Abstract

Objective

Little research has been conducted on the timing of the onset and course of suicidality relative to the timing of the onset and temporal status of homelessness. Therefore, this longitudinal study investigated suicidal ideation and plans and suicide attempts in a homeless population in relation to housing attainment, psychiatric disorders, and substance use/disorders.

Method

Prospective longitudinal follow-up data were collected from a representative sample of literally homeless adults in St. Louis (N = 255) using the Diagnostic Interview Schedule/Homeless Supplement, the Composite International Diagnostic Interview-Substance Abuse Module, and urine drug screens. Associations among suicidal symptom variables, housing status, psychiatric/substance use disorders, and substance use were examined at baseline and longitudinally.

Results

Lifetime prevalence of suicidal ideation/plan and suicide attempts in this homeless population were much higher than in the general population. Onset of suicidal symptoms had typically preceded onset of homelessness. Few individuals experienced suicidal ideation/plans or attempted suicide during this study, and even fewer experienced new suicidal symptoms after baseline. Securing stable housing during the study follow-up was associated with lower rates of suicidal ideation/plans.

Conclusions

This study’s findings contradict assumptions that the high prevalence of suicidal symptoms in homeless populations can be explained by the difficulties and miseries of homelessness. Psychiatric illness, substance abuse, and psychosocial factors associated with homelessness may be direct contributors to suicidal symptoms and thus represent strategic intervention targets.

• HIGHLIGHTS

• Most suicidality reported at baseline first emerged long before first homelessness

• After baseline, few reported new suicidal symptoms or had active suicidal symptoms

• Significantly fewer reports of suicidal ideation/plans over time were found in those with the most stable housing outcome

中文翻译：

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无家可归人口样本自杀倾向的纵向研究

摘要

客观的

关于自杀的发作时间和过程与无家可归的发作时间和时间状态相关的研究很少。因此，这项纵向研究调查了无家可归者的自杀意念和计划以及自杀企图与住房获得、精神障碍和物质使用/障碍的关系。

方法

 使用诊断访谈时间表/无家可归补充、综合国际诊断访谈-药物滥用模块和尿液药物筛查，从圣路易斯 ( N = 255) 的真正无家可归成年人的代表性样本中收集前瞻性纵向随访数据。在基线和纵向检查了自杀症状变量、住房状况、精神/物质使用障碍和物质使用之间的关联。

结果

在这个无家可归的人群中，自杀意念/计划和自杀未遂的终生流行率远高于一般人群。自杀症状的发作通常先于无家可归。在这项研究期间，很少有人经历过自杀意念/计划或企图自杀，在基线后经历新的自杀症状的人更少。在研究随访期间获得稳定的住房与较低的自杀意念/计划发生率有关。

结论

这项研究的发现与以下假设相矛盾，即无家可归者的自杀症状高发可以用无家可归者的困难和痛苦来解释。与无家可归相关的精神疾病、药物滥用和心理社会因素可能是自杀症状的直接原因，因此代表了战略干预目标。

• 强调

• 大多数基线报告的自杀率在第一次无家可归之前很久就出现了

• 基线后，很少有人报告新的自杀症状或有活跃的自杀症状

• 随着时间的推移，在住房结果最稳定的人群中，自杀意念/计划的报告显着减少