Chronically Medically Ill Homeless Women: Characteristics at Baseline Romina Kee MD, MPH Collaborative Research Unit John H. Stroger Hospital CRU

A Personal Story JC is a 40 year old African-American woman diagnosed with AIDS and enrolled into our study after a hospitalization for pneumonia. She has 3 children ages 12 to 18 who have been placed into adoption and with whom she has no contact. Her mother is deceased and her father is currently in prison.

A Personal Story Homeless for the last 2 years she is dependent on crack cocaine and alcohol with 3 failed attempts at residential treatment. Her recent stay at a local women’s shelter came to an end when she was barred for exchange sex and drug activity. Despite multiple incarcerations she has continued participating in the study.

Background Homelessness rates have increased over the last 2 decades Chronic medical illness among the homeless is common (30-45%) Medical hospitalization rates are 4-5X of general population Psychiatric hospitalization rates are 2X higher

Background Female heads of households who are homeless found to have increasing rates physical health limitations, major depressive illness and Post Traumatic Stress Disorder* Limited data on medical health status of hospitalized homeless women * Weinreb LF et al., AJPH 2006 Aug: 96 (8)

Study Goal To describe the baseline physical and mental health syndromes in homeless women hospitalized for a chronic medical illness (CMI)

Methods Sub-study of a longitudinal randomized clinical trial evaluating the effect of providing housing and comprehensive case management to the homeless with CMIs Recruited from 3 Chicago hospitals (public, private, VA)

Methods One of 15 qualifying CMIs Unstable Housing 30 days prior Able to self-care No dependents requiring housing English or Spanish speaking Face to face interview ACTG-SF 21, Prime-MD PHQ, ASI

Demographics (N = 99) % or Mean, SD Mean Age 43, 9.7 African-American81 White/Other16 Latino2 High School or greater53 Never Married52 Currently Married5

Demographics (N = 99) % or Mean, SD Children - yes80 Children - number2.7, 2.3 Lived 30 days prior enrollment family/friends6518, 11 shelter2417, 12 street3818, 9 institution377, 7 treatment facility 414, 14

Health Status % CMI single69 two22 Hypertension43 HIV34 Pulmonary Disease27 Diabetes10 Self-Rated Health Status fair-poor79

Mental Health % Somatoform disorder 56 Anxiety syndrome45 (37/82) Depression major16 other23 Suicidal Ideation36

Substance Use % Alcohol Abuse13 Use past 30 days % Mean Days, SD Alcohol505, 9 Alcohol-Intoxication353,7 Heroin324, 10 Cocaine476, 10

Women compared to Men Women % Men % p value Children - Yes Hypertension Somatoform Alcohol abuse Lived 30 days prior to enrollment Family/friends Institution

Conclusions This cohort of homeless women had multiple CMIs poor self-rated health status substantial and recent alcohol, drug use high rates of suicidal ideation, anxiety and depressive symptoms frequently lived street or shelter prior to admission

Conclusions Specific service needs may include Medical case management Mental Health Crisis Intervention Substance abuse screening & referral for treatment

A Quote What advice would you give to help provide better services? “Be sure to deal with people on an individual basis and try not to generalize…..” TT, Age 46

Acknowledgements Participants Research Assistants & Coordinator Arturo Bendixen (AIDS Foundation) Dr. David Buchanan (Co-Investigator) Dr. Laura Sadowski (PI, Co-Chair CRU)