteria for a psychiatric diagnosis. There is, therefore, a need for studies which assess mental health in dispensary users with standardized and well validated scientific instruments, such as those used in clinical drug trials. METHODS One hundred medical cannabis users were recruited from a community dispensary. All subjects completed a structured clinical interview with the Mini-International Neuropsychiatric Interview (MINI). Subjects also completed the Perceived Stress Scale-10, PROMIS Fatigue Scale, PROMIS Sleep Disturbance Scale, Beck Depression Inventory, the Patient Health Questionnaire-15 and the Brief Pain Inventory. Details about cannabis use were also recorded. RESULTS Lifetime prevalence of mental illness in this cohort was high, and a large proportion of subjects endorsed psychological symptoms. The proportion of subjects who met criteria for classification of a current psychiatric disorder was low for mood disorders, but high for anxiety disorders and substance abuse/dependence. Cannabis use differed between the main psychiatric conditions. CONCLUSIONS The present results indicate that rates of mental illness may be high in medical cannabis dispensary users. Use of structured clinical assessments combined with standardized symptom severity questionnaires provide a feasible way to provide a more rigorous and detailed evaluation of conditions and symptoms in this population.
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Affiliation(s)
- Jade C. Yau
- 0000 0001 2288 9830grid.17091.3eDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - Shu Min Yu
- 0000 0001 2288 9830grid.17091.3eDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
| | - William J. Panenka
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Hadley Pearce
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Kristina M. Gicas
- 0000 0004 1936 9430grid.21100.32Department of Psychology, York University, Toronto, Ontario Canada
| | - Ric M. Procyshyn
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Caroline MacCallum
- 0000 0001 2288 9830grid.17091.3eDepartment of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - William G. Honer
- 0000 0001 2288 9830grid.17091.3eDepartment of Psychiatry, University of British Columbia, Vancouver, British Columbia Canada
| | - Alasdair M. Barr
- 0000 0001 2288 9830grid.17091.3eDepartment of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3 Canada
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Rowe CL, Riley ED, Eagen K, Zevin B, Coffin PO. Drug overdose mortality among residents of single room occupancy buildings in San Francisco, California, 2010-2017. Drug Alcohol Depend 2019; 204:107571. [PMID: 31581024 PMCID: PMC11105971 DOI: 10.1016/j.drugalcdep.2019.107571] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 08/14/2019] [Accepted: 08/14/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Single room occupancy (SRO) buildings, also known as residential hotels, are a form of affordable housing common to cities in North America, and residents of these buildings face elevated rates of substance use, physical and mental multimorbidity, and mortality. Identifying distinct populations at greater risk of overdose death is crucial to the planning of interventions aiming to reduce drug-related mortality, yet no studies have assessed the population burden of overdose mortality among SRO residents. The present study quantifies and characterizes drug overdose mortality among residents of SRO buildings in a large U.S. city. METHODS We used mortality records and a database of SRO buildings to calculate rate ratios comparing overdose mortality due to opioids, cocaine, and methamphetamine among SRO residents and non-SRO residents in San Francisco, CA 2010-2017 and assessed bivariate differences in decedent and death location characteristics between SRO resident and other overdose decedents. RESULTS There were 1,551 overdose deaths during the study period, with an overall rate of 21.3 per 100,000 residents (95%CI = 20.2-22.6). The rate among SRO residents (278.7, 95%CI = 252.9-306.5) was 19.3 (95%CI = 17.1-21.7) times that of non-SRO residents (21.3, 95%CI = 20.2-22.6). An additional 79 (5%) deaths among non-residents occurred in SRO buildings, and 86% of SRO resident decedents died at home compared to 64% of non-SRO residents (p < 0.05). CONCLUSIONS Overdose mortality was substantially higher among SRO residents, who were also more likely to die from overdose at home, which highlights the need for resources and targeted interventions directed towards residents of SRO buildings.
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Affiliation(s)
- Christopher L Rowe
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States; University of California, Berkeley, 2121 Berkeley Way, 5th Floor, Berkeley, CA, 94702, United States.
| | - Elise D Riley
- University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, United States
| | - Kellene Eagen
- San Francisco Department of Public Health, 230 Golden Gate Avenue, San Francisco, CA 94102, United States
| | - Barry Zevin
- San Francisco Department of Public Health, 50 Ivy Street, San Francisco, CA 94102, United States
| | - Phillip O Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, 94143, United States
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Waclawik K, Jones AA, Barbic SP, Gicas KM, O'Connor TA, Smith GN, Leonova O, Mathias S, Barr AM, Procyshyn RM, Lang DJ, Woodward ML, MacEwan GW, Panenka WJ, Yamamoto A, Honer WG, Thornton AE. Cognitive Impairment in Marginally Housed Youth: Prevalence and Risk Factors. Front Public Health 2019; 7:270. [PMID: 31649909 PMCID: PMC6792471 DOI: 10.3389/fpubh.2019.00270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022] Open
Abstract
Objective: Homeless and marginally housed youth are particularly vulnerable members of society, and are known to experience numerous health problems, including psychiatric illness, substance use, and viral infection. Despite the presence of these risk factors for cognitive compromise, there is limited research on the cognitive functioning of homeless and marginally housed youth. The present study examines the degree and pattern of cognitive impairment and associations with key risk factors in a sample of marginally housed young adults. Method: Participants (N = 101) aged 20–29 years old were recruited from single-room occupancy hotels, and underwent cognitive, psychiatric, neurological, and serological assessments. Results: Forty percent of participants were identified as mildly cognitively impaired across multiple domains, and 16% were moderately-severely impaired. Deficits in memory and attention were most prevalent, while impairments in inhibitory control/processing speed and cognitive flexibility were also present but tended to be less severe. Developmental and historical factors (premorbid intellectual functioning, neurological soft signs, earlier exposure to and longer duration of homelessness or marginal housing), as well as current health risks (stimulant dependence and hepatitis C exposure), were associated with cognitive impairment. Conclusions: The strikingly high rate of cognitive impairment in marginally housed young adults represents a major public health concern and is likely to pose a significant barrier to treatment and rehabilitation. These results suggest that the pathway to cognitive impairment involves both developmental vulnerability and modifiable risk factors. This study highlights the need for early interventions that address cognitive impairment and risk factors in marginalized young people.
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Affiliation(s)
- Kristina Waclawik
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Skye P Barbic
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Providence Health Care and Foundry, Vancouver, BC, Canada
| | - Kristina M Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Geoffrey N Smith
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Steve Mathias
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.,Providence Health Care and Foundry, Vancouver, BC, Canada.,St. Paul's Hospital, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L Woodward
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,St. Paul's Hospital, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
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Tabi K, Choi F, Mithani Z, Nikoo M, Jang K, Krausz M. History of parenting instability and lifetime suicidal behavior in people who inject drugs. Psychiatry Res 2019; 280:112493. [PMID: 31376790 DOI: 10.1016/j.psychres.2019.112493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 07/19/2019] [Accepted: 07/21/2019] [Indexed: 11/26/2022]
Abstract
Despite high rates of suicide in people who inject drugs, little is known about the risk factors for suicide related to childhood and family history in this population. We aimed to explore the relationship between the history of out-of-home care (OHC) and lifetime suicide attempts among people who inject opioids. Participants (N = 202) were current injection opioid users with at least one previous episode of opioid maintenance treatment. They were recruited into a double-blind randomized controlled trial for opioid substitution treatment. Secondary analysis of baseline data was conducted from the European Addiction Severity Index and basic demographics questionnaires. A total of 81 (40%) participants reported a history of living in OHC and 27% reported attempting suicide. Participants who reported living in OHC were more likely to report lifetime suicide attempts compared to those who did not live in OHC. History of OHC and suicidal ideation were significant risk factors for suicide attempts adjusting for depression and anxiety. Highest rates of lifetime attempts were among participants who lived in a group home, foster care, and/or psychiatric facility. Living in OHC during childhood was significantly associated with higher rates of suicide attempts in our sample. Greater efforts should be made to provide children from vulnerable families with environments where stable one-to-one relationships can be cultivated.
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Affiliation(s)
- Katarina Tabi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Department of Pharmacology, Masaryk University, Brno, Czech Republic.
| | - Fiona Choi
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Zamina Mithani
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kerry Jang
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Knerich V, Jones AA, Seyedin S, Siu C, Dinh L, Mostafavi S, Barr AM, Panenka WJ, Thornton AE, Honer WG, Rutherford AR. Social and structural factors associated with substance use within the support network of adults living in precarious housing in a socially marginalized neighborhood of Vancouver, Canada. PLoS One 2019; 14:e0222611. [PMID: 31545818 PMCID: PMC6756550 DOI: 10.1371/journal.pone.0222611] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The structure of a social network as well as peer behaviours are thought to affect personal substance use. Where substance use may create health risks, understanding the contribution of social networks to substance use may be valuable for the design and implementation of harm reduction or other interventions. We examined the social support network of people living in precarious housing in a socially marginalized neighborhood of Vancouver, and analysed associations between social network structure, personal substance use, and supporters' substance use. METHODS An ongoing, longitudinal study recruited 246 participants from four single room occupancy hotels, with 201 providing social network information aligned with a 6-month observation period. Use of tobacco, alcohol, cannabis, cocaine (crack and powder), methamphetamine, and heroin was recorded at monthly visits. Ego- and graph-level measures were calculated; the dispersion and prevalence of substances in the network was described. Logistic mixed effects models were used to estimate the association between ego substance use and peer substance use. Permutation analysis was done to test for randomness of substance use dispersion on the social network. RESULTS The network topology corresponded to residence (Hotel) with two clusters differing in demographic characteristics (Cluster 1 -Hotel A: 94% of members, Cluster 2 -Hotel B: 95% of members). Dispersion of substance use across the network demonstrated differences according to network topology and specific substance. Methamphetamine use (overall 12%) was almost entirely limited to Cluster 1, and absent from Cluster 2. Different patterns were observed for other substances. Overall, ego substance use did not differ over the six-month period of observation. Ego heroin, cannabis, or crack cocaine use was associated with alter use of the same substances. Ego methamphetamine, powder cocaine, or alcohol use was not associated with alter use, with the exception for methamphetamine in a densely using part of the network. For alters using multiple substances, cannabis use was associated with lower ego heroin use, and lower ego crack cocaine use. Permutation analysis also provided evidence that dispersion of substance use, and the association between ego and alter use was not random for all substances. CONCLUSIONS In a socially marginalized neighborhood, social network topology was strongly influenced by residence, and in turn was associated with type(s) of substance use. Associations between personal use and supporter's use of a substance differed across substances. These complex associations may merit consideration in the design of interventions to reduce risk and harms associated with substance use in people living in precarious housing.
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Affiliation(s)
- Verena Knerich
- Departments of Computer Science, and Cultural Anthropology, Ludwig-Maximilians University, Munich, Germany
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sam Seyedin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Siu
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Louie Dinh
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Sara Mostafavi
- Department of Statistics, University of British Columbia, Vancouver, BC, Canada
- Medical Genetics, Department Office, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Gicas KM, Thornton AE, Waclawik K, Wang N, Jones AA, Panenka WJ, Lang DJ, Smith GN, Vila-Rodriguez F, Leonova O, Barr AM, Procyshyn RM, Buchanan T, Su W, Vertinsky AT, Rauscher A, MacEwan GW, Honer WG. Volumes of the Hippocampal Formation Differentiate Component Processes of Memory in a Community Sample of Homeless and Marginally Housed Persons. Arch Clin Neuropsychol 2019; 34:548-562. [PMID: 30407496 DOI: 10.1093/arclin/acy066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Persons who are homeless or marginally housed exhibit significant cognitive dysfunction, with memory being the most impaired domain. Hippocampal subfield volumes have been found to differentially relate to component processes of memory. The neural correlates of memory have not been previously examined in marginalized persons who are understudied and underserved. We examined whether hippocampal subfields and entorhinal cortex volumes are uniquely related to indices of verbal episodic memory using the Hopkins Verbal Learning Test - Revised. METHOD Data was used from a large sample of community dwelling homeless and marginally housed adults (N = 227). Regression analyses were conducted to examine hippocampal subfield volumes (CA1, CA3, CA4, dentate gyrus, subiculum) and entorhinal cortex, and their associations with measures of verbal immediate recall, learning slope, and verbal delayed recall. RESULTS Greater CA3 subfield volume was associated with better performance on an index of encoding (immediate recall), but only in older individuals. Greater CA1 and subiculum volumes were associated with better performance on immediate and delayed recall (measures that tap into retrieval processes), but not with learning slope (a more pure index of encoding). Entorhinal cortex volume was related to all components of memory beyond total hippocampal volume. CONCLUSIONS Our results suggest common neuroanatomical correlates of memory dysfunction in large sample of marginalized persons, and these are uniquely related to different components of memory. These findings have clinical relevance for marginalized populations and theoretical relevance to the growing literature on functional specialization of the hippocampal subfields.
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Affiliation(s)
- Kristina M Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | | | - Nena Wang
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Geoff N Smith
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Alexander Rauscher
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
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Zhou LW, Panenka WJ, Jones AA, Gicas KM, Thornton AE, Heran MKS, Volders D, Lang DJ, Vertinsky AT, Rauscher A, Su W, Barr AM, MacEwan GW, Honer WG, Field TS. Prevalence and Risk Factors of Brain Infarcts and Associations With Cognitive Performance in Tenants of Marginal Housing. J Am Heart Assoc 2019; 8:e011412. [PMID: 31242796 PMCID: PMC6662377 DOI: 10.1161/jaha.118.011412] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Homeless and vulnerably housed individuals are at increased risk for multimorbidity compared with the general population. We assessed prevalence of brain infarcts on neuroimaging and associations with vascular risk factors and cognitive performance in a prospective study of residents living in marginal housing. Methods and Results Two hundred twenty‐eight participants underwent structured clinical interviews, targeted clinical, laboratory, and neuropsychological assessments, and magnetic resonance imaging with T1, T2‐fluid‐attenuated inversion recovery and susceptibility‐weighted images. Subjects underwent cognitive testing to assess premorbid IQ, verbal learning and memory, inhibition, sustained attention, mental flexibility, and decision making. In this sample (mean age 44.0 years [SD 9.4], 77% male), prevalence of conventional vascular risk factors was lower than in the general population apart from tobacco use (94%). Ten‐year Framingham risk for any cardiovascular event was 11.4%±9.2%. Brain infarcts were present in 25/228 (11%). All were ischemic (40% cortical, 56% lacunar, 4% both). Participants with infarcts were older than those without (48.9±9.4 versus 43.4±9.2, P=0.006). In a multivariable regression analysis, only age remained a significant predictor of brain infarcts (odds ratio 1.08, 95% CI1.02–1.14, P=0.004). After controlling for age and education, the presence of infarct was a significant predictor of impaired decision making on the Iowa Gambling Task of decision making (β −28.2, 95% CI −42.7 to −14.1, P<0.001). Conclusions Prevalence of infarcts on neuroimaging in this disadvantaged, community‐dwelling cohort was much higher than expected for age and was associated with impaired decision making. Further research is needed to identify individuals at highest risk who may benefit from targeted preventative strategies.
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Affiliation(s)
- Lily W Zhou
- 1 Vancouver Stroke Program Division of Neurology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - William J Panenka
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada.,7 British Columbia Provincial Neuropsychiatry Program Vancouver British Columbia Canada.,8 British Columbia Mental Health and Substance Abuse Research Institute Vancouver British Columbia Canada
| | - Andrea A Jones
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
| | - Kristina M Gicas
- 3 Department of Psychology Simon Fraser University Burnaby British Columbia Canada
| | - Allen E Thornton
- 3 Department of Psychology Simon Fraser University Burnaby British Columbia Canada
| | - Manraj K S Heran
- 4 Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - David Volders
- 4 Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | - Donna J Lang
- 4 Department of Radiology University of British Columbia Vancouver British Columbia Canada
| | | | - Alexander Rauscher
- 6 Department of Pediatrics University of British Columbia Vancouver British Columbia Canada
| | - Wayne Su
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
| | - Alasdair M Barr
- 5 Department of Anesthesia, Pharmacology & Therapeutics University of British Columbia Vancouver British Columbia Canada
| | - Gordon William MacEwan
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
| | - William G Honer
- 2 Department of Psychiatry University of British Columbia Vancouver British Columbia Canada
| | - Thalia S Field
- 1 Vancouver Stroke Program Division of Neurology Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
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Gicas KM, Jones AA, Panenka WJ, Giesbrecht C, Lang DJ, Vila-Rodriguez F, Leonova O, Barr AM, Procyshyn RM, Su W, Rauscher A, Vertinsky AT, Buchanan T, MacEwan GW, Thornton AE, Honer WG. Cognitive profiles and associated structural brain networks in a multimorbid sample of marginalized adults. PLoS One 2019; 14:e0218201. [PMID: 31194834 PMCID: PMC6564539 DOI: 10.1371/journal.pone.0218201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Cognition is impaired in homeless and vulnerably housed persons. Within this heterogeneous and multimorbid group, distinct profiles of cognitive dysfunction are evident. However, little is known about the underlying neurobiological substrates. Imaging structural covariance networks provides a novel investigative strategy to characterizing relationships between brain structure and function within these different cognitive subgroups. Method Participants were 208 homeless and vulnerably housed persons. Cluster analysis was used to group individuals on the basis of similarities in cognitive functioning in the areas of attention, memory, and executive functioning. The principles of graph theory were applied to construct two brain networks for each cognitive group, using measures of cortical thickness and gyrification. Global and regional network properties were compared across networks for each of the three cognitive clusters. Results Three cognitive groups were defined by: higher cognitive functioning across domains (Cluster 1); lower cognitive functioning with a decision-making strength (Cluster 3); and an intermediate group with a relative executive functioning weakness (Cluster 2). Between-group differences were observed for cortical thickness, but not gyrification networks. The lower functioning cognitive group exhibited higher segregation and reduced integration, higher centrality in select nodes, and less spatially compact modules compared with the two other groups. Conclusions The cortical thickness network differences of Cluster 3 suggest that major disruptions in structural connectivity underlie cognitive dysfunction in a subgroup of people who have a high multimorbid illness burden and who are vulnerably housed or homeless. The origins, and possible plasticity of these structure-function relationships identified with network analysis warrant further study.
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Affiliation(s)
- Kristina M. Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
- * E-mail:
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | | | - Donna J. Lang
- Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC Canada
| | - Ric M. Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Alexander Rauscher
- Department of Paediatrics, University of British Columbia, Vancouver, BC Canada
| | - A. Talia Vertinsky
- Department of Radiology, University of British Columbia, Vancouver, BC Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - G. William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
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45
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Gicas KM, Cheng A, Rawtaer I, Willi TS, Panenka WJ, Lang DJ, Smith GN, Vila-Rodriguez F, Leonova O, Giesbrecht CJ, Jones AA, Barr AM, Procyshyn RM, Buchanan T, MacEwan GW, Su W, Vertinsky AT, Rauscher A, O'Rourke N, Loken Thornton W, Thornton AE, Honer WG. Diffusion tensor imaging of neurocognitive profiles in a community cohort living in marginal housing. Brain Behav 2019; 9:e01233. [PMID: 30724486 PMCID: PMC6422717 DOI: 10.1002/brb3.1233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/13/2018] [Accepted: 01/09/2019] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE We investigated white matter differences associated with distinct neurocognitive profiles derived from a large cohort of marginally housed persons with comorbid physical and mental illnesses. Our prior work identified three profile cluster groups: a high functioning group (Cluster 1), a low functioning group with relative strength in decision-making (Cluster 3), and an intermediary group with a relative decision-making weakness (Cluster 2). This study extends previous findings of cortical gray matter differences between these groups with evidence for putative neurodevelopmental abnormalities in the low cognitive functioning group (i.e., Cluster 3). We hypothesized that altered white matter diffusion would be associated with the lowest functioning neurocognitive profile and would be associated with previously observed gray matter differences. METHOD Participants from a socially impoverished neighborhood in Vancouver, Canada underwent neurocognitive evaluation and neuroimaging. We performed Tract-Based Spatial Statistics using diffusion tensor imaging data from 184 participants to examine whole-brain differences in white matter microstructure between cluster analytically derived neurocognitive profiles, as well as unitary neurocognitive measures. Correlations between frontal gray and white matter were also examined. RESULTS Cluster 3 showed increased diffusion in predominately bilateral frontal and interhemisphere tracts (vs. Clusters 1 and 2), with relatively greater diffusion in the left hemisphere (vs. Cluster 1). Differences in radial diffusivity were more prominent compared with axial diffusivity. A weak association between regional frontal fractional anisotropy and previously defined abnormalities in gyrification was observed. CONCLUSIONS In a socially marginalized sample, we established several patterns in the covariation of white matter diffusion and neurocognitive functioning. These patterns elucidate the neurobiological substrates and vulnerabilities that are apt to underlie functional impairments inherent to this complex and heterogeneous population.
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Affiliation(s)
- Kristina M Gicas
- Department of Psychology, Simon Fraser University, Burnaby, Canada.,Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Alex Cheng
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Iris Rawtaer
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Taylor S Willi
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancover, Canada
| | - Geoff N Smith
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | | | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | | | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancover, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancover, Canada
| | | | - Alexander Rauscher
- Department of Paediatrics, University of British Columbia, Vancover, Canada
| | - Norm O'Rourke
- Department of Public Health and Centre for Multidisciplinary Research in Aging, University of the Negev, Be'er Sheva, Israel
| | | | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancover, Canada
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Abstract
We explore informal recyclers' perceptions and experiences of the social determinants of health in Vancouver, Canada, and investigate the factors that contribute to the environmental health inequities they experience. Based on in-depth interviews with 40 informal recyclers and 7 key informants, we used a social determinants of health framework to detail the health threats that informal recyclers associated with their work and the factors that influenced their access to health-related resources and services. Our analysis reveals that the structural factors influencing environmental health inequities included insufficient government resources for low-income urbanites; the potential for stigma, clientization, and discrimination at some health and social service providers; and the legal marginalization of informal recycling and associated activities. We conclude that Vancouver's informal recyclers experience inequitable access to health-related resources and services, and they are knowledgeable observers of the factors that influence their own health and well-being.
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Affiliation(s)
- Josie Wittmer
- 1 Department of Geography, University of Guelph, Canada
| | - Kate Parizeau
- 1 Department of Geography, University of Guelph, Canada
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47
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Barbic SP, Jones AA, Woodward M, Piercy M, Mathias S, Vila-Rodriguez F, Leonova O, Smith GN, Buchanan T, Vertinsky AT, Gillingham S, Panenka WJ, Rauscher A, Barr AM, Procyshyn RM, MacEwan GW, Lang DJ, Thornton AE, Heran MK, Leon AM, Krausz M, Honer WG. Clinical and functional characteristics of young adults living in single room occupancy housing: preliminary findings from a 10-year longitudinal study. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2018; 109:204-214. [PMID: 29981045 PMCID: PMC6964603 DOI: 10.17269/s41997-018-0087-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/10/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Young adults living in single room occupancy (SRO) hotels, a form of low-income housing, are known to have complex health and substance problems compared to their peers in the general population. The objective of this study is to comprehensively describe the mental, physical, and social health profile of young adults living in SROs. METHODS This study reports baseline data from young adults aged 18-29 years, as part of a prospective cohort study of adults living in SROs in Vancouver, British Columbia, Canada. Baseline and follow-up data were collected from 101 young adults (median follow-up period 1.9 years [IQR 1.0-3.1]). The comprehensive assessment included laboratory tests, neuroimaging, and clinician- and patient-reported measures of mental, physical, and social health and functioning. RESULTS Three youth died during the preliminary follow-up period, translating into a higher than average mortality rate (18.6, 95% CI 6.0, 57.2) compared to age- and sex-matched Canadians. High prevalence of interactions with the health, social, and justice systems was reported. Participants were living with median two co-occurring illnesses, including mental, neurological, and infectious diseases. Greater number of multimorbid illnesses was associated with poorer real-world functioning (ρ = - 0.373, p < 0.001). All participants reported lifetime alcohol and cannabis use, with pervasive use of stimulants and opioids. CONCLUSION This study reports high mortality rates, multimorbid illnesses, poor functioning, poverty, and ongoing unmet mental health needs among young adults living in SROs. Frequent interactions with the health, social, and justice systems suggest important points of intervention to improve health and functional trajectories of this vulnerable population.
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Affiliation(s)
- Skye P Barbic
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, BC, Canada.
- Department of Psychiatry, UBC, Vancouver, BC, Canada.
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.
- Foundry, Vancouver, BC, Canada.
- Faculty of Medicine, Department of Occupational Science and Occupational Therapy, The University of British Columbia St. Paul's Hospital, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Andrea A Jones
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
| | - Melissa Woodward
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Radiology, UBC, Vancouver, BC, Canada
| | | | - Steve Mathias
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
- Foundry, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
| | - Olga Leonova
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
| | - Geoffrey N Smith
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
| | - Tari Buchanan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
| | | | | | - William J Panenka
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
| | - Alexander Rauscher
- Foundry, Vancouver, BC, Canada
- Department of Pediatrics, UBC, Vancouver, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, UBC, Vancouver, BC, Canada
| | - Ric M Procyshyn
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
| | - G William MacEwan
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Donna J Lang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Radiology, UBC, Vancouver, BC, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Manraj K Heran
- Foundry, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Adelena M Leon
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, BC, Canada
| | - Michael Krausz
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - William G Honer
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Psychiatry, UBC, Vancouver, BC, Canada
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Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, Tweed EJ, Lewer D, Vittal Katikireddi S, Hayward AC. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet 2018; 391:241-250. [PMID: 29137869 PMCID: PMC5803132 DOI: 10.1016/s0140-6736(17)31869-x] [Citation(s) in RCA: 425] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 06/23/2017] [Accepted: 07/05/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Inclusion health focuses on people in extremely poor health due to poverty, marginalisation, and multimorbidity. We aimed to review morbidity and mortality data on four overlapping populations who experience considerable social exclusion: homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals. METHODS For this systematic review and meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library for studies published between Jan 1, 2005, and Oct 1, 2015. We included only systematic reviews, meta-analyses, interventional studies, and observational studies that had morbidity and mortality outcomes, were published in English, from high-income countries, and were done in populations with a history of homelessness, imprisonment, sex work, or substance use disorder (excluding cannabis and alcohol use). Studies with only perinatal outcomes and studies of individuals with a specific health condition or those recruited from intensive care or high dependency hospital units were excluded. We screened studies using systematic review software and extracted data from published reports. Primary outcomes were measures of morbidity (prevalence or incidence) and mortality (standardised mortality ratios [SMRs] and mortality rates). Summary estimates were calculated using a random effects model. FINDINGS Our search identified 7946 articles, of which 337 studies were included for analysis. All-cause standardised mortality ratios were significantly increased in 91 (99%) of 92 extracted datapoints and were 11·86 (95% CI 10·42-13·30; I2=94·1%) in female individuals and 7·88 (7·03-8·74; I2=99·1%) in men. Summary SMR estimates for the International Classification of Diseases disease categories with two or more included datapoints were highest for deaths due to injury, poisoning, and other external causes, in both men (7·89; 95% CI 6·40-9·37; I2=98·1%) and women (18·72; 13·73-23·71; I2=91·5%). Disease prevalence was consistently raised across the following categories: infections (eg, highest reported was 90% for hepatitis C, 67 [65%] of 103 individuals for hepatitis B, and 133 [51%] of 263 individuals for latent tuberculosis infection), mental health (eg, highest reported was 9 [4%] of 227 individuals for schizophrenia), cardiovascular conditions (eg, highest reported was 32 [13%] of 247 individuals for coronary heart disease), and respiratory conditions (eg, highest reported was 9 [26%] of 35 individuals for asthma). INTERPRETATION Our study shows that homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals experience extreme health inequities across a wide range of health conditions, with the relative effect of exclusion being greater in female individuals than male individuals. The high heterogeneity between studies should be explored further using improved data collection in population subgroups. The extreme health inequity identified demands intensive cross-sectoral policy and service action to prevent exclusion and improve health outcomes in individuals who are already marginalised. FUNDING Wellcome Trust, National Institute for Health Research, NHS England, NHS Research Scotland Scottish Senior Clinical Fellowship, Medical Research Council, Chief Scientist Office, and the Central and North West London NHS Trust.
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Affiliation(s)
- Robert W Aldridge
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK.
| | - Alistair Story
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; University College London NHS Foundation Trust, London, UK
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Merete Nordentoft
- Mental Health Centre Copenhagen and Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Serena A Luchenski
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Greg Hartwell
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Emily J Tweed
- Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Dan Lewer
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK
| | - Srinivasa Vittal Katikireddi
- Medical Research Council/Scottish Government Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Andrew C Hayward
- Centre for Public Health Data Science, Institute of Health Informatics, University College London, London, UK; The Farr Institute of Health Informatics Research, University College London, London, UK; Institute of Epidemiology and Health Care, University College London, London, UK
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Zhang L, Norena M, Gadermann A, Hubley A, Russell L, Aubry T, To MJ, Farrell S, Hwang S, Palepu A. Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada. J Dual Diagn 2018; 14:21-31. [PMID: 29494795 DOI: 10.1080/15504263.2017.1392055] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Individuals who are homeless or vulnerably housed have a higher prevalence of concurrent disorders, defined as having a mental health diagnosis and problematic substance use, compared to the general housed population. The study objective was to investigate the effect of having concurrent disorders on health care utilization among homeless or vulnerably housed individuals, using longitudinal data from the Health and Housing in Transition Study. METHODS In 2009, 1190 homeless or vulnerably housed adults were recruited in Ottawa, Toronto, and Vancouver, Canada. Participants completed baseline interviews and four annual follow-up interviews, providing data on sociodemographics, housing history, mental health diagnoses, problematic drug use with the Drug Abuse Screening Test (DAST-10), problematic alcohol use with the Alcohol Use Disorders Identification Test (AUDIT), chronic health conditions, and utilization of the following health care services: emergency department (ED), hospitalization, and primary care. Concurrent disorders were defined as the participant having ever received a mental health diagnosis at baseline and having problematic substance use (i.e., DAST-10 ≥ 6 and/or AUDIT ≥ 20) at any time during the study period. Three generalized mixed effects logistic regression models were used to examine the independent association of having concurrent disorders and reporting ED use, hospitalization, or primary care visits in the past 12 months. RESULTS Among our sample of adults who were homeless or vulnerably housed, 22.6% (n = 261) reported having concurrent disorders at baseline. Individuals with concurrent disorders had significantly higher odds of ED use (adjusted odds ratio [AOR] = 1.71; 95% confidence interval [CI], 1.4-2.11), hospitalization (AOR = 1.45; 95% CI, 1.16-1.81), and primary care visits (AOR = 1.34; 95% CI, 1.05-1.71) in the past 12 months over the four-year follow-up period, after adjusting for potential confounders. CONCLUSIONS Concurrent disorders were associated with higher rates of health care utilization when compared to those without concurrent disorders among homeless and vulnerably housed individuals. Comprehensive programs that integrate mental health and addiction services with primary care as well as community-based outreach may better address the unmet health care needs of individuals living with concurrent disorders who are vulnerable to poor health outcomes.
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Affiliation(s)
- Linda Zhang
- a Division of General Internal Medicine , Department of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Monica Norena
- b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Anne Gadermann
- b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada.,c School of Population and Public Health, University of British Columbia , Vancouver , British Columbia , Canada
| | - Anita Hubley
- d Department of Education Counselling Psychology and Special Education , University of British Columbia , Vancouver , British Columbia , Canada
| | - Lara Russell
- b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada
| | - Tim Aubry
- e School of Psychology, University of Ottawa , Ottawa , Ontario , Canada
| | - Matthew J To
- f Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada
| | - Susan Farrell
- g Royal Ottawa Health Care Group , Ottawa , Ontario , Canada
| | - Stephen Hwang
- f Centre for Urban Health Solutions, St. Michael's Hospital , Toronto , Ontario , Canada.,h Division of General Internal Medicine, Department of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Anita Palepu
- a Division of General Internal Medicine , Department of Medicine, University of British Columbia , Vancouver , British Columbia , Canada.,b Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital , Vancouver , British Columbia , Canada
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50
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Maremmani AGI, Bacciardi S, Somers JM, Nikoo M, Schütz C, Jang KL, Krausz M. Substance Dependence Among Bipolar, Unipolar Depression and Psychotic Homeless: A Canadian National Study. Front Psychiatry 2018; 9:701. [PMID: 30618874 PMCID: PMC6305348 DOI: 10.3389/fpsyt.2018.00701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/03/2018] [Indexed: 12/30/2022] Open
Abstract
Introduction: Homeless individuals are often mischaracterized as members of a homogeneous population that suffers from a wide mental health and addiction issues, with little consideration of potentially important differences within or between samples. The aim of the present study was to investigate the comorbidy of alcohol and/or substance dependence (ASD) and major psychiatric diagnoses (bipolar disorder, unipolar depression, and psychotic disorder) in a large Canadian sample of homeless individuals, and to examine potential sources of variability including location and ethnicity. Materials and Methods: A sample of 1,585 homeless individuals were assessed for alcohol and/or substance dependence and bipolar disorder, unipolar depression and psychotic disorder with the Mini-International Neuropsychiatric Interview (version 6.0). Regional and ethnic differences in major psychiatric diagnoses between homeless with and without ASD were examined using univariate (i.e., chi-square) and multivariate (i.e., logistic regression) statistics. Results: Members of the sample with ASD were found to be younger, Aboriginal, less well-educated, and born in the Americas. They were more significantly more prevalent in Western Canada and less prevalent in Central and Eastern Canada. The odds of having ASD were higher among people affected by bipolar disorder and (to a less extent) unipolar depression. Limitations: Data collected were self-reported and no urinalyses were performed. We considered diagnosis of ASD according to the previous 12 months only. Conclusions: Homeless people with major mental illness are at high risk for concurrent ASD, however the prevalence of ASD varies significantly between cities, and based on ethnicity and specific psychiatric diagnosis (with greater prevalence in individuals affected by bipolar disorder and, to a less extent, unipolar depression). Clinicians, administrators and policy makers should develop and deliver services based on careful assessment of the local population.
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Affiliation(s)
- Angelo G I Maremmani
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy.,Local Health Unit (Versilia Zone), Department of Psychiatry, North-Western Tuscany Region, Viareggio, Italy
| | - Silvia Bacciardi
- "Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Julian M Somers
- Somers Research Group, Faculty of Health Science, Simon Fraser University, Barnaby, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Christian Schütz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Kerry L Jang
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael Krausz
- Department of Psychiatry, Institute of Mental Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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