El impacto de la implementación de Housing First en la salud mental de las personas sin hogar

una revisión sistemática

Autores/as

DOI:

https://doi.org/10.59487/2965-1956-2-11604

Palabras clave:

Persona sin hogar, Trastorno mental, Housing First

Resumen

Introducción: Los trastornos mentales son problemas de salud muy prevalentes en las personas sin hogar, siendo una de las principales barreras de atención para esta población. El modelo Housing First (HF) ha demostrado ser una propuesta innovadora y efectiva para mejorar este segmento. Objetivo: Presentar una síntesis de conocimientos sobre el impacto que tiene el HF en la salud mental de la población sin hogar. Evaluando su contribución al seguimiento y tratamiento de las enfermedades psiquiátricas. Metodología: Revisión sistemática realizada en las bases de datos MedLine, Cochrane, LILACS y Google Académico, seleccionando 18 ensayos clínicos radomizados. Resultados: No hubo consenso en todos los criterios evaluados al relacionar HF y salud mental de personas sin hogar. En relación con los síntomas psiquiátricos, la adherencia al tratamiento y el número y período de hospitalizaciones, se encontraron mejoras directas o indirectas en el grupo de HF. En cuanto al consumo de sustancias, no hubo consenso entre los artículos evaluados. En cuanto a la conducta suicida, no hubo una mejora significativa. Conclusión: Aún se necesitan más estudios en el área debido a la falta de consenso en los resultados, pero según los artículos analizados, la estrategia HF se ha mostrado prometedora en brindar mayor autonomía a los usuarios, que es uno de los principales medios para mejorar la salud mental. La relación entre estabilidad del hogar y salud mental es evidente, por lo que la elección por HF debe verse desde una perspectiva de salud pública y no sólo como un problema urbano y social.

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Citas

Observatório de Políticas Públicas com a População em Situação de Rua. OBPOPRUA [Internet]. Página inicial. 2022. Disponível em: <https://obpoprua.direito.ufmg.br/moradia_pop_rua.html>. Acesso em: 12/09/2023.

Fundação Instituto de Pesquisas Econômicas (FIPE). Censo da População em Situação de Rua da Cidade de São Paulo [Internet]. São Paulo, 2015. Disponível em: <https://www.prefeitura.sp.gov.br/cidade/secretarias/upload/assistencia_social/censo/1862%20-%20PRODUTO%2015%20-%20OUT%2015.pdf>. Acesso em: 12/09/2023.

Nilsson SF, Laursen TM, Hjorthøj C, et al. Risk of psychiatric disorders in offspring of parents with a history of homelessness during childhood and adolescence in Denmark: a nationwide, register-based, cohort study. Lancet Public Health. 2017 Dec;2(12):e541-e550. DOI: 10.1016/S2468-2667(17)30210-4.

Santana CLA, Rosa AS. Saúde mental das pessoas em situação de rua: conceitos e práticas para profissionais da assistência social. 1ª ed. São Paulo: Epidaurus Medicina e Arte; 2016. Disponível em: <http://www.prefeitura.sp.gov.br/cidade/secretarias/upload/desenvolvimento_urbano/saude_mental_pop_rua.pdf>. Acesso em: 12/09/2023.

Bassuk EL, Rubin L, Lauriat A. Is homelessness a mental health problem? Am J Psychiatry. 1984 Dec;141(12):1546-50. DOI: 10.1176/ajp.141.12.1546.

Brasil. Ministério da Mulher, da Família e dos Direitos Humanos. É possível Housing First no Brasil?: experiências de moradia para população em situação de rua na Europa e no Brasil / Ministério da Mulher, da Família e dos Direitos Humanos. – Brasília: MMFDH, 2019.

Greenwood RM, Schaefer-McDaniel NJ, Winkel G, et al. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. Am J Community Psychol. 2005 Dec;36(3-4):223-38. DOI: 10.1007/s10464-005-8617-z.

Brasil. Ministério dos Direitos Humanos e da Cidadania. Moradia Primeiro. Página inicial [Internet]. Disponível em: <https://www.gov.br/mdh/pt-br/navegue-por-temas/populacao-em-situacao-de-rua/acoes-e-programas/moradia-primeiro>. Acesso em: 06/10/2023.

Teixeira MB, Lacerda A, Ribeiro JM. Potencialidades e desafios de uma política pública intersetorial em drogas: o Programa “De Braços Abertos” de São Paulo, Brasil. Physis. 2018;28(3):e280306. DOI: 10.1590/S0103-73312018280306.

Alves YDD, Pereira PPG, Peres PS. Nascimento, vida e morte de uma política pública: uma etnografia do programa De Braços Abertos. Cad Saude Publica. 2020;36(3):e00213918. DOI: 10.1590/0102-311x00213918.

Gilmer TP, Stefancic A, Ettner SL, et al. Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Arch Gen Psychiatry. 2010 Jun;67(6):645-52. DOI: 10.1001/archgenpsychiatry.2010.56.

Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135.

Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. Chichester (UK): John Wiley & Sons, 2019.

Stergiopoulos et al. Housing First: exploring participants’ early support needs. BMC Health Services Research. 2014;14:167. DOI:10.1186/1472-6963-14-167.

Chung TE, Gozdzik A, Palma Lazgare LI, et al. Housing First for older homeless adults with mental illness: a subgroup analysis of the At Home/Chez Soi randomized controlled trial. Int J Geriatr Psychiatry. 2018 Jan;33(1):85-95. DOI: 10.1002/gps.4682.

Tsemberis S, Gulcur L, Nakae M. Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. Am J Public Health. 2004 Apr;94(4):651-6. DOI: 10.2105/ajph.94.4.651.

Greenwood RM, Schaefer-McDaniel NJ, Winkel G, et al. Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. Am J Community Psychol. 2005 Dec;36(3-4):223-38. DOI: 10.1007/s10464-005-8617-z.

Loubière S, Lemoine C, Boucekine M, et al. Housing First for homeless people with severe mental illness: extended 4-year follow-up and analysis of recovery and housing stability from the randomized Un Chez Soi d’Abord trial. Epidemiol Psychiatr Sci. 2022 Feb 7;31:e14. DOI: 10.1017/S2045796022000026.

Tinland A, Loubière S, Boucekine M, et al. Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomised controlled trial. Epidemiol Psychiatr Sci. 2020 Sep 30;29:e169. DOI: 10.1017/S2045796020000785.

Parpouchi M, Moniruzzaman A, Rezansoff SN, et al. The effect of Housing First on adherence to methadone maintenance treatment. Int J Drug Policy. 2018 Jun;56:73-80. doi: 10.1016/j.drugpo.2018.03.012.

Rezansoff SN, Moniruzzaman A, Fazel S, et al. Housing First Improves Adherence to Antipsychotic Medication Among Formerly Homeless Adults With Schizophrenia: Results of a Randomized Controlled Trial. Schizophr Bull. 2017 Jul 1;43(4):852-861. DOI: 10.1093/schbul/sbw136.

Gulcur L, Stefancic A, Shinn M, et al. Housing, hospitalization and cost outcomes for homeless individuals with psychiatric disabilities participating in continuum of care and housing first programmes. J Community Appl Soc Psychol. 2003 13(2);171–186.

Chu CMT, Moodie EEM, Streiner DL, et al. Trajectories of Homeless Shelter Utilization in the At Home/Chez Soi Trial of Housing First. Psychiatr Serv. 2020 Jul 1;71(7):648-655. DOI: 10.1176/appi.ps.201900260.

Padgett DK, Gulcur L, Tsemberis S. Housing First Services for People Who Are Homeless With Co-Occurring Serious Mental Illness and Substance Abuse. Research on Social Work Practice. 2006 16(1);74–83. https://doi.org/10.1177/1049731505282593.

Tsemberis S, Kent D, Respress C. Housing stability and recovery among chronically homeless persons with co-occuring disorders in Washington, DC. Am J Public Health. 2012 Jan;102(1):13-6. DOI: 10.2105/AJPH.2011.300320.

Kirst M, Zerger S, Misir V, et al. The impact of a Housing First randomized controlled trial on substance use problems among homeless individuals with mental illness. Drug Alcohol Depend. 2015 Jan 1;146:24-9. DOI: 10.1016/j.drugalcdep.2014.10.019.

Loubière S, Tinland A, Taylor O, et al. Determinants of healthcare use by homeless people with schizophrenia or bipolar disorder: results from the French Housing First Study. Public Health. 2020 Aug;185:224-231. DOI: 10.1016/j.puhe.2020.05.019.

Kerman N, Sylvestre J, Aubry T, et al. The effects of housing stability on service use among homeless adults with mental illness in a randomized controlled trial of housing first. BMC Health Serv Res. 2018 18(1):190.

Lachaud J, Mejia-Lancheros C, Durbin A, et al. The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial. J Urban Health. 2021 Aug;98(4):505-515. DOI: 10.1007/s11524-021-00550-1.

Kerman N, Aubry T, Adair CE, et al. Effectiveness of Housing First for Homeless Adults with Mental Illness Who Frequently Use Emergency Departments in a Multisite Randomized Controlled Trial. Adm Policy Ment Health. 2020 Jul;47(4):515-525. DOI: 10.1007/s10488-020-01008-3.

Aquin JP, Roos LE, Distasio J, et al. Effect of Housing First on Suicidal Behaviour: A Randomised Controlled Trial of Homeless Adults with Mental Disorders. Can J Psychiatry. 2017 Jul;62(7):473-481. DOI: 10.1177/0706743717694836.

Brasil. Ministério da Mulher, da Família e dos Direitos Humanos (MMFDH). Portaria nº. 2.927, de 26 de agosto de 2021. Institui o Projeto Moradia Primeiro no âmbito do Ministério da Mulher, da Família e dos Direitos Humanos. Diário Oficial da União 163 ago 2021; Seção 1.

Publicado

2024-01-05

Cómo citar

1.
Leal FM, D’Almeida ACT, Brunocilla G, Cardoso LM, Camarotto MM. El impacto de la implementación de Housing First en la salud mental de las personas sin hogar: una revisión sistemática. Dialog Interdis Psiq S Ment [Internet]. 5 de enero de 2024 [citado 21 de noviembre de 2024];2(2):e11604. Disponible en: https://revistas.uece.br/index.php/dipsm/article/view/11604