title: Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings.
abstract: BACKGROUND
  Research on discrimination in healthcare settings has primarily focused on health implications of race-based discrimination among ethno-racial minority groups. Little is known about discrimination experiences of other marginalized populations, particularly groups facing multiple disadvantages who may be subjected to other/multiple forms of discrimination.
  
  
  OBJECTIVE
  (1) To examine the prevalence of perceived discrimination due to homelessness/poverty, mental illness/alcohol/drug related problems, and race/ethnicity/skin color while seeking healthcare in the past year among racially diverse homeless adults with mental illness; (2) To identify whether perceiving certain types of discrimination is associated with increased likelihood of perceiving other kinds of discrimination; and (3) To examine association of these perceived discrimination experiences with socio-demographic characteristics, self-reported measures of psychiatric symptomatology and substance use, and Emergency Department utilization.
  
  
  METHODS
  We used baseline data from the Toronto site of the At Home/Chez Soi randomized controlled trial of Housing First for homeless adults with mental illness (n = 550). Bivariate statistics and multivariable logistic regression models were used for the analysis.
  
  
  RESULTS
  Perceived discrimination related to homelessness/poverty (30.4%) and mental illness/alcohol/substance use (32.5%) is prevalent among ethnically diverse homeless adults with mental illness in healthcare settings. Only 15% of the total participants reported discrimination due to race/ethnicity/skin color. After controlling for relevant confounders and presence of psychosis, all types of discrimination in healthcare settings were associated with more frequent ED use, a greater - 3 - severity of lifetime substance abuse, and mental health problems. Perceiving discrimination of one type was associated with increased likelihood of perceiving other kinds of discrimination.
  
  
  CONCLUSIONS
  Understanding the experience of discrimination in healthcare settings and associated healthcare utilization is the first step towards designing policies and interventions to address health disparities among vulnerable populations. This study contributes to the knowledge base in this important area.
  
  
  BACKGROUND
  This study has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374.
authors.forename: Anna
authors.initials: A
authors.lastname: Skosireva
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
authors.forename: Suzanne
authors.initials: S
authors.lastname: Zerger
authors.forename: Catharine
authors.initials: C
authors.lastname: Chambers
authors.forename: Susan
authors.initials: S
authors.lastname: Gapka
authors.affiliation: Centre for Research on Inner City Health, Li Ka-Shing Knowledge Institute, Keenan Research, Centre, St, Michael's Hospital, Toronto, Canada. StergiopoulosV@smh.ca.
authors.forename: Vicky
authors.initials: V
authors.lastname: Stergiopoulos
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006268:Health Facilities; D006703:Ill-Housed Persons / Q000523:psychology; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D011369:Professional-Patient Relations; D063505:Racism; D063508:Social Discrimination