Chronically Medically Ill Homeless Women: Characteristics at Baseline

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

2. 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.

3. 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.

4. 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

5. 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)

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

7. 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)

8. 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

9. Demographics (N = 99) % or Mean , SD Mean Age 43, 9.7 African-American 81 White/Other 16 Latino 2 High School or greater 53 Never Married 52 Currently Married 5

10. Demographics (N = 99) % or Mean, SD Children - yes 80 Children - number 2.7, 2.3 Lived 30 days prior enrollment family/friends 65 18, 11 shelter 24 17, 12 street 38 18, 9 institution 37 7, 7 treatment facility 4 14, 14

11. Health Status % CMI single 69 two 22 Hypertension 43 HIV 34 Pulmonary Disease 27 Diabetes 10 Self-Rated Health Status fair-poor 79

12. Mental Health % Somatoform disorder 56 Anxiety syndrome 45 (37/82) Depression major 16 other 23 Suicidal Ideation 36

13. Substance Use % Alcohol Abuse 13 Use past 30 days %Mean Days, SD Alcohol 50 5, 9 Alcohol-Intoxication 35 3,7 Heroin 32 4, 10 Cocaine476, 10

14. Women compared to Men Women %Men %p value Children - Yes 80 68 .010 Hypertension 43 31 .013 Somatoform 57 43 .022 Alcohol abuse 13 87 .006 Lived 30 days prior to enrollment Family/friends 66 45 .000 Institution 38 55 .022

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

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

17. 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

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