The prevalence of psychiatric disorders and use of care by homeless people in Paris.

BACKGROUND

Homelessness is a growing problem in the cities of the western world, and homeless people have a plethora of mental health and social difficulties. These are, nevertheless, difficult to evaluate epidemiologically.

METHOD: In this paper we present a population survey using the Composite International Diagnostic Interview (CIDI) conducted in the city of Paris in winter 1996 on a representative sample of 838 homeless people. Night shelters as well as food kitchens were randomly sampled, and the mean response rate was around 65%.

RESULTS

The sample was relatively young and predominantly male (85%). Forty percent were born outside France, 96% had worked at some time, and one-third reported no resources at all. The lifetime prevalence of psychiatric disorders was 57.9%, while the 1-year prevalence was 29.1%. For definite psychotic disorders, prevalence was 16% (lifetime) and 6% (1 year). Generally, this Parisian homeless population had some access to care: in the preceding 6 months 57.7% of them had been medically attended and 14.2% of these had been hospitalised. The survey was cross-sectional, and did not evaluate regular access to care or the quality of care.

CONCLUSIONS

The implications for health and social systems are discussed in the light of comparisons with European and North American data.