The Mental and Physical Health of the Homeless Evidence From the National Survey on Psychiatric and Somatic Health of Homeless Individuals (the NAPSHI Study)

Background: The health status of homeless individuals in Germany has been de-scribed incompletely. Mental and somatic illnesses seem to contribute to the high mortality in this cohort. Methods: In this national, multicenter, cross-sectional study, data were collected on the health of 651 homeless individuals in the metropolitan regions of Hamburg, Frankfurt, Leipzig, and Munich metropolitan regions. The lifetime prevalences of physician-diagnosed mental and somatic illnesses were determined with interview -based questionnaires. Furthermore, clinical and laboratory examinations were carried out. Multivariable regressions were performed to identify determinants of health status and access to care. Results: High prevalences of both mental and somatic illnesses were confirmed. Particularly, cardiovascular and metabolic diseases were highly prevalent. Evidence for possible unrecognized arterial hypertension and possible unrecognized hyper-cholesterolemia was found in 27.5% and 15.6% of homeless individuals, respec - tively. 23.1% of study participants reported having received a diagnosis of a mental illness. Evidence for a possible unrecognized mental illness was found in 69.7%. A history of immigration from another country to Germany was found to be an import-ant determinant of the summed scores for mental, somatic, and possible unrecog-nized illness. Homeless individuals of non-German origin were more likely to be living without shelter (p = 0.03) and to lack health insurance (p < 0.001). Conclusion: High prevalence rates for mental and somatic illnesses and limited access to mainstream medical care were found. Homeless individuals appear to receive inadequate care for mental illness. Healthcare programs for homeless indi-viduals in Germany should pay particular attention to homeless migrants.