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Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia

Research output: Contribution to journalArticle

Abebaw Fekadu, Charlotte Hanlon, Emebet Gebre-Eyesus, Melkamu Agedew, Haddis Solomon, Solomon Teferra, Tsehaysina Gebre-Eyesus, Yonas Baheretibeb, Girmay Medhin, Teshome Shibre, Abraham Workneh, Teketel Tegegn, Alehegn Ketema, Philip Timms, Graham Thornicroft, Martin Prince

Original languageEnglish
Article number138
Pages (from-to)1-12
Number of pages12
JournalBMC Medicine
Volume12
Early online date20 Aug 2014
DOIs
Publication statusPublished - 2014

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Abstract

Background
The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia.

Methods
A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule.

Results
We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness.

Conclusion
Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.

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