The burden of comorbidity among the homeless at a drop-in clinic

The study was a retrospective chart review based on 174 patients seen during their initial visit. Information was obtained from data reported by each patient during the history and physical exam.

Patients most likely to use the clinic were predominantly male (92%), between the ages of 20 and 39 (71%), African-American (64%), and living in an emergency shelter (73%). Sixty-eight (39%) patients had some insurance coverage. Comorbidity was significant with 34 (20%) patients reporting all three types of pathology: physical, mental health, and substance abuse. Homeless patients reporting substance abuse were likely to report the coexistence of a medical condition (54%) or a mental health problem (27%). Patients who reported problems of depression, anxiety, or suicidal ideation or who heard voices had a significant concomitant occurrence of all three types of clinical pathology (P < .001). Patients living in an emergency shelter or on the street (as opposed to living with family or friends) were at high risk of medical problems (P < .001), mental health problems (P < .001), and substance abuse (P < .001).

The prevalence of a medical problem, mental health problem, and substance abuse among the homeless is significant. Homeless patients may be at high risk of two or more comorbid conditions if they live in an emergency shelter or on the street, have a substance abuse problem, or have a mental health problem. Targeted clinical services and preventive medicine programs would be beneficial to these patients.