Abstract Objective: Concurrent mental and substance use disorders or dual diagnosis are highly prevalent among individuals experiencing homelessness. Studies have indicated that dual diagnosis leads to poorer health outcomes and higher health service utilization among those affected. This study aims to estimate the prevalence of dual diagnoses among homeless populations in British Columbia (BC), Canada, and understand their characteristics and specific factors associated with dual diagnoses. Methods: The BC Health of the Homeless Survey is a cross-sectional study involving the homeless population of three cities in BC. The survey assessed addiction and concurrent disorders with standardized interviews—the Mini-International Neuropsychiatric Interview Plus, the Maudsley Addiction Profile, and the Brief Symptom Inventory—in a sample of 500 individuals who are homeless living in shelters or on the street. We characterized individuals after categorizing them into four groups: those without any current mental disorder, those with substance use disorders only, those with mental disorders only, and those with concurrent substance use and mental disorders. Focusing on the concurrent disorder group, we completed a multivariate analysis comparing individuals with dual diagnosis to those without concurrent disorders. Results: Consistent with previous studies, we found that individuals with dual diagnoses report more severe physical and psychological symptoms. Among the homeless, they were more likely to be Aboriginal and younger and more likely to not make it into a shelter. They also reported substantially more difficulties in getting the health care service that they need. Conclusions: Within this marginalized group, individuals with dual diagnosis were more likely to be from groups considered to be more vulnerable with more complex needs. They were having more problems accessing even basic support, such as shelters and health care. Without a systematic approach in providing appropriate care to individuals with dual diagnosis, the most vulnerable clients are not only the ones likely to suffer the most but also the ones having the most problems meeting their basic needs.

中文翻译：

---

生活在双重诊断和无家可归的境地：被边缘化的群体中的边缘化

摘要 目的：在无家可归的个体中，并发的精神和物质使用障碍或双重诊断非常普遍。研究表明，双重诊断会导致受影响人群的健康结果较差和卫生服务利用率较高。本研究旨在估计加拿大不列颠哥伦比亚省 (BC) 无家可归人群中双重诊断的患病率，并了解他们的特征和与双重诊断相关的具体因素。方法：卑诗省无家可归者健康调查是一项横断面研究，涉及卑诗省三个城市的无家可归人口。该调查通过标准化访谈评估了成瘾和并发疾病——迷你国际神经精神病学访谈加、莫兹利成瘾概况、和简要症状清单——以 500 名住在收容所或街头的无家可归者为样本。我们在将个体分为四组后对其进行了表征：目前没有任何精神障碍的人、仅有物质使用障碍的人、仅有精神障碍的人以及同时存在物质使用和精神障碍的人。针对并发障碍组，我们完成了一项多变量分析，将双重诊断的个体与没有并发障碍的个体进行比较。结果：与之前的研究一致，我们发现双重诊断的个体报告更严重的身体和心理症状。在无家可归者中，他们更有可能是土著和更年轻的人​​，也更有可能无法进入收容所。他们还报告说，在获得所需的医疗保健服务方面遇到了更多困难。结论：在这个边缘化群体中，双重诊断的个体更有可能来自被认为更脆弱、需求更复杂的群体。他们在获得庇护所和医疗保健等基本支持方面也遇到了更多问题。如果没有系统的方法来为双重诊断的个人提供适当的护理，最脆弱的客户不仅是最有可能遭受痛苦的人，而且也是在满足其基本需求方面遇到最多问题的人。他们在获得庇护所和医疗保健等基本支持方面也遇到了更多问题。如果没有系统的方法来为双重诊断的个人提供适当的护理，最脆弱的客户不仅是最有可能遭受痛苦的人，而且也是在满足其基本需求方面遇到最多问题的人。他们在获得庇护所和医疗保健等基本支持方面也遇到了更多问题。如果没有系统的方法来为双重诊断的个人提供适当的护理，最脆弱的客户不仅是最有可能遭受痛苦的人，而且也是在满足其基本需求方面遇到最多问题的人。