title: Multiply disadvantaged: Health and service utilisation factors faced by homeless injecting drug consumers in Australia.
abstract: OBJECTIVE
  Homelessness status is strongly correlated with higher rates of substance use. Few studies, however, examine the complex relationship between housing status and substance use in people who inject drugs (PWID). This study extends previous research by comparing the physical and mental health status and service utilisation rates between stably housed and homeless PWID.
  
  
  METHODS
  A cross-sectional sample of 923 PWID were recruited for the 2012 Illicit Drug Reporting System. Multivariate models were generated addressing associations between homelessness and the domains of demographics; substance use; and health status, service utilisation and criminal justice system contact, with significant correlates entered into a final multivariate model.
  
  
  RESULTS
  Two-thirds of the PWID sample were male. The median age was 39 years and 16% identified as Indigenous. Almost one-quarter (23%) reported that they were homeless. Homeless PWID were significantly more likely to be unemployed [adjusted odds ratio (AOR) 2.83, 95% confidence interval (CI) 1.26, 6.34], inject in public (AOR 2.01, 95% CI 1.38, 3.18), have poorer mental health (AOR 0.98, 95% CI 0.97, 1.00), report schizophrenia (AOR 2.31, 95% CI 1.16, 4.60) and have a prison history (AOR 1.53, 95% CI 1.05, 2.21) than stably housed PWID.
  
  
  CONCLUSIONS
  Findings highlight the challenge of mental health problems for homeless PWID. Our results demonstrate that further research that evaluates outcomes of housing programs accommodating PWID, particularly those with comorbid mental health disorders, is warranted. Results also emphasise the need to better utilise integrated models of outreach care that co-manage housing and mental health needs.
authors: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors: Elizabeth
authors: E
authors: Whittaker
authors: NHMRC Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors: Wendy
authors: W
authors: Swift
authors: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors: Amanda
authors: A
authors: Roxburgh
authors: Centre for Population Health, Burnet Institute, Melbourne, Australia.
authors: Paul
authors: P
authors: Dietze
authors: Centre for Population Health, Burnet Institute, Melbourne, Australia.
authors: Shelley
authors: S
authors: Cogger
authors: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.|School of Medicine, University of Tasmania, Hobart, Australia.
authors: Raimondo
authors: http://orcid.org/0000-0001-6673-833X
authors: R
authors: Bruno
authors: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors: Natasha
authors: N
authors: Sindicich
authors: National Drug and Alcohol Research Centre, UNSW, Sydney, Australia.
authors: Lucy
authors: L
authors: Burns
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006304:Health Status; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*
keywords: Australia; homeless person; mental disorder; street drug; substance-related disorder