The prevalence of psychiatric disorders and use of care by homeless peoplein Paris

Background: Homelessness is a growing problem in the cities of the western world, and homeless people have a plethora of mental health and social diff iculties. These are, nevertheless, difficult to evaluate epidemiologically. Method: In this paper we present a population survey using the Composite I nternational Diagnostic Interview (CIDI) conducted in the city of Paris in winter 1996 on a representative sample of 838 homeless people. Night shelte rs as well as food kitchens were randomly sampled, and the mean response ra te was around 65%. Results: The sample was relatively young and predominant ly male (85%). Forty percent were born outside France, 96% had worked at so me time, and one-third reported no resources at all. The lifetime prevalenc e of psychiatric disorders was 57.9%, while the I-year prevalence was 29.1% . For definite psychotic disorders, prevalence was 16% (lifetime) and 6% (1 -year). Generally, this Parisian homeless population had some access to car e: in the preceding 6 months 57.7% of them had been medically attended and 14.2% of these had been hospitalised. The survey was cross-sectional, and d id not evaluate regular access to care or the quality of care. Conclusions: The implications for health and social systems are discussed in the light of comparisons with European and North American data.