Chronic Pain Among Homeless Persons with Mental Illness.
OBJECTIVE
Chronic pain is an important public health issue. However, characteristics and needs of marginalized populations have received limited attention. Studies on prevalence and correlates of chronic pain among homeless persons are lacking. We assessed chronic pain among homeless persons with mental illness in the At Home/Chez Soi study.


METHODS
Cross-sectional data from a randomized controlled trial on homelessness and mental health.


METHODS
Data collected between 2009 and 2013 in three Canadian cities.


METHODS
One thousand two hundred eighty-seven homeless persons with mental illness.


METHODS
Data on chronic pain and utilization of prescribed and nonprescribed interventions was assessed using a chronic pain screening instrument. Mental illness was diagnosed with the Mini-International Neuropsychiatric Interview.


RESULTS
Forty-three percent reported moderate to severe chronic pain, interfering with general daily activities (80%), sleep (78%), and social interactions (61%). Multivariate analysis indicated that increasing age and diagnoses of major depressive disorder, mood disorder with psychotic features, panic disorder, and post-traumatic stress disorder (PTSD) were independent predictors of chronic pain. Chronic pain was further associated with increased suicidality. Among participants reporting chronic pain, 64% had sought medical treatment and 56% treated pain with prescribed drugs, while 38% used illicit drugs for pain relief.


CONCLUSIONS
Chronic pain is very common among homeless persons with mental illness and affects activities of daily living. Clinicians treating this population should be aware of the common connections between chronic pain, depression, panic disorder, PTSD, and substance use. While the data indicate the contribution of chronic pain to complex treatment needs, they also indicate a clear treatment gap.
University of Basel, Department of Psychiatry, Basel, Switzerland.|Department of Psychiatry, Institute of Mental Health.
Marc
M
Vogel
Department of Psychiatry, Institute of Mental Health.
Anastasia
A
Frank
Department of Psychiatry, Institute of Mental Health.
Fiona
F
Choi
Department of Psychiatry, Institute of Mental Health.|Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, British Columbia, Canada.
Verena
V
Strehlau
Department of Psychiatry, Institute of Mental Health.
Nooshin
N
Nikoo
Department of Psychiatry, Institute of Mental Health.
Mohammadali
M
Nikoo
Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
Stephen W
SW
Hwang
Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada.
Julian
J
Somers
Department of Psychiatry, Institute of Mental Health.|Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, British Columbia, Canada.
Michael R
MR
Krausz
Department of Psychiatry, Institute of Mental Health.|Centre for Health Evaluation and Outcome Sciences (CHEOS), The University of British Columbia, Vancouver, British Columbia, Canada.
Christian G
CG
Schütz
D000328:Adult; D002170:Canada; D059350:Chronic Pain / Q000150:complications* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence
Chronic Pain; Comorbidity; Homeless Persons; Mental Illness; Substance Use