|Year : 2015 | Volume
| Issue : 2 | Page : 92-94
Psychiatric morbidity among inmates of center for destitutes: A cross-sectional study
Raghavendra B Nayak, Sandeep Patil, Nanasaheb Patil, Sameeran S Chate, Vinayak A Koparde
Department of Psychiatry, KLE University's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
|Date of Web Publication||14-May-2015|
Raghavendra B Nayak
Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences, Dharwad - 580 008, Karnataka
Source of Support: None, Conflict of Interest: None
Context: One percent of the population in India is homeless (destitutes) which include beggars, commercial sex workers, homeless mentally ill, elderly women with dependent children, street children, and persons with disability. Psychiatric disorders are generally seen to be common among homeless individuals. The data are limited regarding psychiatric morbidity and its prevalence in this populace in Indian context. Aim: The aim was to study the prevalence of psychiatric morbidity among the inmates of a center for destitutes. Settings and Design: Cross-sectional study. Materials and Methods: The study included all the residents (n = 50) of a center of destitutes. Psychiatric evaluation was done by qualified practicing psychiatrist. Brief Psychiatric Rating Scale and Global Assessment of Functioning instruments were used to assess the severity of psychiatric symptoms and general functioning of the individuals with mental disorders. Statistical Analysis Used: SPSS version 13 was used for statistical analysis. Results: All residents (n = 50) of center of destitutes were evaluated for psychiatric co-morbidity. 42 (84%) inmates were suffering from psychiatric disorders. Most common psychiatric disorder among them was psychotic disorders in 19 (38%), followed by affective disorders, mainly depression in 16 (32%), somatoform disorders in 5 (10%), and anxiety disorders in 2 (4%). No significant gender differences were noted (P = 0.335). Substance abuse was present in 22 (44%) of the inmates. A significant negative correlation between psychiatric symptoms and functioning of the subject was seen, (P < 0.001). Conclusion: Psychiatric disorders and in particular substance abuse, are common among the homeless people who stay in the center of destitutes. Psychiatric disorders are likely to be the cause significant functional impairment.
Keywords: Destitutes, homeless population, psychiatric morbidity
|How to cite this article:|
Nayak RB, Patil S, Patil N, Chate SS, Koparde VA. Psychiatric morbidity among inmates of center for destitutes: A cross-sectional study. J Sci Soc 2015;42:92-4
|How to cite this URL:|
Nayak RB, Patil S, Patil N, Chate SS, Koparde VA. Psychiatric morbidity among inmates of center for destitutes: A cross-sectional study. J Sci Soc [serial online] 2015 [cited 2018 Dec 9];42:92-4. Available from: http://www.jscisociety.com/text.asp?2015/42/2/92/157038
| Introduction|| |
A destitute is one who is without the basic necessities of life, one who is poor enough to need help of others. These people can also be called as houseless/homeless population. A "house" is defined as a structure with a roof in the Census of India.  Houseless population is defined in the Census of India as the persons who are not living in "census house." Almost every city in India has homeless individuals and they have been neglected in terms of medical or psychological services tendered to them. Experts report that at least 1% of the population of cities in India is homeless.  The destitute population among homeless includes beggars, commercial sex workers, mentally ill, elderly women with dependent children, street children, and persons with disability. Amongst these, some of them have migrated from other states and some are local residents.
Government initiatives have failed to meet the basic needs of homeless people in spite of good efforts. However, homeless people are to some extent taken care by both government and nongovernmental organizations through setting up center for destitute. These people are picked up by either police or social welfare officers from different places and are kept in center of destitute in order to give these people a better living and provide medical support if required. Parker et al., in a study in a similar population in Australia, found that the prevalence of mental illness in homeless people may range from 2% to 90%.  At present, there is limited data available regarding psychiatric morbidity and its prevalence among Indian destitute population. In view of the limited literature and widespread presence, it is necessary to evaluate and thus provide better care for this populace.
| MATERIALS and Methods|| |
This is a cross-sectional study which included all the inmates (n = 50) of a center for destitutes. Most of the inmates were staying at this center for at least few weeks and some were staying for few months. Permission from the Chairman of the center of destitutes was obtained to carry out the study. After taking the informed consent from the inmates, instruments were applied, and data were collected from them and caregivers of the center for destitutes. All inmates underwent both physical and psychiatric evaluation. A qualified psychiatrist evaluated the residents identifying possible psychiatric disorders. Psychiatric disorders were diagnosed using International Classification of Disorders-10 diagnostic criteria.  Later these diagnoses were grouped different dimensions of psychiatric disorders. The inmates who screened positively were assessed for severity of psychiatric symptoms using Brief Psychiatric Rating Scale (BPRS).  The functional impairment was assessed using Global Assessment of Functioning (GAF) scale.  The data was tabulated and analyzed using SPSS version 13 software (SPSS Inc, Chicago). Descriptive statistics and parametric tests (Chi-square test, t-test, and Pearson's correlation test) were used for assessment. P ≤ 0.05 was considered to be statistically significant.
| Results|| |
The study included 50 inmates of government run center of destitute in an urban area. The details are tabulated in [Table 1]. 33 (66%) inmates were male, and 17 (34%) were females. Mean age of male inmates was 45.06 ± 15.21 years and 49.47 ± 16.17 years for female residents. Overall 42 (84%) of the destitute were suffering from psychiatric illness. Most common psychiatric disorder among them was psychotic disorders in 19 (38%), followed by depressive disorders in 16 (32%), somatoform disorders in 5 (10%), and anxiety disorders in 2 (4%). There is no significant gender difference in the presentation of psychiatric illness in this group (P = 0.335). Substance abuse is present in 22 (44%) of the destitutes. Substance abuse was significantly more in males than females (P = 0.038). The most common substance abused was tobacco.
|Table 1: Nature of psychiatric co-morbidity, severity and global functioning among destitutes|
Click here to view
Brief Psychiatric Rating Scale was used to assess the severity of psychiatric symptoms. There was no significant difference in BPRS scores among males and females (P = 0.716) with psychiatric illness. GAF scale was used to assess the level of functioning. Both gender had almost same level of functional impairment due to psychiatric illness (P = 0.449). There was a significant negative correlation between BPRS score and GAF score (P < 0.001).
| Discussion|| |
As per census of 2011, the population of India is approximately 1200 million.  Mander et al. reported that about 1% of the population may be homeless,  which accounts for nearly 12 million people on the streets. Psychiatric illnesses are more common in a homeless population than the general population in the western population.  The prevalence of psychiatric illness in this study was 84%. A study of prevalence of mental disorders in homeless people in Britain demonstrated a prevalence of 30-50% and functional psychosis was the commonest psychiatric illness in them.  In United States, 20-25% of the homeless population suffers from some form of severe mental illness.  In another US study, 33% of the homeless people had mental illness, and 27% had alcoholism. 
In our study, psychotic disorders were most common, followed by depressive disorders, somatoform disorders, and anxiety disorders. 22 (44%) of inmates had substance abuse pattern and was more common among males. In a study of homeless people in Delhi, India, revealed that only 5.4% of the homelessness was due to mental illness.  There is wide variation of prevalence of mental illness in homeless people that may range from 2% to 90%.  There is higher prevalence of mental illness in our study compared a study done at Delhi. The reasons could be:
It is difficult to comment on the relationship between homelessness and mental illness. Homelessness may increase mental illness based on stress hypothesis and many mentally ill become homeless because core illness factors. Some authors opine deinstitutionalization has led to increase in homelessness in mentally ill people.  Most of the center of destitutes still lack psychiatric services. Whenever there is an acute exacerbation of psychiatric symptoms, they are brought to the hospital for psychiatric care. Hence, regular psychiatric services to the center of destitutes will help in better treatment and rehabilitation of the inmates of the center of destitutes.
- Our study was carried out at a government-run center for destitute and not fully representative of a community homeless populace;
- This center has limited number beds, so chronic and severely ill would likely to occupy beds at the center and;
- Because of sparse resources police and social welfare officers are likely to identify more severely affected homeless people in city and refer to center for rehabilitation.
In the current study, there was a significant correlation between BPRS scores and GAF scores. This suggests that severity psychiatric symptoms directly hamper the functioning of these homeless individuals. Small sample size could be a limitation in this study that could be improved by including more number of center of destitutes in the future studies.
| Conclusion|| |
Psychiatric disorders and in particular substance abuse are common among the homeless people who stay in center of destitutes. The prevalence of psychiatric disorders in this study was 84% and these are likely to be the cause of their significant functional impairment. This necessitates prompt identification and appropriate intervention for overall improvement.
| References|| |
Mander H, Chachra S, Joseph A, Gandhi K, Chatterjee P, Anuradha K, et al
. National programme for urban homeless - NAC WG proposal. Centre for equity studies, Delhi. Available from: http://www.nac.nic.in/pdf/urban_homeless.pdf. [Last cited on 2013 Jun 14].
Parker S, Limbers L, McKeon E. Working for mental health - Homeless and mental illness: Mapping the way home. Mental Coordinating Council; 2002. p. 4. Available from: http://www.mhcc.org.au/documents/Homelessness-and-Mental-Illness-Apr02.pdf. [Last cited on 2013 Jun 20].
The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva, Delhi: World Health Organization, AITBS; 2002.
Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep 1962;10:799-812.
Global Assessment of Functioning (GAF) Scale. Diagnostic and Statistical Manual of Mental Disorders. 4 th
ed. Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000. p. 34.
Size, growth rate and distribution of population. Provisional Population Totals Paper 1 of 2011 India Series. Government of India, ministry of home affairs. Office of registrar general and census commissioner, India. Available from: http://www.censusindia.gov.in/2011-prov-results/data_files/india/Final_PPT_2011_chapter3.pdf. [Last cited on 2013 Jul 01].
Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS Med 2008;5:e225.
Scott J. Homelessness and mental illness. Br J Psychiatry 1993;162:314-24.
Mental Illness and Homelessness. National Coalition for the Homeless, July 2009. Available from: http://www.nationalhomeless.org/factsheets/Mental_Illness.html. [Last cited on 2013 Jun 13].
Schlay AB, Rossi PH. Social science research and contemporary studies of home-lessness. Annu Rev Sociol 1992;18:129-60.
Mander H. Living Rough Surviving City Streets. A Study of Homeless Populations in Delhi, Chennai, Patna and Madurai - For the Planning Commission of India. Available from: http://www.planningcommission.nic.in/reports/sereport/ser/ser_rough.pdf. [Last cited on 2013 Jul 01].
Nieto G, Gittelman M, Abad A. Homeless mentally Ill persons: A bibliography review. Int J Psychosoc Rehabil 2008;12. Available from: http://www.psychosocial.com/IJPR_12/Homeless_Mentally_Ill_Nieto.html. [Last cited on 2013 Jul 01.].