O8.6. RISK OF HOMELESSNESS AFTER DISCHARGE FROM PSYCHIATRIC WARDS

BACKGROUND: Homelessness is an increasing societal problem in most high-income countries and often linked to mental illness and substance use disorders. However, there are few high-quality studies examining the risk of homelessness following discharge from in-patient psychiatric treatment. such information might be used as documentation for the need of structural changes to prevent homelessness in people with severe mental illness. We aimed to analyse the absolute and relative risk of homelessness following discharge from psychiatric wards in Denmark in the period from 2001 to 2015 and to identify high-risk diagnostic groups. METHODS: We did a nationwide, register-based cohort study including people aged 18+ years discharged from psychiatric wards in Denmark between 1 January 2001 and 31 December 2015. We analysed associations between psychiatric diagnoses and the risk of homelessness using survival analysis. RESULTS: A total of 126,848 psychiatric in-patients were included accounting for 94,835 person-years. The incidence of homelessness one year following discharge was 28.18 (95% CI 26.69–29.75) and 9.27 (95% CI 8.45–10.16) per 1000 person-years at risk in men and women, respectively. The one-year cumulative probability of first homelessness after discharge from psychiatric wards with a schizophrenia disorder was 1.54% (95% CI 1.25–1.88) in males and 0.60% (95% CI 0.40–0.87) in females. Substance use disorders increased the risk of homelessness after discharge with adjusted incidence rate ratios of 6.60 (95% CI 5.19–8.40) (men) and 13.06 (95% CI 9.31–18.33) (women), compared with depressive disorders. Schizophrenia increased the risk of homelessness after discharge by 1.91 (95% CI 1.29–2.83) and by 2.53 (95% CI 1.41–4.54) in men and women, respectively, also compared with depressive disorders. Prior history of homelessness was an important predictor for homelessness following discharge. DISCUSSION: The first year following discharge from psychiatric wards is a high-risk period of homelessness, especially when having a substance use disorder or a prior history of homeless shelter contact. Schizophrenia was also an important predictor of homelessness. Improved efforts to prevent homelessness are needed.