Drug problems among homeless individuals in Toronto, Canada: prevalence, drugs of choice, and relation to health status

<p>Abstract</p> <p>Background</p> <p>Drug use is believed to be an important factor contributing to the poor health and increased mortality risk that has been widely observed among homeless individuals. The objective of this study was to determine the prevalence and characteristics of drug use among a representative sample of homeless individuals and to examine the association between drug problems and physical and mental health status.</p> <p>Methods</p> <p>Recruitment of 603 single men, 304 single women, and 284 adults with dependent children occurred at homeless shelters and meal programs in Toronto, Canada. Information was collected on demographic characteristics and patterns of drug use. The Addiction Severity Index was used to assess whether participants suffered from drug problems. Associations of drug problems with physical and mental health status (measured by the SF-12 scale) were examined using regression analyses.</p> <p>Results</p> <p>Forty percent of the study sample had drug problems in the last 30 days. These individuals were more likely to be single men and less educated than those without drug problems. They were also more likely to have become homeless at a younger age (mean 24.8 vs. 30.9 years) and for a longer duration (mean 4.8 vs. 2.9 years). Marijuana and cocaine were the most frequently used drugs in the past two years (40% and 27%, respectively). Drug problems within the last 30 days were associated with significantly poorer mental health status (-4.9 points, 95% CI -6.5 to -3.2) but not with poorer physical health status (-0.03 points, 95% CI -1.3 to 1.3)).</p> <p>Conclusions</p> <p>Drug use is common among homeless individuals in Toronto. Current drug problems are associated with poorer mental health status but not with poorer physical health status.</p

Narrative skills and time sense in the discourse of psychotic inpatients: diagnostic differences

Thesis (Ph.D.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.The current study devised two instruments for rating autobiographical free speech samples with the aim of assessing narrative construction skills. 38 inpatients assigned to schizophrenic, schizoaffective and affective diagnostic groups were also subdivided for comparisons based on level and type of formal thought disorder. Covariate analyses designed to control for differences in verbal productivity, intelligence, thought disorder and educational level were used to contrast diagnostic groups and thought disorder subtypes. In addition, an attempt was made to assess links between these findings and subjective time sense as reflected in the subjects' use of verbs. One narrative measure used was "transformational capacity." Raters used this instrument to score subjects' level of predicate elaboration. A menu of such transformations (Todorov, 1977) was implemented to determine an overall score. The second narrative measure assessed subjects' use of spoken language to perform operations upon the listener. Inspired by "speech act theory" (Austin, 1962; Searle, 1969), this instrument was used to categorize action qualities of discourse as contextually accurate/appropriate or inaccurate/inappropriate. Finally, time, aspect and voice of predicates were evaluated and used as well to contrast groups defined by thought disorder subtypes. Thought disorder subtyping was done by dividing the sample along two separate dimensions severe/non-severe and positive/negative formal thought disorder. Results were consistent with the hypothesis that schizophrenic subjects would show impaired narrative skills. Subjects with higher narrative skills in one comparison and subjects with a positive formal thought disorder in another showed a trend toward greater flexibility in subjective time sense. Unexpectedly, subjects who were rated as severely thought disordered displayed more accurate speech acts in addition to a predicted excess of inaccurate speech acts. These results demonstrate the potential utility of narrative level language assessment. The concluding discussion considers how narrative skills reflect a combination of socialization and neurodevelopmental effects and offers suggestions for further research.2031-01-0

Rooming House Residents: Challenging the Stereotypes

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The health of homeless immigrants

Background: This study examined the association between immigrant status and current health in a representative sample of 1189 homeless people in Toronto, Canada. Methods: Multivariate regression analyses were performed to examine the relationship between immigrant status and current health status (assessed using the SF-12) among homeless recent immigrants (⩽10 years since immigration), non-recent immigrants (>10 years since immigration) and Canadian-born individuals recruited at shelters and meal programmes (response rate 73%). Results: After adjusting for demographic characteristics and lifetime duration of homelessness, recent immigrants were significantly less likely to have chronic conditions (RR 0.7, 95% CI 0.5 to 0.9), mental health problems (OR 0.4, 95% CI 0.2 to 0.7), alcohol problems (OR 0.2, 95% CI 0.1 to 0.5) and drug problems (OR 0.2, 95% CI 0.1 to 0.4) than non-recent immigrants and Canadian-born individuals. Recent immigrants were also more likely to have better mental health status (+3.4 points, SE ±1.6) and physical health status (+2.2 points, SE ±1.3) on scales with a mean of 50 and a SD of 10 in the general population. Conclusion: Homeless recent immigrants are a distinct group who are generally healthier and may have very different service needs from other homeless people

Factors Associated with Poor Mental Health Status Among Homeless Women With and Without Dependent Children

The purpose of this study was to estimate the prevalence of mental health problems among a representative sample of homeless women with and without dependent children and determine if the effects of risk factors for mental health are modified by the presence of dependent children. Homeless women (n = 522) were recruited in 2004–2005 from shelters and meal programs in Toronto, Canada. Linear and logistic regression was performed to identify factors associated with mental health status. Poor mental health was associated with low perceived access to social support, physical/sexual assault in the past 12 months, presence of a chronic health condition, and presence of a drug use problem in the past month. Efforts to improve mental health in this population will need to address the associated problems of victimization, substance abuse, and lack of social supports