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Lifetime Psnnnnychosis, Substance Use, and Current Distress in New Arrivals at New York City Shelters

Ezra Susser, MD, MPH; Elmer L. Struening, PhD; Sarah Conover, MPH

Arch Gen Psychiatry. 1989;46(9):845-850.

Abstract
• We assessed psychiatric states in 223 men at first entry to New York, NY, municipal men's shelters, overall and differentiated by prior experience of homelessness. Instruments included a diagnostic interview (Structured Clinical Interview for DSM-III-R: Psychotic Disorders), the Short Michigan Alcoholism Screening Test, and the Center for Epidemiologic Studies of Depression Scale. The use of a "first timer" sample, and of a clinical diagnostic interview, had not, to our knowledge, been previously attempted in studies of psychiatric problems in the homeless. The majority of men had a history of mental disorder or of heavy substance use. On diagnostic interview, 17% of the men had a definite or probable history of psychosis, and another 8% had a possible history of psychosis. A confident diagnosis of schizophrenia was made in 8%. A history of alcohol or other drug abuse was evident in 58% Cocaine was already (in 1985) the drug of choice; 27% of the study sample had used it more than 50 times. One third of the men were in extreme distress, much of it apparently acute and associated with the transition to the shelter, and 7% reported suicidal thoughts at the time of the interview. The newly homeless, compared with those who had been homeless for much of the 5 years prior to shelter entry, were younger and had fewer psychiatric problems.

Author Affiliations
From the Statistical Sciences and Epidemiology Division, the Nathan S Kline Institute for Psychiatric Research, Orangeburg, NY (Dr Susser); the Department of Psychiatry, New York University School of Medicine, New York (Dr Susser); and Epidemiology of Mental Disorders Research Department and Community Support Systems, New York State Psychiatric Institute, New York (Dr Struening and Ms Conover); and the Division of Epidemiology, Columbia University School of Public Health, New York, NY (Dr Struening)

Footnotes
Accepted for publication March 24, 1989.

Reprint requests to Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962 (Dr Susser).

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