title: A longitudinal study of suicidal ideation among homeless, mentally ill individuals.
abstract: OBJECTIVE
  Previous cross-sectional studies have indicated that homeless individuals may present with high rates of suicidal ideation, which are strongly associated with completed suicide. We conducted the first known longitudinal study of suicidal ideation in the homeless.
  
  
  METHODS
  We used data collected over 24 months in the Vancouver At Home project (N = 497), comprised two randomized-controlled trials of housing interventions for homeless individuals with mental disorders. Presence of suicidal ideation was determined using the Colorado symptom index.
  
  
  RESULTS
  Suicidal ideation significantly decreased over time [odds ratio (OR) = 0.31 at 24 months, 95 % confidence interval (CI) 0.21-0.46]. Baseline diagnoses of mood (OR = 2.18, 95 % CI 1.48-3.21) and anxiety disorders (OR = 2.05, 95 % CI 1.42-2.97), as well as depressive mood (OR = 2.52, 95 % CI 1.90-3.33), use of any substance (OR = 1.59, 95 % CI 1.09-2.32), and polysubstance use (OR = 1.90, 95 % CI 1.40-2.60) were significantly associated with suicidal ideation in the multivariate model. Baseline diagnosis of a psychotic disorder (protective effect), daily substance use, intravenous drug use, recent arrest, multiple physical illnesses and history of traumatic brain injury were significantly associated with suicidal ideation in the unadjusted model only.
  
  
  CONCLUSIONS
  Interventions targeting depressive symptoms and substance use could help decrease suicide risk in homeless individuals. Mental health services need to be tailored to address the complex needs of socially marginalized individuals.
  
  
  BACKGROUND
  Current controlled trials: ISRCTN57595077 (Vancouver At Home study: Housing First plus Assertive Community Treatment versus congregate housing plus supports versus treatment as usual) and ISRCTN66721740 (Vancouver At Home study: Housing first plus intensive case management versus treatment as usual). Assigned 9 Oct. 2012.
authors.affiliation: Department of Psychiatry, Université de Montréal, Montreal, Canada. francois.noel@umontreal.ca.|Institut Universitaire en Santé Mentale de Montréal, 7401 Hochelaga, Montreal, QC, H1N 3M5, Canada. francois.noel@umontreal.ca.
authors.forename: François
authors.initials: F
authors.lastname: Noël
authors.affiliation: Faculty of Health Sciences, Simon Fraser University (SFU), Burnaby, Canada.
authors.forename: Akm
authors.initials: A
authors.lastname: Moniruzzaman
authors.affiliation: Faculty of Health Sciences, Simon Fraser University (SFU), Burnaby, Canada.
authors.forename: Julian
authors.initials: J
authors.lastname: Somers
authors.affiliation: School of Population and Public Health (SPPH), University of British Columbia, Vancouver, Canada.
authors.forename: Jim
authors.initials: J
authors.lastname: Frankish
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, Canada.|CHEOS Centre of Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.
authors.forename: Verena
authors.initials: V
authors.lastname: Strehlau
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, Canada.|CHEOS Centre of Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Schütz
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, Canada.|CHEOS Centre of Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Krausz
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000523:psychology; D059020:Suicidal Ideation
keywords: Homeless persons; Mood disorders; Substance-related disorders; Suicidal ideation