Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada

Autoři: Andrea A. Jones aff001;  Kristina M. Gicas aff001;  Sam Seyedin aff001;  Taylor S. Willi aff001;  Olga Leonova aff001;  Fidel Vila-Rodriguez aff001;  Ric M. Procyshyn aff001;  Geoffrey N. Smith aff001;  Toby A. Schmitt aff001;  A. Talia Vertinsky aff002;  Tari Buchanan aff001;  Alex Rauscher aff003;  Donna J. Lang aff002;  G. William MacEwan aff001;  Viviane D. Lima aff004;  Julio S. G. Montaner aff004;  William J. Panenka aff001;  Alasdair M. Barr aff005;  Allen E. Thornton aff006;  William G. Honer aff001
Působiště autorů: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada aff001;  Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada aff002;  Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada aff003;  Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada aff004;  Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada aff005;  Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada aff006
Vyšlo v časopise: Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003172
Kategorie: Research Article



The “trimorbidity” of substance use disorder and mental and physical illness is associated with living in precarious housing or homelessness. The extent to which substance use increases risk of psychosis and both contribute to mortality needs investigation in longitudinal studies.

Methods and findings

A community-based sample of 437 adults (330 men, mean [SD] age 40.6 [11.2] years) living in Vancouver, Canada, completed baseline assessments between November 2008 and October 2015. Follow-up was monthly for a median 6.3 years (interquartile range 3.1–8.6). Use of tobacco, alcohol, cannabis, cocaine, methamphetamine, and opioids was assessed by interview and urine drug screen; severity of psychosis was also assessed. Mortality (up to November 15, 2018) was assessed from coroner’s reports and hospital records. Using data from monthly visits (mean 9.8, SD 3.6) over the first year after study entry, mixed-effects logistic regression analysis examined relationships between risk factors and psychotic features. A past history of psychotic disorder was common (60.9%). Nonprescribed substance use included tobacco (89.0%), alcohol (77.5%), cocaine (73.2%), cannabis (72.8%), opioids (51.0%), and methamphetamine (46.5%). During the same year, 79.3% of participants reported psychotic features at least once. Greater risk was associated with number of days using methamphetamine (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.05–1.24, p = 0.001), alcohol (aOR 1.09, 95% CI 1.01–1.18, p = 0.04), and cannabis (aOR 1.08, 95% CI 1.02–1.14, p = 0.008), adjusted for demographic factors and history of past psychotic disorder. Greater exposure to concurrent month trauma was associated with increased odds of psychosis (adjusted model aOR 1.54, 95% CI 1.19–2.00, p = 0.001). There was no evidence for interactions or reverse associations between psychotic features and time-varying risk factors. During 2,481 total person years of observation, 79 participants died (18.1%). Causes of death were physical illness (40.5%), accidental overdose (35.4%), trauma (5.1%), suicide (1.3%), and unknown (17.7%). A multivariable Cox proportional hazard model indicated baseline alcohol dependence (adjusted hazard ratio [aHR] 1.83, 95% CI 1.09–3.07, p = 0.02), and evidence of hepatic fibrosis (aHR 1.81, 95% CI 1.08–3.03, p = 0.02) were risk factors for mortality. Among those under age 55 years, a history of a psychotic disorder was a risk factor for mortality (aHR 2.38, 95% CI 1.03–5.51, p = 0.04, adjusted for alcohol dependence at baseline, human immunodeficiency virus [HIV], and hepatic fibrosis). The primary study limitation concerns generalizability: conclusions from a community-based, diagnostically heterogeneous sample may not apply to specific diagnostic groups in a clinical setting. Because one-third of participants grew up in foster care or were adopted, useful family history information was not obtainable.


In this study, we found methamphetamine, alcohol, and cannabis use were associated with higher risk for psychotic features, as were a past history of psychotic disorder, and experiencing traumatic events. We found that alcohol dependence, hepatic fibrosis, and, only among participants <55 years of age, history of a psychotic disorder were associated with greater risk for mortality. Modifiable risk factors in people living in precarious housing or homelessness can be a focus for interventions.

Klíčová slova:

Alcoholism – Cannabis – Cocaine – Housing – Medical risk factors – Psychoses – Traumatic brain injury – Traumatic injury risk factors


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