TOPLINE

Among adults with addiction and mental health (AMH) conditions, those experiencing homelessness had more than nine times the risk for suicide attempts and more than eight times the risk for all-cause mortality compared to housed individuals with AMH conditions. People experiencing homelessness (PEH) also had higher risks for AMH-related emergency department (ED) visits and hospitalizations.

METHODOLOGY

• Researchers conducted a retrospective cohort study using linked administrative data from Alberta Health Services, Canada, from April 2013 to March 2023, with an index date of April 1, 2018.
• A total of 622,614 adults with diagnosed AMH conditions within 5 years before the index date were included; 3390 (0.54%) had an indicator of homelessness in the year prior to the index date.
• Outcomes included ED visits, hospitalizations (both AMH-related and non-AMH-related), suicide attempts, death by suicide, and all-cause mortality over 5 years.

TAKEAWAY

• In age- and sex-adjusted analyses, PEH with AMH conditions had a greater risk for AMH-related ED visits (hazard ratio [HR], 8.75; 95% CI, 8.37-9.16) and non-AMH-related ED visits (HR, 2.56; 95% CI, 2.47-2.63).
• PEH had a greater risk for AMH-related hospitalizations (HR, 8.34; 95% CI, 7.73-9.00) and non-AMH-related hospitalizations (HR, 6.03; 95% CI, 5.73-6.35).
• PEH were at greater risk for suicide attempts (HR, 9.18; 95% CI, 8.43-10.01), death by suicide (HR, 2.20; 95% CI, 1.30-3.74), and all-cause mortality (HR, 8.15; 95% CI, 7.56-8.79).
• In propensity-matched analyses, findings were attenuated but remained significant across all outcomes, except for the risk for death by suicide, for which the propensity-matched analysis could not be performed due to low event counts.

IN PRACTICE

"Overall, our findings persistently show an increased risk of healthcare usage and adverse outcomes including suicide attempts and mortality among PEH over time," the authors wrote. "Interventions tailored to the needs of PEH are critically needed to prevent elevated risk of premature death, suicide attempts, ED visits, and hospitalizations."

SOURCE

The study was led by Rebecca Barry, PhD, Department of Psychiatry, University of Calgary, Calgary, Canada. It was published online on July 16 in Canadian Journal of Psychiatry.

LIMITATIONS

The cohort included only individuals with documented AMH diagnoses based on administrative data, limiting generalizability to PEH without diagnosed conditions. The homelessness definition potentially excluded individuals with lower acuity or limited healthcare access. Unmeasured baseline characteristics such as disease severity could have led to residual confounding. The study could not examine death by suicide in propensity-matched analyses due to limited power.

DISCLOSURES

The study was funded by the Calgary Health Foundation through the PRECISE-MH grant. Barry received personal fees from Alberta Health Services unrelated to this study. Disclosure information for the other study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.