Concurrent Disorders and Health Care Utilization Among Homeless and Vulnerably Housed Persons in Canada

Area of Science:

• Public Health
• Mental Health Services Research
• Health Services Research

Background:

• Homeless and vulnerably housed populations exhibit a higher prevalence of concurrent disorders (mental health diagnosis and problematic substance use) compared to the general population.
• Concurrent disorders present unique challenges to healthcare systems due to complex and often unmet needs.

Purpose of the Study:

• To investigate the impact of concurrent disorders on healthcare utilization among homeless or vulnerably housed individuals.
• To analyze longitudinal data to understand the relationship between concurrent disorders and service use patterns.

Main Methods:

• Longitudinal study of 1190 homeless/vulnerably housed adults in Canada (2009-2013).
• Data collected via baseline and annual follow-up interviews on sociodemographics, housing, mental health, and substance use (DAST-10, AUDIT).
• Generalized mixed-effects logistic regression models assessed associations between concurrent disorders and healthcare utilization (ED, hospitalization, primary care).

Main Results:

• 22.6% of participants had concurrent disorders at baseline.
• Individuals with concurrent disorders showed significantly higher odds of emergency department use (AOR=1.71), hospitalization (AOR=1.45), and primary care visits (AOR=1.34).
• These associations remained significant after adjusting for potential confounders.

Conclusions:

• Concurrent disorders are linked to increased healthcare utilization in homeless/vulnerably housed individuals.
• Integrated mental health, addiction, and primary care services are crucial.
• Community-based outreach programs are needed to address the unmet healthcare needs of this population.