New research shows that homeless men and women have mortality rates some six times higher than the general population. Furthermore, homeless men and women aged 15-24 years have life expectancy that is shorter than the general population by 22 years (men) and 17 years (women). And around six in 10 homeless people also have a psychiatric disorder. The study is the first to be based on an established nationwide homeless register that represents a complete homeless shelter population, and is published Online First by The Lancet, written by Sandra Feodor Nielsen, Mental Health Centre Copenhagen, Denmark, and colleagues.
The authors analysed 32 711 homeless people aged 16 years and over (23 040 men and 9671 women) who were registered in the Danish Homeless Register, and found that 62% and 58% respectively has registered psychiatric disorders, while 49% of men and 37% of women had a substance abuse diagnosis. During the study period, 3839 men (17%) and 951 women (10%) died. The increased mortality compared with the general population was slightly higher in women (6.7 times) than in men (5.6 times) and external causes (including suicide and violence) accounted for 28% of 4161 deaths for which information on the cause was available. Registered substance abuse disorder was associated with the highest mortality risk compared with no psychiatric contact registered (with a 40% increased risk for men affected and a 70% increased risk for women affected).
The authors say: "There was a larger disparity in life expectancy between the homeless shelter population and the general population than previous studies have found. Cause-specific standardised mortality ratios for both sexes showed high excess mortality by suicide and unintentional injuries…We found substance abuse to be the diagnosis associated with the highest mortality risk. This study suggests that homeless people living in shelters constitute a high-risk population in a public health perspective. This study underlines that this marginalised population needs more attention on the health agenda."
In a linked Comment, Professor John Geddes and Dr Seena Fazel, Department of Psychiatry, University of Oxford, UK, say: "Nielsen and colleagues' study has important implications for health services. It suggests that integrated psychiatric and substance abuse treatment is necessary to address these inequalities, and further treatment trials on the best strategies to treat dual-diagnosis homeless patients and homeless youth need to be conducted. Such enhanced treatment is likely to confer additional benefits including reduction in violent crime, specific causes of mortality including suicide, and victimisation."
Sandra Feodor Nielsen, Mental Health Centre Copenhagen, Denmark. T) +45 20607552 E) frkfeodor@hotmail.com
Professor John Geddes, Department of Psychiatry, University of Oxford, UK. T) +44 (0) 1865 226480 E) john.geddes@psych.ox.ac.uk
Journal
The Lancet