The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis

Background Homelessness continues to be a pressing public health concern in many countries, and mental disorders in homeless persons contribute to their high rates of morbidity and mortality. Many primary studies have estimated prevalence rates for mental disorders in homeless individuals. We conducted a systematic review and meta-analysis of studies on the prevalence of any mental disorder and major psychiatric diagnoses in clearly defined homeless populations in any high-income country. Methods and findings We systematically searched for observational studies that estimated prevalence rates of mental disorders in samples of homeless individuals, using Medline, Embase, PsycInfo, and Google Scholar. We updated a previous systematic review and meta-analysis conducted in 2007, and searched until 1 April 2021. Studies were included if they sampled exclusively homeless persons, diagnosed mental disorders by standardized criteria using validated methods, provided point or up to 12-month prevalence rates, and were conducted in high-income countries. We identified 39 publications with a total of 8,049 participants. Study quality was assessed using the JBI critical appraisal tool for prevalence studies and a risk of bias tool. Random effects meta-analyses of prevalence rates were conducted, and heterogeneity was assessed by meta-regression analyses. The mean prevalence of any current mental disorder was estimated at 76.2% (95% CI 64.0% to 86.6%). The most common diagnostic categories were alcohol use disorders, at 36.7% (95% CI 27.7% to 46.2%), and drug use disorders, at 21.7% (95% CI 13.1% to 31.7%), followed by schizophrenia spectrum disorders (12.4% [95% CI 9.5% to 15.7%]) and major depression (12.6% [95% CI 8.0% to 18.2%]). We found substantial heterogeneity in prevalence rates between studies, which was partially explained by sampling method, study location, and the sex distribution of participants. Limitations included lack of information on certain subpopulations (e.g., women and immigrants) and unmet healthcare needs. Conclusions Public health and policy interventions to improve the health of homeless persons should consider the pattern and extent of psychiatric morbidity. Our findings suggest that the burden of psychiatric morbidity in homeless persons is substantial, and should lead to regular reviews of how healthcare services assess, treat, and follow up homeless people. The high burden of substance use disorders and schizophrenia spectrum disorders need particular attention in service development. This systematic review and meta-analysis have been registered with PROSPERO (CRD42018085216). Trial registration PROSPERO CRD42018085216.

Download Full-text

Prevalence of common mental disorders in adult Syrian refugees resettled in high income Western countries: a systematic review and meta-analysis

BMC Psychiatry ◽

10.1186/s12888-021-03664-7 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Thomas P. Nguyen ◽

Maria Gabriela Uribe Guajardo ◽

Berhe W. Sahle ◽

Andre M. N. Renzaho ◽

Shameran Slewa-Younan

Keyword(s):

Systematic Review ◽

Mental Illness ◽

Mental Disorders ◽

Common Mental Disorders ◽

Meta Analysis ◽

High Income ◽

Syrian Refugees ◽

Prevalence Rates ◽

Western Countries ◽

Pooled Prevalence

Abstract Background The immense social upheaval and ongoing humanitarian crisis created by the 2011 war in Syria has forced millions of civilians to flee their homeland, many of whom seek refugee status in Western nations. Whilst it is known that the prevalence of mental illness is higher within refugee populations, this systematic review and meta-analysis aims to pool the prevalence rates of common mental disorders (namely posttraumatic stress disorder, depression and generalized anxiety disorder) in adult Syrian refugees resettled in high income Western countries. Methods Seven electronic databases (Medline, PsychInfo, CINAHL, PTSDpubs, SCOPUS, PubMed and Embase) were searched up to the 31st of December 2020. Using pre-determined inclusion and exclusion criteria, relevant articles were screened by title and abstract, and later by full text. A meta-analysis was used to estimate the prevalence rates for each mental illness. Results Eleven studies met the eligibility criteria for the systematic review. Nine of these studies had a low-moderate risk of bias and were included in the meta-analysis. Of the 4873 refugees included in the meta-analysis, the total pooled prevalence rate of having any of the three mental disorders was 33% (CI 95%, 27-40%), 40% for anxiety (CI 95%, 31-50%), 31% for depression (CI 95%, 20-44%) and 31% for PTSD (CI 95%, 22-41%). A meta-regression revealed that the total pooled prevalence rate for having any of the three mental disorders was not influenced by age, host country, duration in host country, educational or marital status. Conclusions Despite significant study heterogeneity, the prevalence rates of common mental disorders in adult Syrian refugees resettled in high-income Western countries are significantly higher than reported rates in the general population.

Download Full-text

Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people

BMJ Open ◽

10.1136/bmjopen-2020-040061 ◽

2021 ◽

Vol 11 (2) ◽

pp. e040061

Author(s):

Getinet Ayano ◽

Asmare Belete ◽

Bereket Duko ◽

Light Tsegay ◽

Berihun Assefa Dachew

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Depressive Disorders ◽

Meta Analysis ◽

Random Effect ◽

Homeless People ◽

Sensitivity Analyses ◽

Prevalence Rates ◽

Major Depressive ◽

Major Depressive Disorders

ObjectivesTo assess the global prevalence estimates of depressive symptoms, dysthymia and major depressive disorders (MDDs) among homeless people.DesignSystematic review and meta-analysis.Data sourcesDatabases including PubMed, Scopus and Web of Science were systematically searched up to February 2020 to identify relevant studies that have reported data on the prevalence of depressive symptoms, dysthymia and MDDs among homeless people.Eligibility criteriaOriginal epidemiological studies written in English that addressed the prevalence of depressive problems among homeless people.Data extraction and synthesisA random-effect meta-analysis was performed to pool the prevalence estimated from individual studies. Subgroup and sensitivity analyses were employed to compare the prevalence across the groups as well as to identify the source of heterogeneities. The Joanna Briggs Institute’s quality assessment checklist was used to measure the study quality. Cochran’s Q and the I2 test were used to assess heterogeneity between the studies.ResultsForty publications, including 17 215 participants, were included in the final analysis. This meta-analysis demonstrated considerably higher prevalence rates of depressive symptoms 46.72% (95% CI 37.77% to 55.90%), dysthymia 8.25% (95% CI 4.79% to 11.86%), as well as MDDs 26.24% (95% CI 21.02% to 32.22%) among homeless people. Our subgroup analysis showed that the prevalence of depressive symptoms was high among younger homeless people (<25 years of age), whereas the prevalence of MDD was high among older homeless people (>50 years of age) when compared with adults (25–50 years).ConclusionThis review showed that nearly half, one-fourth and one-tenth of homeless people are suffering from depressive symptoms, dysthymia and MDDs, respectively, which are notably higher than the reported prevalence rates in the general population. The findings suggest the need for appropriate mental health prevention and treatment strategies for this population group.

Download Full-text

Short-acting intramuscular second-generation antipsychotic drugs for acutely agitated patients with schizophrenia spectrum disorders. A systematic review and network meta-analysis

Schizophrenia Research ◽

10.1016/j.schres.2021.01.021 ◽

2021 ◽

Vol 229 ◽

pp. 3-11

Author(s):

Giulia Paris ◽

Irene Bighelli ◽

Giacomo Deste ◽

Spyridon Siafis ◽

Johannes Schneider-Thoma ◽

...

Keyword(s):

Systematic Review ◽

Antipsychotic Drugs ◽

Second Generation ◽

Meta Analysis ◽

Schizophrenia Spectrum Disorders ◽

Short Acting ◽

Schizophrenia Spectrum ◽

Second Generation Antipsychotic ◽

Spectrum Disorders

Download Full-text

Opioid Use Disorder Comorbidity in Individuals With Schizophrenia-Spectrum Disorders: A Systematic Review and Meta-Analysis

The Canadian Journal of Addiction ◽

10.1097/cxa.0000000000000128 ◽

2021 ◽

Vol 12 (4) ◽

pp. 26-37

Author(s):

Marlon Danilewitz ◽

Anees Bahji

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Opioid Use Disorder ◽

Schizophrenia Spectrum Disorders ◽

Opioid Use ◽

Schizophrenia Spectrum ◽

Spectrum Disorders

Download Full-text

Depressive psychopathology in first-episode schizophrenia spectrum disorders: a systematic review, meta-analysis and meta-regression

Psychological Medicine ◽

10.1017/s0033291719002344 ◽

2019 ◽

Vol 49 (15) ◽

pp. 2463-2474 ◽

Cited By ~ 5

Author(s):

Sarah E. Herniman ◽

Kelly Allott ◽

Lisa J. Phillips ◽

Stephen J. Wood ◽

Jacqueline Uren ◽

...

Keyword(s):

Systematic Review ◽

Depressive Disorder ◽

Meta Analysis ◽

First Episode ◽

Schizophrenia Spectrum Disorders ◽

Schizophrenia Spectrum ◽

Pooled Prevalence ◽

Meta Regression ◽

Spectrum Disorders ◽

First Episode Schizophrenia

AbstractBackgroundDespite knowing for many decades that depressive psychopathology is common in first-episode schizophrenia spectrum disorders (FES), there is limited knowledge regarding the extent and nature of such psychopathology (degree of comorbidity, caseness, severity) and its demographic, clinical, functional and treatment correlates. This study aimed to determine the pooled prevalence of depressive disorder and caseness, and the pooled mean severity of depressive symptoms, as well as the demographic, illness, functional and treatment correlates of depressive psychopathology in FES.MethodsThis systematic review, meta-analysis and meta-regression was prospectively registered (CRD42018084856) and conducted in accordance with PRISMA and MOOSE guidelines.ResultsForty studies comprising 4041 participants were included. The pooled prevalence of depressive disorder and caseness was 26.0% (seven samples, N = 855, 95% CI 22.1–30.3) and 43.9% (11 samples, N = 1312, 95% CI 30.3–58.4), respectively. The pooled mean percentage of maximum depressive symptom severity was 25.1 (38 samples, N = 3180, 95% CI 21.49–28.68). Correlates of depressive psychopathology were also found.ConclusionsAt least one-quarter of individuals with FES will experience, and therefore require treatment for, a full-threshold depressive disorder. Nearly half will experience levels of depressive symptoms that are severe enough to warrant diagnostic investigation and therefore clinical intervention – regardless of whether they actually fulfil diagnostic criteria for a depressive disorder. Depressive psychopathology is prominent in FES, manifesting not only as superimposed comorbidity, but also as an inextricable symptom domain.

Download Full-text