Life in Substandard Housing Linked to Mental, Physical Illness

Living in substandard housing is far more than just unpleasant. It appears to be strongly related to substance dependence, mental illness, and infectious disease, according to a study published August 19 in AJP in Advance.

Brian Kladko

Researchers with the Department of Psychiatry at the University of British Columbia conducted a study investigating the multimorbidities associated with people living in substandard dwellings. William Honer, M.D., the lead author and the Jack Bell Chair in Schizophrenia at the University of British Columbia, said in an interview with Psychiatric News that the health of individuals living in substandard housing is not well characterized. “Our focus was on the people living in marginal housing, which complements the more extensive evidence base of research concerning frank homelessness.”

Honer and colleagues recruited nearly 300 adults living in single-room-occupancy hotels in a low-income neighborhood in Vancouver. The hotels were in need of major repair and plagued with bedbug, cockroach, and rodent infestations. Each floor had a communal toilet and shower facility that was shared by 10 to 15 tenants. The study participants received monthly evaluations for a median of two years to assess incidence of mortality and substance dependence, as well as psychiatric illness other than substance dependence, neurological disorders, and infectious diseases.

At the end of the study, there was a 5 percent death rate that was attributed to consequences of physical illness or drug overdose. No deaths were due to suicide. According to the multiple assessments for diagnoses of DSM-IV psychiatric disorders, including substance abuse, nearly 100 percent of the participants reported drug abuse—mainly drug injection—while half of the participants had a mental illness—mostly psychosis.

Neurological disorders, such as those with involuntary movements, were present in 45 percent of patients, and positive serology for the human immuno-

deficiency virus (HIV) and hepatitis C were detected in 18 percent and 70 percent of patients, respectively.

In addition, participants who received a comorbid diagnosis of psychosis and drug dependency or HIV were less likely to adhere to psychiatric treatment than those with psychosis alone. However, the presence of comorbidity did not negatively influence the frequency of treatment for opioid addiction or HIV disease.

“The reasons [for the discrepancy in treatment] are unclear at present,” said Honer. “One possibility is that psychosis is more difficult to diagnose than the other two broad categories of illness, and comorbidity may make diagnosing psychosis more challenging…. Another reason could be that psychosis was diagnosed, but participants were unwilling to take medication.”

The authors did acknowledge limitations in the study, including the effects of other illnesses that were not diagnosed and the relatively small sample size of female subjects. Honer told Psychiatric News that he and his colleagues are working with Vancouver Coastal Health, a regional health agency, to increase study size by 3,000 people to address these and other limitations.

“We just hope the take home message in our current study is that a good assessment for the possibility of mental illness needs to be carried out in those living in marginal housing and presenting with substance use or physical illness,” Honer said. “Psychiatric care in this situation may be best delivered in a shared-care model with general medicine and addiction care.”

The study was funded by the British Columbia Mental Health and Addictions Services and the Canadian Institutes of Health Research. ■