Mental Health and Illness in a 15-Year Longitudinal, Community-Based Study of People Living in Precarious Housing or Homelessness

Learning Objectives

1. Describe how a community-based study can increase understanding of the complex, comorbid disorders affecting people living in homelessness or precarious housing;
2. Review risk factors for psychosis and depressed mood in this group of people, and the contribution of substance use;
3. Report on investigations of traumatic brain injury and cerebrovascular disease;
4. Integrate psychiatric and neurologic findings as related to symptoms of pain severity, and cognitive function.

Abstract

The Hotel study (referring to single-room occupancy residences) involved over 500 participants from 2008-2023. Monthly visits assessed psychosis, mood, and substance use; comprehensive annual visits included a psychiatric assessment, neuropsychological testing, and neuroimaging. The community-based strategy allowed identification of risk and protective factors for mental illness, and monitored changes in substance use or exposure over time. Evidence of neurovascular disease on MRI was higher than expected for age; a history of traumatic brain injury was remarkably common, as were new events. Multiple factors contribute to chronic pain in the participants, as well as to cognitive dysfunction. The mortality rate over 8-fold greater than the Canadian population represents a serious public health concern, requiring a comprehensive approach for amelioration.

Literature References

1. Jones AA, et al., Pain, opioid use, depressive symptoms, and mortality in adults living in precarious housing or homelessness: A longitudinal prospective study. Pain 2022;163:2213-2223
2. O’Connor TA, et al., Traumatic brain injury in precariously housed persons: incidence and risks. eClinical Med 2022;44:101227
3. Jones AA, et al., Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: a longitudinal, community-based study in Vancouver, Canada. PLoS Medicine 2020;17:e1003172
4. Honer WG, et al., The Hotel study – clinical and health service effectiveness in a cohort of homeless or marginally housed persons. Can J Psychiatry 2017;62:482-492
5. Vila-Rodriguez F et al., The Hotel study: multimorbidity in a community sample living in marginal housing. Am J Psychiatry 2013;170;1413-1422