Risk of psychiatric readmission in the homeless population: A 10-year follow-up study

Jesús Herrera-Imbroda; José Guzmán-Parra; Antonio Bordallo-Aragón; Berta Moreno-Küstner; Fermín Mayoral-Cleríes

doi:10.3389/fpsyg.2023.1128158

Risk of psychiatric readmission in the homeless population: A 10-year follow-up study

Front Psychol. 2023 Feb 15:14:1128158. doi: 10.3389/fpsyg.2023.1128158. eCollection 2023.

Authors

Jesús Herrera-Imbroda^{1

2}, José Guzmán-Parra¹, Antonio Bordallo-Aragón¹, Berta Moreno-Küstner^{1

3}, Fermín Mayoral-Cleríes¹

Affiliations

¹ Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain.
² Departamento de Farmacología y Pediatría, Facultad de Medicina, Universidad de Málaga, Andalucía Tech, Málaga, Spain.
³ Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, Universidad de Málaga, Andalucía Tech, Málaga, Spain.

Abstract

Homelessness continues to be a major social and clinical problem. The homeless population has a higher burden of disease that includes psychiatric disorders. In addition, they have a lower use of ambulatory health services and a higher use of acute care. Few investigations analyze the use of services of this population group in the long term. We analyzed the risk of psychiatric readmission of homeless individuals through survival analysis. All admissions to a mental health hospitalization unit in the city of Malaga, Spain, from 1999 to 2005, have been analyzed. Three analyses were carried out: two intermediate analyses at 30 days and 1 year after starting follow-up; and one final analysis at 10 years. In all cases, the event was readmission to the hospitalization unit. The adjusted Hazard Ratio at 30 days, 1-year, and 10-year follow-ups were 1.387 (p = 0.027), 1.015 (p = 0.890), and 0.826 (p = 0.043), respectively. We have found an increased risk of readmission for the homeless population at 30 days and a decreased risk of readmission at 10 years. We hypothesize that this lower risk of long-term readmission may be due to the high mobility of the homeless population, its low degree of adherence to long-term mental health services, and its high mortality rate. We suggest that time-critical intervention programs in the short term could decrease the high rate of early readmission of the homeless population, and long-term interventions could link them with services and avoid its dispersion and abandonment.

Keywords: health management; homelessness; psychiatric readmission; psychopathology; social psychiatry.

Grants and funding

JH-I has received a “Río Hortega” contract grant (CM21/00255) from the Ministry of Science and Innovation of Spain (Carlos III Health Institute). FM-C and JG-P has received funding from the Andalusia Government in the grants for human resources reinforcement in the research activity (Acción A de intensificación 2019 and Acción B de refuerzos de larga duración 2014). The funding sources had no further role in study design, collection, analysis and interpretation of data, writing of the report; and decision to submit the manuscript for publication.