Severe mental illness among homeless adults and its association with longitudinal outcomes

A probability sample of urban homeless adults (N = 420) from Buffalo, NY, w as followed every 3 months for 18 months using measures with established re liability and validity. Rates of mental disorder varied depending on the me asure and/or operationalization applied (e.g., 46% had a high score on a sy mptom checklist but only 13% had been hospitalized for a mental disorder). Based on the Diagnostic Interview Schedule (DIS), 23% received a lifetime D SM-III diagnosis of severe mental illness (schizophrenia or major affective disorder). Those with a diagnosis of severe mental illness differed from t hose without a diagnosis on many dimensions at baseline, reporting more neg ative recent and past family environments, more housing moves, greater stre ss, more psychological and health symptoms, and poorer self-efficacy. Howev er, those with and without a diagnosis differed only on a few longitudinal outcomes, and the entire sample showed improvements on the time spent homel ess, income, stress, and physical and psychological symptoms. Both groups a lso showed significant declines on two measures of social support.