title: Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia.
abstract: BACKGROUND
  The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia.
  
  
  METHODS
  A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule.
  
  
  RESULTS
  We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness.
  
  
  CONCLUSIONS
  Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.forename: Emebet
authors.initials: E
authors.lastname: Gebre-Eyesus
authors.forename: Melkamu
authors.initials: M
authors.lastname: Agedew
authors.forename: Haddis
authors.initials: H
authors.lastname: Solomon
authors.forename: Solomon
authors.initials: S
authors.lastname: Teferra
authors.forename: Tsehaysina
authors.initials: T
authors.lastname: Gebre-Eyesus
authors.forename: Yonas
authors.initials: Y
authors.lastname: Baheretibeb
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.forename: Teshome
authors.initials: T
authors.lastname: Shibre
authors.forename: Abraham
authors.initials: A
authors.lastname: Workneh
authors.forename: Teketel
authors.initials: T
authors.lastname: Tegegn
authors.forename: Alehegn
authors.initials: A
authors.lastname: Ketema
authors.forename: Philip
authors.initials: P
authors.lastname: Timms
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D013405:Suicide