title: Utilization of psychiatric emergency services by homeless persons in Spain.
abstract: OBJECTIVE
  Studies examining the relationship between homeless persons and the use of psychiatric emergency services (PES) in a country with universal access to health care are lacking. This study aimed to determine the prevalence of homelessness in adults visiting a PES in Spain, identify the differences between homeless and non-homeless patients in the use of PES and analyze the factors associated with homelessness and the decision to hospitalize.
  
  
  METHODS
  The study included a total of 11 578 consecutive admissions to a PES in a tertiary hospital in Barcelona, Spain, over a 4-year period. Data collected included socio-demographic and clinical information, and score on the Severity of Psychiatric Illness (SPI) scale. Multivariate logistic regression analyses were used to calculate odds ratios for the factors associated with homelessness and the decision to hospitalize.
  
  
  RESULTS
  Five hundred sixty (4.8%) admissions were considered homeless. Homeless patients had more psychotic and drug abuse disorders, greater severity of symptoms, more risk of being a danger to others and more frequent hospitalization needs than non-homeless patients. Factors related to homelessness were male gender, substance abuse and immigrant status from North Africa, Sub-Sahara Africa and Western countries. The decision to hospitalize homeless patients was associated with psychosis diagnosis, suicide risk, danger to others, symptom severity, medical problems and noncompliance with treatment.
  
  
  CONCLUSIONS
  In an attempt to decrease the use of emergency resources and prevent the risk of homelessness, mental health planners in a universal healthcare system should improve outpatient access for populations with risk factors such as substance abuse and immigration.
authors.affiliation: Universitat Autònoma de Barcelona, Barcelona, Spain. jpascual@hsp.santpau.es <jpascual@hsp.santpau.es>
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Pascual
authors.forename: Angeles
authors.initials: A
authors.lastname: Malagón
authors.forename: Jose M
authors.initials: JM
authors.lastname: Arcega
authors.forename: Jose M
authors.initials: JM
authors.lastname: Gines
authors.forename: Ricard
authors.initials: R
authors.lastname: Navinés
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gurrea
authors.forename: Carlos
authors.initials: C
authors.lastname: Garcia-Ribera
authors.forename: Antoni
authors.initials: A
authors.lastname: Bulbena
mesh_terms: D000328:Adult; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006779:Hospitals, Public; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009313:National Health Programs; D016017:Odds Ratio; D012720:Severity of Illness Index; D013030:Spain