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Mental illness in a representative sample of homeless men in Munich, Germany

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Abstract

The aim of the study was to reliably assess the 6-month and lifetime prevalence of mental illness according to DSM-III criteria in a representative sample of homeless individuals in the city of Munich, Germany. Because the characteristics of the homeless population were unknown, we first conducted a pre-sampling survey to determine a proportionate allocation of the main interviews in three nested sampling strata. For the pre-sampling we approached 300 males, who appeared tobe homeless, for a brief interview; of these, 271 were homeless according to our definition and were allocated to one of three sectors (“shelter”, “meal services”, “outdoor”). Thereafer, we randomly sampled homeless males in these three strata until the indicated allocations were met. The Diagnostic Interview Schedule (DIS) was used for diagnostic classification according to DSM-III in the main interview. Results from this representative urban sample show that the mean age of the homeless males was 43 years; most were unmarried or divorced, had a relatively low level of school education and a long duration of homelessness. Based on the main interviews with 146 homeless males the following lifetime prevalence rates were obtained: 91.8% for substance use disorder (82.9% alcohol dependence), 41.8% for affective disorders, 22.6% for anxiety disorders and 12.4% for schizophrenia. Of the homeless males in Munich, 94.5% had at least one DIS/DSM-III axis I diagnosis. Six-month prevalence data is also presented. Results are compared with those of a very similar study on homeless individuals in Los Angeles, which also used DIS/DSM-III diagnoses. In comparison with representative community samples in the United States and in Germany, mental illness was much more frequent among homeless individuals in Munich as well as in Los Angeles. Implications for health care planning are discussed.

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References

  • Abdul-Hamid W, Wykes T, Stansfield S (1993) The homeless mentally ill: myths and realities. Int J Soc Psychiatry 39(4): 237–254

    Google Scholar 

  • American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders (DSM III) American Psychiatric Press, Washington, DC

    Google Scholar 

  • Arce AA, Tadlock M, Vergare MV, Shapiro SH (1983) A psychiatric profile of street people admitted to an emergency shelter. Hosp Commun Psychiatry 34:812–817

    Google Scholar 

  • Blazer D, George LK, Landerman R, Pennybacker M, Melville ML, Woodbury M, Manton KG (1985) Psychiatric disorders, A rural/urban comparison. Arch Gen Psychiatry 42:651–656

    Google Scholar 

  • Burnam MA, Koegel P (1988) Methodology for obtaining a representative sample of homeless persons: The Los Angeles Skid Row study. Eval Rev 12:117–152

    Google Scholar 

  • Burnam MA, Hough RL, Escobar JI, Karno M, Tibers DM, Telles CA, Locke BZ (1987) Six-month prevalence of psychiatric disorders: Mexican Americans and non-Hispanic whites in Los Angeles. Arch Gen Psychiatry 44:687–694

    Google Scholar 

  • Calsyn RJ, Allen G, Morse GA, Smith R (1993) Can you trust selfreport data provided by homeless mentally ill individuals? Eval Rev 17(3):353–366

    Google Scholar 

  • Caton CLM, Shrout PE, Eagle PF, Opler LA, Felix A, Dominguez B (1994) Risk factors for homelessness among schizophrenic men: a case-control study. Am J Public Health 84(2):265–270

    Google Scholar 

  • Crystal S (1982) Chronic and situational dependency: long-term residents in a shelter for men. Human Resources Administration, New York

    Google Scholar 

  • Crystal S, Goldstein M (1984) Correlates of shelter utilization: one-day study. Human Resources Administration, New York

    Google Scholar 

  • Eikelmann B, Inhester ML, Reker T (1992) Psychische Störungen bei nichtsesshaften Männern. Defizite in der psychiatrischen Versorgung. Sozialpsychiatr Inf 2:29–32

    Google Scholar 

  • Farr RK, Koegel P, Burnam A (1986) A study of homelessness and mental illness in the skid row area of Los Angeles. Los Angeles County Department of Mental Health, Los Angeles

    Google Scholar 

  • Fichter MM (ed) (1990) Verlauf psychischer Erkrankungen in der Bevölkerung. Springer, Heidelberg New York.

    Google Scholar 

  • Fischer PJ, Breakey WR (1987) Profile of the Baltimore homeless with alcohol problems. Alcohol Health Res World 11(3):36–37, 61

    Google Scholar 

  • Fischer PJ, Breakey R (1991) The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychol 46(11):1115–1128

    Google Scholar 

  • Fischer P, Shapiro S, Breakey WR, Anthony JC, Kramer M (1986) Mental health and social characteristics of the homeless: a survey of Baltimore shelter users. Am J Public Health 76:519–524

    Google Scholar 

  • Folstein NF, Folstein SE, Hughes PR (1975) Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Google Scholar 

  • Gelberg L, Linn LS, Leake BD (1988) Mental health, alcohol and drug use, and criminal history among homeless adults. Am J Psychiatry 145:2, 191–196

    Google Scholar 

  • Greifenhagen A, Fichter M (1996) Psychiatrische Obdachlosenforschung — von der “Psychopathologie des Landstreichers” zu den “Homeless Mentally III”. Der Nervenarzt

  • Greifenhagen A, Fichter M, Koniarczyk M, Wölz J, Wittchen U (in preparation) Mental illness in homeless women: an epidemiological study in Munich

  • Harris SN, Mowbray CT, Solarz A (1994) Physical health mental health, and substance abuse problems of shelter users. Health Soc Work 19(1):37–45

    Google Scholar 

  • Herrman H, McGorry P, Bennett P, Riel R van, Singh B (1989). Prevalence of severc mental disorders in disaffiliated and homeless people in inner Melbourne. Am J Psychiatry 146(9): 1179–1184

    Google Scholar 

  • Hough R, Karno M, Burnam MA, Escobar V, Timbers DM (1983) The Los Angeles Epidemiologic Catchment Area research program and the epidemiology of psychiatric disorders among Mexican-Americans. J Operat Psychiatry 14:42–51

    Google Scholar 

  • Karno M, Hough RL, Burnam MA, Escobar JI, Timbers DM, Santana F, Boyd JH (1987) Lifetime prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites. Arch Gen Psychiatry 44:687–694

    Google Scholar 

  • Katz SE, Nardacci MD, Sabatini A (eds) (1993) Intensive treatment of the homeless Mentally Ill. American Psychiatric Press, Washington, DC

    Google Scholar 

  • Koegel P, Burnam MA (1988) Alcoholism among homeless adults in the inner city of Los Angeles. Arch Gen Psychiatry 45: 1011–1018

    Google Scholar 

  • Koegel P, Burnam MA, Farr RK (1988) The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Arch Gen Psychiatry 45:1085–1092

    Google Scholar 

  • Kujat H (1991) Der immer wiederkehrende Patient — aus der Sicht einer Einrichtung der Nichsesshaftenhilfe. Sozialpsychiatr Inf 2:35–37

    Google Scholar 

  • Ladner S, Crystal S, Towber R, Callender B, Calhoun J (1986) Project Future Human Resources Administration, New York

  • Lamb RH (1993) Lessons learned from deinstitionalization in the US. Br J Psychiatry 162:587–592

    Google Scholar 

  • Linn LS, Gelberg L (1989) Priority of basic needs among homeless adults. Soc Psychiatry Psychiatr Epidemiol 24:23–29

    Google Scholar 

  • Morse GA (1992) Causes of homelessness. In: Robertson MJ, Greenbaltt M (eds) Homelessness: a national perspective. Plenum Press, New York

    Google Scholar 

  • Morse G, Calsyn RJ (1986) Mentally distrubed homeless people in St. Louis: needy, willing, but underserved. Int J Men Health 14: 74–94

    Google Scholar 

  • Nordentoft M (1994) Homeless on the streets of Copenhagen. Ugeskr Laeger 156(20):3032–3039

    Google Scholar 

  • North CS, Smith EM (1993) A comparison of homeless men and women: different populations, different needs. Commun Ment Health J 29(5):423–431

    Google Scholar 

  • North CS, Smith EM (1993) A systematic study of mental health services utilization by homeless men, and women. Soc Psychiatry Psychiatr Epidemiol 28(2):77–83

    Google Scholar 

  • Regier DA, Boyd JH, Burke JD, Rae DS, Myers JK, Kramer M, Robins LN, George LK, Karno M, Locke BZ (1988) Onemonth prevalence of mental disorders in the United States. Arch Gen Psychiatry 45:977–986

    Google Scholar 

  • Rieger J, Wesel T (1992) Ambulante und stationäre, Nichtsesshaftenhilfe: Endstation Armut — wohnungs- und arbeitslose Abhängigkeitskranke ohne Chance? In: Wienberg G (ed) Die vergessene Mehrheit. Psychiatrie Verlag, Bonn, pp 159–167

    Google Scholar 

  • Robertson MJ, Greenblatt M (eds) (1992) Homelessness. A national perspective. Plenum Press, New York

    Google Scholar 

  • Robins LN, Helzer JE, Cronghan J, Ratcliffe KS (1981) National Institute of Mental Health Diagnostic Interview Schedule. Arch Gen Psychiatry 38:381–389

    Google Scholar 

  • Robins LN, Helzer JE, Orvaschel H et al. (1985) The Diagnostic Interview Schedule. In: Eaton WW (ed) Epidemiologic field methods in psychiatry. Academic Press, Orlando

    Google Scholar 

  • Rössler W, Salize HJ, Biechele U (1994) Psychisch kranke Wohnsitzlose — Die vergessene Minderheit. Psychiat Prax 21:173–178

    Google Scholar 

  • Rossi PH, Wright JD, Fisher GA, Willis G (1987) The urban homeless: estimating composition and size. Science 235: 1336–1341

    Google Scholar 

  • Roth D, Bean GJ (1986) New perspectives on homelessness: findings from a statewide epidemiological study. Hosp Commun Psychiatry 37:712–719

    Google Scholar 

  • Schutt RK, Garrett GR (1992) Responding to the Homeless. Plenum Press, New York

    Google Scholar 

  • Scott J (1993) Homelessness and mental illness. Br J Psychiatry 162:314–324

    Google Scholar 

  • Smith EM, North CS, Spitznagel EL (1993) Alcohol, drugs and psychiatric comorbidity among homeless women: an epidemiologic study. J Clin Psychiatry 54(3):82–87

    Google Scholar 

  • Statistisches Bundesamt (1988) Statistisches Jahrbuch 1988 für die Bundesrepublik Deutschland. Kohlhammer Verlag Stuttgart, p 64, 348

    Google Scholar 

  • Stössel U, Locher G (1991) Gesundheit und Krankheit bei alleinstehenden wohnungslosen Männern: Eine Sekundäranalyse von Daten einer diakonischen Einrichtung in der Bundesrepublik Deutschland. Soz Präventiv Med 36:327–332

    Google Scholar 

  • Sullivan JG, Burnam A, Koegel P (1995) Pathways to homelessness among the mentally ill. Paper presented at the 148th Annual Meeting of the American Psychiatric Association, Miani Florida, 20–25 May

  • Susser E, Conover S, Struening EL (1989) Problems of epidemiologic method in assessing the type and extent of mental illness among homeless adults. Hosp Community Psychiatry 40(3): 261–265

    Google Scholar 

  • Turner TH, Ness MN, Imison CT (1992) Mentally disordered persons found in public places, Diagnostic and social aspects of police referrals (section 136). Psychol Med 22:765–774

    Google Scholar 

  • Virgona A, Buhrich N, Teesson M (1993) Prevalence of schizophrenia among women in refuges for the homeless Aust N Z J Psychiatry 27(3):405–410

    Google Scholar 

  • Wittchen HU, Essau CA, Zerssen D von, Krieg JC, Zaudig M (1992) Lifetime and six-month prevalence of mental disorders in the Munich follow-up study. Eur Arch Psychiatry Clin Neurosci 241:247–258

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, Ludwig-Maximilians University Munich, D-80336, Munich, Germany

    M. M. Fichter, N. Quadflieg & J. Wölz

  2. Klinik Roseneck, D-83209, Prien, Germany

    M. M. Fichter

  3. Haar State Hospital, D-85540, Haar, Germany

    M. Koniarczyk

  4. Department of Psychiatry, Technical University Munich, D-81675, Munich, Germany

    A. Greifenhagen

  5. The Rand Corporation, 90400, Santa Monica, California, USA

    P. Koegel

  6. Max-Planck-Institute of Psychiatry, D-80804, Munich, Germany

    H. -U. Wittchen

Authors
  1. M. M. Fichter
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  2. M. Koniarczyk
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  3. A. Greifenhagen
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  4. P. Koegel
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  5. N. Quadflieg
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  6. H. -U. Wittchen
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  7. J. Wölz
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Fichter, M.M., Koniarczyk, M., Greifenhagen, A. et al. Mental illness in a representative sample of homeless men in Munich, Germany. Eur Arch Psychiatry Clin Nuerosci 246, 185–196 (1996). https://doi.org/10.1007/BF02188952

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  • DOI: https://doi.org/10.1007/BF02188952

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