Differential patterns of mental disorders among the homeless in Madrid (Spain) and Los Angeles (USA)

In this paper we compare rates of mental disorders (major depression, dysthymia, cognitive impairment, and schizophrenia) among homeless people in Madrid and Los Angeles (LA) and examine the ordering of the onset of both conditions (i.e., homelessness and mental disorders). In the Madrid study, 262 homeless persons were interviewed using the CIDI. In the LA study, 1563 homeless persons were interviewed with the DIS. To make an item-by-item comparison, we companied the databases from both studies to submit a single database to statistical analyses. Results showed no significant differences in DSM-III-R life-time prevalence rates of mental disorders between both samples. However, the Madrid sample showed higher 12-month prevalence rates of dysthymia and cognitive impairment as compared to the LA sample. Most subjects across both cities first experienced symptoms of their mental disorders before first becoming homeless. The only significant difference was that all of the depressed adults in Madrid experienced depression prior to first becoming homeless, whereas this was the case for only 59.1% of LA depressed homeless people. We discuss the reasons for these cultural differences and their implications for cross-national public health research and intervention.