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Newly homeless and not very healthy

Bella M. Schanzer, MD1, Patrick E. Shrout, PhD2, Carol L. M. Caton, PhD3, and Boanerges Dominguez, MS1. (1) Joseph Mailman School of Public Health, Columbia University, 600 W168th St., 5th Flr., New York, NY 10023, 212-305-0425, bms12@columbia.edu, (2) Psychology, New York University, 6 Washington Place, Room 308, New York, NY 10003, (3) Joseph L. Mailman School of Public Health, Columbia University, 1051 Riverside Drive, Unit 56, New York, NY 10032

Health problems of the chronically homeless have received wide attention, but there is scant information on the health of individuals on the cusp of homelessness. We studied 445 newly “literally” homeless subjects, upon entry into New York’s (NY) homeless shelter system, as part of a NIDA-funded longitudinal study of the course of homelessness. Included in the assessment were the Structured Clinical Interview for DSM-IV and a self-report of health-related problems. Most subjects (90.1%; n=441) were minorities with a median age of 36 years and a mean duration in NY of 23.6 years prior to becoming homeless. We found impressive rates of disease relative to prevalence rates in the general population of similarly aged individuals. The results included rates of 6.5% (n=29) for diabetes mellitus, 16.4% (n=73) for asthma, 33.7% (n=150) for major depressive disorder, and 51.2% (n=228) for any lifetime DSM_IV diagnosis with 28.1% (n=125) meeting criteria in the month prior to becoming homeless. 47.6% (n=212) met a lifetime diagnosis of any substance abuse or dependence and 21.8% (n=97) within the month prior to becoming homeless. 56.4% (n=251) of the group lacked health insurance. 342 subjects sought out medical treatment in the year prior to becoming homeless, 41.5% (n=142) received that care in an emergency room (ER) (p<.001).This cohort’s heavy disease burden coupled with the lack of insurance and overuse of ERs exposes a gap in health care provision to at-risk and newly homeless adults. These findings highlight the need for increased primary care and mental health services in poor communities from within which this newly homeless population came and to which they will return.

Learning Objectives: At the conclusion of this presentation, the participant will be able to

Keywords: Homelessness, Access to Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Access to and Utilization of Health and Human Services Among the Homeless

The 132nd Annual Meeting (November 6-10, 2004) of APHA