Association Between Homelessness and Mental Healthcare Utilization Among People With Addictions and Mental Health Problems: A Population-Based Study From Alberta Canada

ObjectiveAddiction and mental health (AMH) disorders present significant psychosocial challenges among affected individuals. Previous research indicates a higher prevalence of AMH conditions among people experiencing homelessness (PEH). This study aims to determine the risk of mortality, suicide attempts, emergency department (ED) visits and hospitalizations among PEH with AMH conditions compared to individuals with AMH conditions who had not experienced homelessness in Alberta.MethodsThis retrospective cohort study used linked administrative data from Alberta Health Services from April 1, 2013 to March 31, 2023. We included adults residing in Alberta and diagnosed with any AMH condition within 5 years before the index date of April 1, 2018. Homelessness in the year prior to the index date was identified using relevant codes in records representing hospitalizations and ED visits. We used Cox Proportional Hazards models to evaluate the risk of ED visits, hospitalizations, suicide attempts, and all-cause mortality for up to 5 years, adjusted for age and sex. We also conducted matched propensity score analyses.ResultsAmong the 622,614 individuals with AMH conditions, 3,390 (0.54%) had an indicator of homelessness. In age and sex-adjusted analyses, PEH were at greater risk for ED visits for both AMH (HR = 8·75, 95% CI [8.37-9.16]) and non-AMH (HR = 2.56, HR = 2.47-2.63) reasons, and at greater risk of hospitalizations for AMH (HR = 8.34, 95% CI [7.73-9.00]) and non-AMH (HR = 6.03, 95% CI [5.73-6.35]) reasons. PEH were at greater risk of suicide attempts (HR = 9.18, 95% CI [8.43-10.01]) and all-cause mortality (HR = 8.15, 95% CI [7.56-8.79]). Findings were attenuated but still significant in the propensity-matched analyses.ConclusionsPEH are at much greater risk of ED visits, hospitalizations, suicide attempts and all-cause mortality. Given this population's high risk of adverse outcomes, PEH will likely need more intensive mental and physical healthcare, coordinated with housing and social support services. Further research is needed on the implementation of interventions tailored to the needs of PEH.