Prediction of Homelessness Within Three Months of Discharge Among Inpatients With Schizophrenia

• Published in: Psychiatric services (Washington, D.C.) Vol. 50; no. 5; pp. 667 - 673
• Main Authors: Olfson, Mark, Mechanic, David, Hansell, Stephen, Boyer, Carol A., Walkup, James
• Format: Journal Article
• Language: English
• Published: Washington, DC American Psychiatric Publishing 01.05.1999; American Psychiatric Association
• Subjects: Adult; Biological and medical sciences; Female; Follow-Up Studies; Forecasting; Homeless Persons - statistics & numerical data; Humans; Male; Medical sciences; New Jersey - epidemiology; Patient Discharge - statistics & numerical data; Prognosis; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; Schizophrenia - rehabilitation; Severity of Illness Index; Social psychiatry. Ethnopsychiatry; Sociocultural environment; Statistics as Topic; New Jersey; Psychosis; Human; Homeless; Hospital discharge; Follow up study; Risk factor; Prediction; Schizophrenia; Hospitalization
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/ps.50.5.667

OBJECTIVE: The authors' goal was to identify factors that place inpatients with schizophrenia at risk of becoming homeless after hospital discharge. METHODS: Patients with schizophrenia or schizoaffective disorder (N=263) were assessed at discharge from general hospitals in New York City and reassessed three months later to evaluate whether they had become homeless. Sociodemographic and clinical characteristics associated with homelessness were identified using likelihood ratio chi square analysis and logistic regression. RESULTS: Twenty patients (7.6 percent) reported an episode of homelessness during the follow-up period. Patients who had a drug use disorder at hospital discharge were significantly more likely to report becoming homeless than those without a drug use disorder. Patients with a total score above 40 on the Brief Psychiatric Rating Scale (BPRS) at hospital discharge were more likely to report becoming homeless than patients with lower scores, as were those with Global Assessment Scores less than 43. Twelve of 30 patients with a drug use disorder, a BPRS score above 40, and a GAS score less than 43 at hospital discharge reported becoming homeless. CONCLUSIONS: The combination of a drug use disorder, persistent psychiatric symptoms, and impaired global functioning at the time of hospital discharge poses a substantial short-term risk of homelessness among patients with schizophrenia. Patients who fit this profile may be candidates for community-based programs that are specifically aimed at preventing homelessness among patients with severe mental illness.