A population study on factors associated with unintentional falls among Iranian older adults.

INTRODUCTION: Falls among older adults are a significant cause of disability, injury, and death worldwide. The high incidence of falls in older adults, combined with the increased susceptibility to injury of the older adult population, leads to severe global health issues. Further studies are needed to comprehensively evaluate the typical personal and environmental risk factors of falls in the Iranian elderly population. Future preventive strategies and intervention programs will be based on these findings. The study determined the risk factors associated with unintentional falls among a representative sample of older adults living in Tehran, the capital city of Iran. METHODS: The study design was cross-sectional. The target population was men/women aged 65 years and over from the general population living in 22 different districts of Tehran who were selected by stratified random sampling. The researchers gathered the data using validated questionnaires and observations. The informed consent was obtained from all participants before starting the interview. Multivariate logistic regression analysis examined the association between falls occurring during the past 12 months with demographics/ socioeconomics and fall-related predictor factors. RESULTS: The risk of falls was higher in women (47.0%) and those aged ≥ 75 years (44.1%). Older adults who were married had their fall risk reduced by 36.4% compared with other types of marital status. Older adults who were illiterate (48.1%), housewives (47.0%), and always had concerns about living expenses (53.9%) tended significantly to have a higher risk of falls. Moreover, participants who live with their family were less likely to fall than those who live alone (36.5% vs. 40.4%). Persons with safe homes were less likely to experience falls than persons with unsafe homes (30.9% vs. 41.4%). The logistic regression analysis showed that the female gender, being worried about living expenses, home safety, functional behavior, and function factors, were independently associated with the risk of falls during the past 12 months. CONCLUSIONS: Our findings revealed that a wide range of intrinsic and extrinsic risk factors contributed to injurious falls; based on the literature, some are preventable. The present data may be helpful as a starting point and guide future efforts for health providers and policymakers to allocate additional resources and develop proper falls prevention or intervention programs at the community level.

Elder maltreatment in Europe and the United States: a transnational analysis of prevalence rates and regional factors.

We investigated the association between type and frequency of elder maltreatment (EM) and residential setting (rural, suburban, and urban settings in the U.S. and northern and southern cities in Europe). We used data on 7,225 participants from European and U.S. cross-sectional studies to estimate rates of EM in three domains in the five settings in logistic-linear models that included setting and demographic variables and tested prespecified contrasts on settings. Northern Europe is similar to the U.S. in rate of financial exploitation; the Mediterranean has higher rates than either of the other two. For emotional and physical maltreatment, the Mediterranean is similar to the U.S; Northern Europe has higher rates. EM differs between and within settings in the U.S. and Europe. There is a need for rigorous research to examine the effects of residential settings and environment on EM. Interventions to reduce EM should be explored.

Lifetime abuse and somatic symptoms among older women and men in Europe.

BACKGROUND: Research suggests that survivors of interpersonal violence have an increasing experience of bodily symptoms. This study aims to scrutinise the association between lifetime abuse and somatic symptoms among older women and men, considering demographics/socio-economic, social support and health variables. METHODS: A sample of 4,467 community-dwelling persons aged 60-84 years (57.3% women) living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain, Sweden) was recruited for this cross-sectional study. Lifetime abuse (psychological, physical, sexual, financial and injury) was assessed on the basis of the UK study of elder abuse and the Conflict Tactics Scale-2, while somatic symptoms were assessed by the Giessen Complaint List short version. RESULTS: Women reported somatic symptoms more frequently than men. Multiple regression analyses revealed that lifetime exposure to psychological abuse was associated with higher levels of somatic symptoms among both women and men, while experiencing lifetime sexual abuse was associated with somatic symptoms only among older women, after adjusting for other demographic and socio-economic variables. Country of residence, older age, and low socio-economic status were other independent factors contributing to a higher level of somatic symptoms. CONCLUSIONS: The positive association between the experience of abuse during lifetime and the reporting of higher levels of somatic symptoms, in particular among older women, seems to suggest that such complaints in later life might also be related to the experience of mistreatment and not only to ageing and related diseases. Violence prevention throughout lifetime could help to prevent somatic symptoms in later life.

The prevalence of elder abuse and neglect in Iran: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to estimate the prevalence of elder abuse and neglect in Iran. METHODS: We searched PubMed, Embase, Scopus, and PsycINFO by the end of 2017. The prevalence was calculated based on the percentage or the amount reported in the studies. Heterogeneity was assessed by the I2 statistic, and the data were combined using random effects model. The results were reported as the pooled estimates and the 95% confidence intervals (CIs). The review protocol was registered in PROSPERO (CRD42017070744). RESULTS: A total of 16 studies involving 6,461 participants aged 60 years and over were included. The pooled prevalence for overall elder abuse was 45.7% (95% CI: 27.3-64.1, p < .001). DISCUSSION: The prevalence of elder abuse and neglect is substantial in the Iranian population aged 60 years and over. More research is needed to investigate the actual prevalence of elder abuse at the national level.

The prevalence, circumstances and consequences of unintentional falls among elderly Iranians: A population study.

BACKGROUND AND AIM: Falling threatens the health, independence and quality of life of older adults. Information about characteristics and predisposing factors of falls is essential to develop and implement effective preventing measure. The aim of this study was to examine the prevalence, circumstances and consequences of falls among community-dwelling older adults in Tehran, Iran, and scrutinize factors (e.g. demographics) associated with falls. METHODS: A cross-sectional study was conducted in Tehran. A total of 653 individuals aged 65 years and over were selected by a stratified random sampling as representing older adults in Tehran. All required data were collected through face-to-face interviews using questionnaires. RESULTS: The prevalence of falls was 39.7% and higher in women than in men. For both sexes, most of the falls occurred in the afternoon (n = 135, 52.1%) and at home (n = 209, 80.7%). One-fourth of the falls (23.2%) occurred in a forward direction, mostly among women (60%). For both sexes, one-third of the causes of falls were loss of balance, mostly among women and the oldest persons. Two-hundred and twelve of the fallers reported injuries. The logistic regression showed that female gender, low education and constant worries about living expenses were significantly associated with falls. CONCLUSIONS: This study may have provided new insights into the characteristics/ circumstances/ consequences of injurious falls and their relation with age, gender and injury severity in Iran. It may be useful for health policy makers and health providers when designing falls intervention and prevention programs at the community level.

The prevalence of lifetime abuse among older adults in seven European countries.

OBJECTIVES: To investigate the lifetime prevalence rate of abuse among older persons and to scrutinize the associated factors (e.g. demographics). METHODS: This cross-sectional population-based study had 4467 participants, aged 60-84, from seven European cities. Abuse (psychological, physical, sexual, financial and injuries) was measured based on The Revised Conflict Tactics Scale, and the UK survey of abuse/neglect of older people. RESULTS: Over 34 % of participants reported experiencing lifetime psychological, 11.5 % physical, 18.5 % financial and 5 % sexual abuse and 4.3 % reported injuries. Lifetime psychological abuse was associated with country, younger age, education and alcohol consumption; physical abuse with country, age, not living in partnership; injuries with country, female sex, age, education, not living in partnership; financial abuse with country, age, not living in partnership, education, benefiting social/partner income, drinking alcohol; and sexual abuse with country, female sex and financial strain. CONCLUSIONS: High lifetime prevalence rates confirm that elder abuse is a considerable public health problem warranting further longitudinal studies. Country of residence is an independent factor associated with all types of elder abuse which highlights the importance of national interventions alongside international collaborations.

Abuse of Older Men in Seven European Countries: A Multilevel Approach in the Framework of an Ecological Model.

BACKGROUND: Several studies on elder abuse indicate that a large number of victims are women, but others report that men in later life are also significantly abused, especially when they show symptoms of disability and poor health, and require help for their daily activities as a result. This study focused on the prevalence of different types of abuse experienced by men and on a comparison of male victims and non-victims concerning demographic/socio-economic characteristics, lifestyle/health variables, social support and quality of life. Additionally, the study identified factors associated with different types of abuse experienced by men and characteristics associated with the victims. METHODS: The cross-sectional data concerning abuse in the past 12 months were collected by means of interviews and self-response during January-July 2009, from a sample of 4,467 not demented individuals aged between 60-84 years living in seven European countries (Germany, Greece, Italy, Lithuania, Portugal, Spain and Sweden). We used a multilevel approach, within the framework of an Ecological Model, to explore the phenomenon of abuse against males as the complex result of factors from multiple levels: individual, relational, community and societal. RESULTS: Multivariate analyses showed that older men educated to higher levels, blue-collar workers and men living in a rented accommodation were more often victims than those educated to lower levels, low-rank white-collar workers and home owners, respectively. In addition, high scores for factors such as somatic and anxiety symptoms seemed linked with an increased probability of being abused. Conversely, factors such as increased age, worries about daily expenses (financial strain) and greater social support seemed linked with a decreased probability of being abused. CONCLUSIONS: Male elder abuse is under-recognized, under-detected and under-reported, mainly due to the vulnerability of older men and to social/cultural norms supporting traditional male characteristics of stoicism and strength. Further specific research on the topic is necessary in the light of the present findings. Such research should focus, in particular, on societal/community aspects, as well as individual and family ones, as allowed by the framework of the Ecological Model, which in turn could represent a useful method also for developing prevention strategies for elder abuse.

The prevalence of self-reported underuse of medications due to cost for the elderly: results from seven European urban communities.

BACKGROUND: The aim of this study was to evaluate the prevalence of self-reported underuse of medications due to procurement costs amongst older persons from seven European urban communities. METHODS: The data were collected in a cross-sectional study ("ABUEL, Elder abuse: A multinational prevalence survey") in 2009. Randomly selected people aged 60-84 years (n = 4,467) from seven urban communities: Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden) were interviewed. Response rate - 45.2%. Ethical permission was received in each country. RESULTS: The results indicate that 3.6% (n = 162) of the respondents self-reported refraining from buying prescribed medications due to cost. The highest prevalence of this problem was identified in Lithuania (15.7%, n = 99) and Portugal (4.3%, n = 28). Other countries reported lower percentages of refraining from buying medications (Germany - 2.0%, Italy - 1.6%, Sweden - 1.0%, Greece - 0.6%, Spain - 0.3%). Females refrained more often from buying medications than males (2.6% vs. 4.4%, p < 0.0001). The prevalence of this refraining tended to increase with economic hardship. DISCUSSION: These differences between countries can be only partly described by the financing of health-care systems. In spite of the presence of cost reimbursement mechanisms, patients need to make co-payments (or in some cases to pay the full price) for prescribed medications. This indicates that the purchasing power of people in 10.1186/s12913-015-1089-4 the particular country can play a major role and be related with the economic situation in the country. Lithuania, which has reported the highest refrain rates, had the lowest gross domestic product (at the time of conducting this study) of all participating countries in the study. CONCLUSIONS: Refraining from buying the prescribed medications due to cost is a problem for women and men in respect to ageing people in Europe. Prevalence varies by country, sex, and economic hardship.

Quality of life and life satisfaction among adults with and without congenital heart disease in a developing country.

BACKGROUND: Life-expectancy of adults with congenital heart disease (CHD) has improved world-wide, but there are limited data on these patients' experiences of quality of life (QoL), life satisfaction (LS), and their determinants (e.g. social support), particularly among patients from developing countries. DESIGN: Cross-sectional case-control. METHODS: A total of 347 CHD patients (18-64 years, 52.2% women) and 353 non-CHD participants, matched by sex/age, were recruited from two heart hospitals in Tehran, Iran. LS and QoL served as dependent variables, and demographic/socioeconomic status, mental-somatic symptoms, social support, and clinical factors (e.g. defect category) served as independent variables in multiple regression analyses once among all participants, and once only among CHD patients. RESULTS: The CHD patients had significantly lower scores in LS and all domains of QoL than the control group. However, having CHD was independently negatively associated only with overall QoL, physical health, and life and health satisfaction. Additionally, multivariate analyses among the CHD patients revealed that female sex, younger age, being employed, less emotional distress, and higher social support were significantly associated with higher perceived QoL in most domains, while LS was associated with female sex, being employed, less emotional distress, and better social support. Neither QoL nor LS was associated with cardiac defect severity. CONCLUSIONS: The adults with CHD had poorer QoL and LS than their non-CHD peers in our developing country. Socio-demographics, emotional health, and social support were important 'determinants' of QoL and LS among the CHD patients. Longitudinal studies are warranted to establish causal links.

Style of coping and its determinants in adults with congenital heart disease in a developing country.

OBJECTIVE: The objective of this study is to compare coping strategies between adults with and without congenital heart disease and to scrutinize the associations between different available resources (e.g., social support) and adoption of certain coping strategies. DESIGN: The study has a cross-sectional case-control design. SETTING: The study was conducted in two university-affiliated heart hospitals in Tehran, Iran. PATIENTS: The participants comprised 347 persons (18-64 years) with and 353 individuals without congenital heart disease, matched by gender and age. OUTCOME MEASURES: Coping strategies, assessed with the Utrecht Coping List-short form, were compared between both groups. Block-wise multiple regression analyses were conducted to scrutinize the associations between different independent variables (e.g., demographic/socioeconomic statuses) and adoption of certain styles of coping (dependent variables) among all participants and separately for each group. RESULTS: The styles of coping in the patients were comparable with those of the control group. Multivariate analyses revealed that congenital heart disease per se was not associated with style of coping except for palliative reaction pattern. The active problem-solving coping style was associated with never married marital status, parenthood, unemployment, higher level of anxiety/somatic symptoms, lower level of depressive symptoms, and better social support. The avoidance behavior style was associated with having a low income, whereas the expression of emotion style was associated with higher anxiety symptoms, experience of financial strain, and income. None of the adopted coping strategies was related to the heart disease variables. CONCLUSIONS: The adults with congenital heart disease coped as well as adults without congenital heart disease. Marital status, parenthood, annual income, financial strain, psychological adjustment, and perceived social support were important explanatory factors in adopting a certain style of coping among adults with congenital heart disease. However, longitudinal studies with repeated measures are warranted.

The relationship between abuse, psychosocial factors, and pain complaints among older persons in Europe.

BACKGROUND AND OBJECTIVE: Abuse and pain complaints are common among older persons. However, little is known about relationships between abuse (e.g. psychological) and pain complaints (e.g. backache) among older persons while considering other factors (e.g. depression). Therefore, the aim of this study was to determine these relationships. MATERIALS AND METHODS: The design was cross-sectional. A total of 4467 women and men aged 60-84 years from Germany, Greece, Italy, Lithuania, Portugal, Spain, and Sweden answered questionnaires regarding various areas such as abuse, mental health (e.g. anxiety) and pain complaints (e.g. backache). The data were examined with bivariate (analyses of variance) and multivariate methods (linear regressions). RESULTS: The bivariate analyses showed that psychological abuse was connected with all pain complaints; physical with headache and head pressure; sexual with neck or shoulder pain and headache; injury with all complaints (except pain in joints or limbs); financial with pain in joints or limbs and head pressure; and overall abuse (one or more types) with all complaints (except headache). The regressions showed that psychological abuse increased the likelihood of being affected by head pressure and heaviness or tiredness in the legs; physical abuse of being affected by headache and head pressure; financial abuse of being affected by head pressure; and overall abuse of being affected by headache and head pressure. In general, respondents from Sweden and younger (60-64 years) were less affected by the complaints than those from other countries (e.g. Germany) and older (e.g. 70-74 years), respectively. Respondents on medication (e.g. pain killers) were less affected by all pain complaints and those with high social support by pain in joints or limbs. High scores on anxiety and depression and having many diseases increased the likelihood of being affect by all pain complaints. CONCLUSIONS: Abuse was related with certain pain complaints (e.g. headache), but other factors and in particular mental health and physical diseases impacted on all pain complaints. Medication and partly social support had a positive effect on the pain experience, i.e. the complaints interfered less with for instance the daily-life of the respondents.

Factors associated with quality of services for marginalized groups with mental health problems in 14 European countries.

BACKGROUND: Different service characteristics are known to influence mental health care delivery. Much less is known about the impact of contextual factors, such as the socioeconomic circumstances, on the provision of care to socially marginalized groups.The objectives of this work were to assess the organisational characteristics of services providing mental health care for marginalized groups in 14 European capital cities and to explore the associations between organisational quality, service features and country-level characteristics. METHODS: 617 services were assessed in two highly deprived areas in 14 European capital cities. A Quality Index of Service Organisation (QISO) was developed and applied across all sites. Service characteristics and country level socioeconomic indicators were tested and related with the Index using linear regressions and random intercept linear models. RESULTS: The mean (standard deviation) of the QISO score (minimum = 0; maximum = 15) varied from 8.63 (2.23) in Ireland to 12.40 (2.07) in Hungary. The number of different programmes provided was the only service characteristic significantly correlated with the QISO (p < 0.05). The national Gross Domestic Product (GDP) was inversely associated with the QISO. Nearly 15% of the variance of the QISO was attributed to country-level variables, with GDP explaining 12% of this variance. CONCLUSIONS: Socioeconomic contextual factors, in particular the national GDP are likely to influence the organisational quality of services providing mental health care for marginalized groups. Such factors should be considered in international comparative studies. Their significance for different types of services should be explored in further research.

Intimate partner violence in Europe: design and methods of a multinational study

Objective: To describe the design, methods, procedures and characteristics of the population involved in a study designed to compare Intimate Partner Violence (IPV) in eight European countries. Methods: Women and men aged 18-65, living in Ghent-Belgium (n = 245), Stuttgart-Germany (n = 546), Athens-Greece (n = 548), Budapest-Hungary (n = 604), Porto-Portugal (n = 635), Granada-Spain (n = 138), Östersund-Sweden (n = 592), London-United Kingdom (n = 571), were sampled and administered a common questionnaire. Chi-square goodness of fit and five-age strata population fractions ratios for sex and education were computed to evaluate samples" representativeness. Results: Differences in the age distributions were found among women from Sweden and Portugal and among men from Belgium, Hungary, Portugal and Sweden. Over-recruitment of more educated respondents was noted in all sites. Conclusion: The use of a common research protocol with the same structured questionnaire is likely to provide accurate estimates of the general population IPV frequency, despite limitations in probabilistic sampling and restrictions in methods of administration (AU)

Objetivo: Describir el diseño, los métodos, los procedimientos y las características de la población participante en un estudio diseñado para comparar la violencia de la pareja íntima en ocho países. Método: Formaron parte de la muestra mujeres y hombres (18-65 años de edad), residentes en Ghent-Bélgica (n= 245), Stuttgart-Alemania (n = 546), Atenas-Grecia (n = 548), Budapest-Hungría (n = 604), Porto-Portugal (n = 635), Granada-España (n = 138), Östersund-Suecia (n = 592) y Londres-Reino Unido (UK) (n = 571). Se les administró un cuestionario común. Se calcularon la prueba de ji al cuadrado de bondad de ajuste y razones de fracciones poblacionales de cinco estratos de edad, según sexo y nivel educativo, con la finalidad de evaluar su representatividad. Resultados: Se encontraron diferencias en las distribuciones de edad en las mujeres de Suecia y Portugal, y en los hombres de Bélgica, Hungría, Portugal y Suecia. Ha habido un exceso de reclutamiento de encuestados con un nivel educativo más alto en todos los países. Conclusiones: Un protocolo común de investigación con el mismo cuestionario estructurado puede proporcionar estimaciones precisas de la frecuencia de violencia de la pareja íntima en la población general, a pesar de las limitaciones existentes en la creación de muestras probabilísticas y en los métodos de administración (AU)

Intimate partner violence in Europe: design and methods of a multinational study.

OBJECTIVE: To describe the design, methods, procedures and characteristics of the population involved in a study designed to compare Intimate Partner Violence (IPV) in eight European countries. METHODS: Women and men aged 18-65, living in Ghent-Belgium (n = 245), Stuttgart-Germany (n = 546), Athens-Greece (n = 548), Budapest-Hungary (n = 604), Porto-Portugal (n = 635), Granada-Spain (n = 138), Östersund-Sweden (n = 592), London-United Kingdom (n = 571), were sampled and administered a common questionnaire. Chi-square goodness of fit and five-age strata population fractions ratios for sex and education were computed to evaluate samples' representativeness. RESULTS: Differences in the age distributions were found among women from Sweden and Portugal and among men from Belgium, Hungary, Portugal and Sweden. Over-recruitment of more educated respondents was noted in all sites. CONCLUSION: The use of a common research protocol with the same structured questionnaire is likely to provide accurate estimates of the general population IPV frequency, despite limitations in probabilistic sampling and restrictions in methods of administration.

Anxiety, depressive and somatic symptoms in adults with congenital heart disease.

OBJECTIVE: Despite the improvement in life-expectancy of adults with congenital heart disease, they may experience unique medical and social challenges that could impact on their psychological functioning. The aims of this study were to address the experience of anxiety, depressive and somatic symptoms among adults with congenital heart disease in comparison with that of non-heart diseased persons considering the role of various factors (e.g. socio-economic). METHODS: In cross-sectional case-control study, the participants consisted of 347 patients with congenital heart disease (18-64 years, 52.2% female) and 353 matched (by sex/age) non-heart diseased persons. The participants completed a questionnaire. The data were analyzed with bivariate and multivariate methods. RESULTS: In bivariate analyses, scores in anxiety and somatic symptoms were higher among patients than the healthy controls (both at p≤0.001), whereas the groups did not differ in depressive symptoms. Following multiple-linear-regression-analyses, only the association between congenital heart disease and somatic symptoms was confirmed. Among the patients, perceived financial strain was significantly related to anxiety, depressive and somatic symptoms; lower perceived social support to anxiety and depression; and low annual income to somatic symptoms. Additionally, somatic symptoms were associated with anxiety and depressive symptoms, and vice versa. And no medical variables were related to anxiety, depressive and somatic symptoms. CONCLUSIONS: Congenital heart disease was only independently associated with somatic symptoms. Financial strain, social support and co-existence of emotional distress with somatic symptoms should be considered in developing appropriate interventions to improve the well-being of patients with congenital heart disease. However, longitudinal research is warranted to clarify causality.

Gender differences in health conditions and socio-economic status of adults with congenital heart disease in a developing country.

BACKGROUND: Providing appropriate care for adults with congenital heart disease requires the evaluation of their current situation. There is limited research in Iran about these patients, particularly in relation to gender differences in the demographic/socio-economic and lifestyle factors, as well as disease parameters. MATERIALS AND METHODS: The sample consisted of 347 congenital heart disease patients in the age group of 18­64 years, including 181 women, assessed by an analytical cross-sectional study. The patients were recruited from the two major heart hospitals in Tehran. Data were collected using questionnaires. RESULTS: The mean age of the patients was 33.24 years. Women were more often married and more often had offspring than men (p < 0.001). Educational level and annual income were similar between women and men. Unemployment was higher among women (p < 0.001), but financial strain was higher among men (p < 0.001). Smoking, alcohol, and water-pipe use was higher among men than among women (p < 0.001). Cardiac factors, for example number of cardiac defects, were similar among women and men, except that there were more hospitalisations owing to cardiac problems, for example arrhythmia, among men. Disease was diagnosed mostly at the hospital (57.4%). Most medical care was provided by cardiologists (65.1%). Only 50.1% of patients had knowledge about their type of cardiac defect. CONCLUSION: Gender differences exist in the socio-economic and lifestyle characteristics of adults with congenital heart disease, in some cases related to the disease severity. Our findings also point to the need for interventions to increase patients' knowledge about, and use of, healthier lifestyle behaviours, irrespective of gender. Furthermore, providing appropriate jobs, vocational training, and career counselling may help patients to be more productive.

Mental health-care provision for marginalized groups across Europe: findings from the PROMO study.

BACKGROUND: Providing mental health care to socially marginalized groups is a challenge. There is limited evidence on what form of mental health-care generic (i.e. not targeting a specific social group) and group-specific services provide to socially marginalized groups in Europe. AIM: To describe the characteristics of services providing mental health care for people with mental disorders from socially marginalized groups in European capitals. METHODS: In two highly deprived areas in different European capital cities, services providing some form of mental health care for six marginalized groups, i.e. homeless, street sex workers, asylum seekers/refugees, irregular migrants, travelling communities and long-term unemployed, were identified and contacted. Data were obtained on service characteristics, staff and programmes. RESULTS: In 8 capital cities, 516 out of 575 identified services were assessed (90%); 297 services were generic (18-79 per city) and 219 group-specific (13-50). All cities had group-specific services for the homeless, street sex workers and asylum seekers/refugees. Generic services provided more health-care programmes. Group-specific services provided more outreach programmes and social care. There was a substantial overlap in the programmes provided by the two types of services. CONCLUSIONS: In deprived areas of European capitals, a considerable number of services provide mental health care to socially marginalized groups. Access to these services often remains difficult. Group-specific services have been widely established, but their role overlaps with that of generic services. More research and conceptual clarity on the function of group-specific services are required.

Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities.

BACKGROUND: Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities. METHOD: Two methods of data collection were employed; (i) In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii) Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them. RESULTS: Across the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision. CONCLUSIONS: While there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of homeless specific and generic services.