Homelessness and incarceration among psychiatric patients in Brazil.

Psychiatric patients are at increased risk of adverse life events, such as being incarcerated and homelessness in their life course. Using data from a cross-sectional multicenter study of 2,475 patients selected from 26 mental health services in Brazil, we examined the association of sociodemographic, clinical, behavioral, and adverse life characteristics with history of homelessness, incarceration or their co-occurrence during lifetime. Odds ratios were obtained by multinomial logistic regression models. The prevalence of homelessness, incarceration and co-occurrence of these two conditions were 8.6%, 16.4%, and 9.4%, respectively. Lower income, living in unstable condition, intellectual disability, and cigarette smoking were associated with homelessness. Being male, lower schooling, sex under effect of alcohol or drugs, and multiple sex partners were associated with incarceration. Psychiatric hospitalizations, substance use, and history of sexually transmitted diseases, and sexual, physical, or verbal violence were associated with co-occurrence of both conditions. Our findings suggest that incarceration and homelessness are very prevalent and correlated in psychiatric patients in Brazil. Many of the associated factors are potentially modifiable, and may act synergistically requiring integrated care.

Homelessness and incarceration among psychiatric patients in Brazil / Pacientes psiquiátricos em situação de rua e encarceramento no Brasil

Abstract Psychiatric patients are at increased risk of adverse life events, such as being incarcerated and homelessness in their life course. Using data from a cross-sectional multicenter study of 2,475 patients selected from 26 mental health services in Brazil, we examined the association of sociodemographic, clinical, behavioral, and adverse life characteristics with history of homelessness, incarceration or their co-occurrence during lifetime. Odds ratios were obtained by multinomial logistic regression models. The prevalence of homelessness, incarceration and co-occurrence of these two conditions were 8.6%, 16.4%, and 9.4%, respectively. Lower income, living in unstable condition, intellectual disability, and cigarette smoking were associated with homelessness. Being male, lower schooling, sex under effect of alcohol or drugs, and multiple sex partners were associated with incarceration. Psychiatric hospitalizations, substance use, and history of sexually transmitted diseases, and sexual, physical, or verbal violence were associated with co-occurrence of both conditions. Our findings suggest that incarceration and homelessness are very prevalent and correlated in psychiatric patients in Brazil. Many of the associated factors are potentially modifiable, and may act synergistically requiring integrated care.

Resumo Os pacientes psiquiátricos estão em risco aumentado de eventos adversos da vida, como ser preso e morar na rua. Investigamos a associação de características sociodemográficas, clínicas, comportamentais e eventos adversos de vida com o histórico de morar na rua, encarceramento e a coocorrência dessas duas condições ao longo da vida em um estudo multicêntrico de corte transversal de 2.475 usuários de 26 serviços de saúde mental no Brasil. "Odds ratios" foram obtidos por modelos de regressão logística multinomial. A prevalência de morar na rua, encarceramento e coocorrência dessas condições foi de 8,6%, 16,4% e 9,4%, respectivamente. Menor renda, viver em habitações instáveis, deficiência mental e tabagismo foram associados a morar na rua. Ser do sexo masculino, ter menor escolaridade, histórico de sexo sob efeito de álcool ou drogas e múltiplos parceiros sexuais foram associados ao encarceramento. Internações psiquiátricas, uso de substâncias, histórico de doenças sexualmente transmissíveis e violência sexual, física ou verbal foram associados à coocorrência das duas condições. Encarceramento e morar na rua são eventos muito prevalentes e correlacionados em pacientes psiquiátricos. Muitos dos fatores associados são modificáveis e podem agir sinergicamente exigindo cuidados integrados.

Factors associated with unprotected sexual practice among men and women with mental illnesses in Brazil.

This study estimated the rate and correlates of recent unprotected sex among sexually active psychiatric patients in Brazil, stratified by gender. The prevalence of unprotected sex among women and men were 89% and 77%, respectively. Significant correlates with unprotected sex were: being married/in union, living with children/partner, and cigarette smoking in both genders; lower income, depression and anxiety diagnoses among men only; older age, no previous HIV testing, sex under the influence of alcohol/drugs, and verbal violence among women only. Interventions to reduce risk behavior among psychiatric patients in Brazil are urgent and should take into account gender differences.

Cigarette smoking among psychiatric patients in Brazil.

The aim of this study was to estimate tobacco smoking prevalence among psychiatric patients attended in care facilities in Brazil and assess associated factors. A cross-sectional multicenter study was conducted of psychiatric patients (N = 2,475) selected from 26 care facilities. Current and ex-smokers were compared to those who had never smoked. Odds ratios were estimated using logistic regression. The current and past smoking prevalence rates were 52.7% and 18.9%, respectively. Being male, aged 40 years or over, drug and alcohol use, unprotected sex and a history of physical violence were factors associated with both current and past smoking, while a low education level (≤ 8 years of schooling), history of homelessness, not practicing a religion, current or previous psychiatric hospitalization, and main psychiatric diagnosis substance use disorders, were factors only associated with current smoking. Tobacco smoking prevalence among this population was high and was higher than the rate in the general population. Appropriate interventions and smoking prevention policies should be incorporated into mental health services.

Factors associated with unprotected sexual practice among men and women with mental illnesses in Brazil / Fatores associados com a prática do sexo desprotegido entre homens e mulheres com transtornos mentais no Brasil / Los factores asociados con la práctica del sexo sin protección entre hombres y mujeres con trastornos mentales en Brasil

This study estimated the rate and correlates of recent unprotected sex among sexually active psychiatric patients in Brazil, stratified by gender. The prevalence of unprotected sex among women and men were 89% and 77%, respectively. Significant correlates with unprotected sex were: being married/in union, living with children/partner, and cigarette smoking in both genders; lower income, depression and anxiety diagnoses among men only; older age, no previous HIV testing, sex under the influence of alcohol/drugs, and verbal violence among women only. Interventions to reduce risk behavior among psychiatric patients in Brazil are urgent and should take into account gender differences.

Este estudo estimou a prevalência e os fatores associados com o sexo desprotegido recente entre pacientes psiquiátricos sexualmente ativos no Brasil, estratificados por sexo. A prevalência de sexo desprotegido entre mulheres e homens foi 89% e 77%, respectivamente. Os fatores associados significativamente com o sexo desprotegido foram: estar casado/em união, viver com filhos/parceiros, e tabagismo em ambos os sexos; baixa renda e diagnósticos de depressão e ansiedade apenas entre homens; idade maior que 40 anos, nenhum teste prévio para o HIV, sexo sob a influência de álcool/drogas e violência verbal apenas entre as mulheres. Intervenções para reduzir comportamentos de risco entre pacientes psiquiátricos no Brasil são urgentes e devem considerar as diferenças de gênero.

Este estudio estima la prevalencia y los factores asociados con el sexo no protegido reciente entre los pacientes psiquiátricos sexualmente activos en Brasil, estratificado por sexo. La prevalencia de relaciones sexuales sin protección entre hombres y mujeres fue de 89% y 77%, respectivamente. Los factores asociados significativamente con el sexo sin protección fueron: estar casado/en unión, vivir con los niños/pareja, y el tabaquismo en ambos sexos; bajos ingresos y diagnóstico de depresión y ansiedad entre los hombres solamente; edad mayor de 40 años, ninguna prueba anterior para VIH, sexo bajo la influencia de alcohol/drogas y la violencia verbal sólo entre las mujeres. Las intervenciones para reducir los comportamientos de riesgo entre los pacientes psiquiátricos en Brasil son urgentes y deben considerar las diferencias de género.

Cigarette smoking among psychiatric patients in Brazil / Tabagismo entre pacientes psiquiátricos no Brasil / Tabaquismo entre los pacientes psiquiátricos en Brasil

The aim of this study was to estimate tobacco smoking prevalence among psychiatric patients attended in care facilities in Brazil and assess associated factors. A cross-sectional multicenter study was conducted of psychiatric patients (N = 2,475) selected from 26 care facilities. Current and ex-smokers were compared to those who had never smoked. Odds ratios were estimated using logistic regression. The current and past smoking prevalence rates were 52.7% and 18.9%, respectively. Being male, aged 40 years or over, drug and alcohol use, unprotected sex and a history of physical violence were factors associated with both current and past smoking, while a low education level (≤ 8 years of schooling), history of homelessness, not practicing a religion, current or previous psychiatric hospitalization, and main psychiatric diagnosis substance use disorders, were factors only associated with current smoking. Tobacco smoking prevalence among this population was high and was higher than the rate in the general population. Appropriate interventions and smoking prevention policies should be incorporated into mental health services.

O objetivo do estudo foi estimar a prevalência e os fatores associados com o tabagismo entre pacientes psiquiátricos no Brasil. Estudo multicêntrico de corte transversal foi conduzido com 2.475 pacientes com transtorno mental, selecionados de 26 serviços. Fumantes e ex-fumantes foram comparados com aqueles que nunca fumaram. Odds ratios foram estimados por meio de regressão logística. As prevalências de fumantes e ex-fumantes foram 52,7% e 18,9%, respectivamente. Sexo masculino, idade 40+ anos, uso de drogas e álcool, prática de sexo desprotegido e histórico de agressão física estiveram associados tanto com fumantes quanto com ex-fumantes. Já a escolaridade ≤ 8 anos, história de ter morado na rua, não ter prática religiosa, internação psiquiátrica atual ou anterior, e transtorno por uso de substâncias como diagnóstico psiquiátrico principal foram associados somente ao tabagismo atual. A prevalência de tabagismo nessa população foi alta e maior do que para a população geral brasileira. Políticas de intervenção e prevenção do tabagismo devem ser adotadas pelos serviços de saúde mental.

El objetivo del estudio fue estimar la prevalencia y los factores asociados con el tabaquismo entre los pacientes psiquiátricos en Brasil. Un estudio transversal multicéntrico fue realizado en 2.475 pacientes con trastorno mental, seleccionados de 26 servicios de salud. Los fumadores y los exfumadores fueron comparados con aquellos que nunca habían fumado. Las odds ratios se calcularon mediante regresión logística. La prevalencia de fumadores y ex fumadores fue un 52,7% y un 18,9%, respectivamente. Hombre, edad 40+ años, uso de las drogas y alcohol, sexo sin protección, e historia de agresión física se asociaron con fumadores y ex fumadores. Escolaridad ≤ 8 años, estar sin hogar, no practicar ninguna religión, hospitalización psiquiátrica actual o anterior, y trastornos por uso de sustancias, así como el diagnóstico psiquiátrico primario, se asociaron únicamente con el tabaquismo actual. La prevalencia de tabaquismo en esta población fue alta y superior a la de la población general de Brasil. Se deben adoptar políticas de intervención y prevención del tabaquismo por parte de los servicios de salud mental.