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Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials

BMC Medicine volume 20, Article number: 224 (2022) Cite this article

Abstract

Background

Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population.

Methods

Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted.

Results

Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was “critically low.” Interventional studies were scant.

Conclusion

While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.

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Background

Homelessness is an important social, public health, and human rights issue worldwide. The prevalence of homelessness varies among diverse countries and cultures around the world. Lifetime prevalence estimates from representative samples are 4.2% in the USA [1] to 4.9% in Europe [2]. However, high-quality data on the prevalence of homelessness in low- and middle-income countries (LMICs) is scant.

The operational definitions for homelessness likewise vary across different literature sources and settings [3] although a commonly accepted and implemented definition of homelessness globally comes from the European Typology of Homeless and Housing Exclusion study [4].

People experiencing homelessness (PEH) may face social and economic challenges that may lead to poor health, such as poverty, poor nutrition, and social exclusion. People who lack stable and appropriate housing appear to be at relatively high risk for a broad range of acute and chronic illnesses, especially infectious diseases, heart diseases, substance use disorders, and severe mental disorders [5]. However, it is unclear whether homelessness causes these disorders or otherwise these illnesses per se contribute to homelessness. Finally, evidence indicates that PEH has a lower probability of receiving proper care for their health conditions compared to the general population [6].

Data about differences in the prevalence of multiple health conditions between PEH and the general population is substantially unreliable, as exemplified by current knowledge about mental health [7] and infectious diseases among PEH [8]. Cohort and case-control studies have reported various health outcomes associated with homelessness, and several health outcomes have been the subject of a multitude of systematic reviews (SRs) and meta-analyses (MAs). While informative, this latter knowledge synthesis is usually restricted to a single outcome, and some of their results may be affected by biases, which are often poorly appraised [9]. Furthermore, randomized controlled trials (RCTs) targeting health-related outcomes in homeless populations are few, thus providing limited evidence to inform health policies [10]. Specifically, significant associations claimed by the original observational studies, or their pooled synthesis may be susceptible to biases such as excess significance [11], publication bias, reporting bias, and residual confounding, leading to misleading or inflated estimates of these associations [12].

Umbrella reviews (URs)—a systematic collection and appraisal of SRs and MAs performed on a specific topic [13]—can disentangle the aforementioned biases through appraising the quality and comprehensiveness of the data, and hence, assess which associations derived from observational studies are supported by the most credible evidence. Likewise, URs can provide a methodological appraisal of RCTs targeting a specific population or condition. Thus, in the current report, we aimed to conduct an umbrella review of the evidence from observational studies and RCTs considering multiple health outcomes involving PEH. In particular, we aimed at (i) assessing the reported association measures between homelessness and any health outcome and (ii) appraising the interventions targeting any health outcome among PEH.

Methods

Search strategy

We performed an umbrella review that included observational or RCTs that investigated the association between homelessness and any health outcome. The PubMed/MEDLINE, EMBASE, and SCOPUS databases were systematically searched from inception up to April 28, 2021. The following string was adopted for PubMed: (((“homeless persons”[MeSH Terms]) OR (“homeless youth”[MeSH Terms])) OR (“vulnerable populations”[MeSH Terms]) OR (homeless*[Title/Abstract])) AND (((((“meta analysis as topic”[MeSH Terms]) OR (“systematic reviews as topic”[MeSH Terms])) OR (“meta analysis”[Title/Abstract])) OR (“systematic review”[Title/Abstract]))). Please see Additional file 1: material 1. The definition of homelessness and related phenomena were independently recorded by two investigators.

Eligibility criteria

For the synthesis of evidence from SRs and MAs of observational studies, we included those studies reporting any health outcome among PEH compared to the general population or otherwise provided controls (i.e., people who are not experiencing homelessness, PEH without a particular exposure). We excluded those SRs or MAs of observational studies that only provided prevalence estimates of a given health condition in PEH without providing a measure of association. Specifically, those studies reporting interventions just targeting housing, but not the related health status, were likewise excluded. The SRs and MAs of RCTs suitable for inclusion were those documenting interventions targeting any health outcome among PEH; controls were PEH exposed to a health-targeting intervention different from the health-outcome intervention delivered to PEH cases. Eligible quantitative SRs and MAs of observational studies had to include at least 3 studies; eligible SRs and MAs of intervention studies had to include at least 5 studies. The rationale for this inclusion criterion is explained in detail elsewhere [14]. In the case of multiple MAs reporting on the same topic (i.e., overlapping with the same type of intervention or exposure), we considered only the one that included the largest number of studies as it is a standard procedure in previously conducted umbrella reviews [15, 16]. In cases there were two or more MAs pooling the same number of studies, we retained the most recent one. Qualitative reports were excluded. There were no language restrictions for the inclusion of studies for this umbrella review.

The protocol for this study was registered in PROSPERO with the following numbers: CRD42021252185, for the protocol investigating observational studies, and CRD42021252191 for the protocol that assessed evidence from intervention studies, respectively. Complete versions of each protocol are fully available online at https://osf.io/am67d/ and https://osf.io/58mhu/.

Data extraction

Three investigators (MDP, MB, MF) independently searched title/abstracts of retrieved references for eligibility, and when a consensus could not be achieved, additional authors with considerable expertise in umbrella reviews (AFC, MS, LS) and the study of homelessness (LS, JGF, SH, MK) were consulted. The same procedure was followed at the full-text level. The reference lists of included studies were also searched for the identification of additional eligible references. Among other variables, we recorded the following: publication year, considered health outcome, study design, number of the included studies, total sample size, homelessness definition, and disclosure of sponsorship. For each primary study included in the SRs or MAs, we additionally recorded the first author, year of publication, study design (i.e., cohort, case-control, cross-sectional, RCT), setting of the study (i.e., inpatients, outpatients, population-based), number of subjects included in the study (total sample, cases, and controls), sex, ethnicity, both adjusted and unadjusted effect sizes (ES), and 95% confidence interval (CI). Intervention and mean duration of RCT studies were likewise extracted.

Data analysis and assessment of the credibility of evidence

We re-analyzed each eligible MA using the extracted individual study estimates to compute the summary effect estimates and the exact p-value under the random-effects model with DerSimonian and Laird method if included studies were equal or more than 10, and Hartung, Knapp, Sidik, and Jonkman (HKSJ) if less than 10 [17, 18]. Cochran’s Q test and the I2 statistics were computed for the evaluation of heterogeneity across studies (I2>50% indicated high heterogeneity) [19, 20]. To further account for heterogeneity between studies, we computed 95% prediction intervals for the summary random-effect estimates [21]. We evaluated the presence of small-study effects (i.e., large studies fetching significantly more conservative results than smaller studies) by adopting the Egger’s regression asymmetry test (p≤0.10) [22]. For statistically significant MAs, we assessed the presence of excess significance bias by evaluating whether the number of observed studies with nominally statistically significant results was different from the expected number of studies with statistically significant results [23]. The expected number of statistically significant studies in each association was calculated from the sum of the statistical power estimates for each component study using an algorithm from a non-central t distribution [24,25,26]. The power estimates of each component study depended on the plausible effect size of the tested association, which was assumed to be the effect size of the largest study in each MA [27]. The presence of excess significance bias for individual MAs was considered at p≤0.10. The credibility of the evidence of each association provided by MAs of observational studies was assessed using the criteria previously applied in various medical fields [26, 28, 29], waiving the “number of cases” criterion since some health outcomes of PEH represent infrequent events. Briefly, the associations that presented nominally significant random-effect summary estimates were considered as “convincing” (Class I), “highly suggestive” (Class II), “suggestive” (Class III), “weak evidence” (Class IV), or “non-significant” (NS). Please, see the credibility box in Additional file 1: Table S1. For MAs of intervention studies, we assessed the significance of the pooled effect size as P<0.005, P=0.005–0.005, and P≥0.05 [30], the 95% prediction interval (excluding the null or not), the significance of the effect size of the largest study, and the presence of large heterogeneity (i.e., I2>50%) [31]. In addition, the methodological quality of those SRs and/or MAs was further appraised with the Assessment of Multiple Systematic Reviews Plus (AMSTAR-Plus) instrument [32]. All statistical tests were two-tailed. The data abstraction was performed using pre-defined Microsoft Excel® forms, while the statistical computations were carried out by an expert senior author (ED) using the STATA/SE, version 17.0 (StataCorp LLC) software. For each eligible quantitative report, two investigators (MDP and MB) independently rated the methodological quality using the AMSTAR-2 (Assessment of multiple SRs) tool [33] for quantitative SRs or MAs of observational studies. The prospective cohort studies included in the quantitative SRs or MAs of observational studies were rated for quality using the Newcastle-Ottawa scale (NOS) [34]. Finally, we adopted the following thresholds for the NOS scores: “good quality” (3-4 stars in the “selection domain” AND 1-2 stars in the “comparability” domain AND 2-3 stars in the “outcome” domain), “fair quality” (2 stars in the “selection domain” AND 1-2 stars in the “comparability” domain AND 2-3 stars in the “outcome” domain), and “poor quality” (0-1 stars in the “selection domain” OR 0 stars in the “comparability” domain OR 0-1 star in the “outcome” domain) [35].

Results

The search returned 1549 potentially eligible records, of which 11 records were manually retrieved. Upon title and abstract screening, 189 records were further assessed at the full-text level, of which 179 were excluded with reasons as detailed in Additional file 1: Table S2 [7, 8, 36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135,136,137,138,139,140,141,142,143,144,145,146,147,148,149,150,151,152,153,154,155,156,157,158,159,160,161,162,163,164,165,166,167,168,169,170,171,172,173,174,175,176,177,178,179,180,181,182,183,184,185,186,187,188,189,190,191,192,193,194,195,196,197,198,199,200,201,202,203,204,205,206,207,208,209,210]. Nine SRs or MAs of observational studies [211,212,213,214,215,216,217,218,219] were included, which yielded 23 comparisons. One MA of interventional studies [220] fetched two comparisons. Figure 1 provides a flowchart for study selection.

Fig. 1
figure 1

Flowchart of the literature search and evaluation process returning 10 systematic reviews and meta-analyses

Full size image

Given the scant evidence for intervention studies, we decided to combine the reporting of both registration protocols into a single publication.

Descriptive characteristics of the 10 included eligible SRs and MAs of observational and intervention studies are outlined in Table 1. The observational studies had the following control groups: PEH without SUD [211], PEH who did not inject drugs [212], people not experiencing homelessness [213,214,215, 218, 219], or the general population [216, 217]. Although substantially overlapping, we nonetheless recorded “people not experiencing homelessness” and “general population” controls, as documented by the original study at review. The included MA of RCTs controlled for various treatment exposures [220].

Table 1 Characteristics of the included SRs or MAs of observational and interventional studies
Full size table

Description and summary of associations

Observational studies

Nine eligible SRs and/or MAs of observational studies assessed 23 associations, evaluated by 122 individual studies from 73 original reports, estimating adverse health outcomes associated with homelessness. Six (26.1%) associations concerned various causes of mortality among PEH, five (21.7%) associations regarded health outcomes related to HIV infection, and four (17.4%) associations inquired about premature geriatric syndromes (e.g., falls, functional limitations). Please refer to Fig. 2 for additional details. Twelve out of 23 (52.2%) associations were nominally statistically significant at a p≤0.005 level based on the random-effects model, and 7 (30.4%) reached p≤1×10−6. Fifteen associations (65.2%) had large heterogeneity, and the 95% prediction interval excluded the null value for only five associations (21.7%). In twenty associations (86.9%), the effect of the largest study was statistically significant at p≤0.05. A small-study effect was detected in one association (4.3%), and excess significance bias occurred in one out of ten studies suitable for such estimation (10%). Please refer to Table 2 for details.

Fig. 2
figure 2

Number of systematic reviews or meta-analyses of observational studies reporting health outcomes among PEH by category of health outcome

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Table 2 Evidence from SRs or MAs of observational studies for the association between homelessness and any health outcome
Full size table

Intervention studies

One eligible MA of intervention studies documented two therapeutic interventions, evaluated by 10 unique RCTs from 10 original reports, estimating interventions associated with mental health status among PEH [220]. One association concerned the psychological interventions among PEH diagnosed with depression, while the remaining one dealt with psychological interventions for anxiety. None of the assessed associations reached a statistically significant value at p≤0.005 based on the random-effects model [30]. The degree of heterogeneity of the documented associations was quantified in I2=42.5% for depression and 39.9% for anxiety. The 95% prediction intervals crossed the null for the outcomes of both interventions. Neither of the largest studies of the two associations was statistically significant at p≤0.05. Please refer to Table 3 for details.

Table 3 Evidence from SRs or MAs of intervention studies for the association between different interventions for PEH and any health outcome
Full size table

Grading of systematic reviews and meta-analyses of observational studies

Concerning the SRs and/or MAs of observational studies, none of them concurrently reached a “convincing evidence” threshold, according to the adapted credibility box, and a “high quality” score based on the AMSTAR-2 tool. According to the latter, every SR and/or MA included in the present study was rated as having “critically low” methodological quality. Please refer to Additional file 1: Table S3 [211,212,213,214,215,216,217,218,219].

Convincing evidence

Among the 23 associations, two (8.7%) were supported by “convincing evidence”: hospitalization due to any cause among PEH diagnosed with HIV infection and the occurrence of falls within the past year among PEH. Both health outcomes were more common among PEH compared to non-homeless controls.

Highly suggestive evidence

Five (21.7%) associations were rated “highly suggestive evidence”: (1) mortality due to any cause; (2) mortality due to external causes (i.e., intentional injury, unintentional injury, poisoning) among PEH compared to the general population; (3) HCV-infection among PEH using injection drugs compared to those who did not; (4) the presence of limitations in activities of daily living (ADL, e.g., dressing, eating, toileting); and (5) instrumental activities of daily living (IADL, e.g., using telephone, using transportations, taking medications) among PEH compared to non-homeless controls. These above-mentioned health outcomes were more common among PEH compared to their respective controls. Mortality due to any cause and mortality due to external causes had high standardized mortality ratios=6.22 (95% C.I.=4.2–9.2), and SMR=15.75 (95% C.I.=10.58–23.44), respectively.

Suggestive, weak, and no evidence

Five (21.7%) associations were rated “suggestive evidence,” four (17.4%) were “weak evidence,” while “no significant evidence” was found in seven (30.5%) associations.

Grading of systematic reviews and meta-analyses of intervention studies

Concerning intervention studies, the sole MA retrieved obtained a score of “10” at the AMSTAR-plus. Please refer to Table 3 for details.

Sensitivity analysis

A sensitivity analysis limited to high-quality prospective cohort studies included eleven (47.8%) associations, rated according to the NOS. Upon sensitivity analysis, two associations worsen, and one association improved in terms of credibility evidence. Hospitalization due to any cause among PEH with HIV infection shifted from “convincing evidence” to “highly suggestive evidence”, non-adherence to antiretroviral therapy (ART) among PEH with HIV infection shifted from “suggestive evidence” to “weak evidence”, and mortality due to any cause among PEH with SUD up-graded from “no significant evidence” to “highly suggestive evidence”. Please refer to Additional file 1: Table S4 [211, 214, 217, 219].

Discussion

Statement of principal findings

We found convincing evidence that all-cause hospitalization in people with HIV infection and the occurrence of falls within the past year were more common among PEH compared to comparison populations. We also found highly suggestive evidence that mortality due to any cause; mortality due to external causes; hepatitis C infection among PEH using injection drugs; limitations in activities of daily living; and limitations in instrumental activities of daily living were significantly more common in PEH compared to their comparison populations. Mortality due to any cause and mortality due to external causes had high standardized mortality ratios such that PEH had a mortality rate six times their comparison groups and they were about 15 times more likely to die from either accidents or intentional self-harm.

Strengths and limitations

To our knowledge, this study is the first umbrella review that systematically inquired about any health-related outcomes and interventions among PEH, grading the evidence by using previously adopted and widely accepted criteria of credibility [14, 16, 29, 31, 221]. All SRs/or MAs of observational studies were graded as having “critically low” methodological quality according to the AMSTAR-2 instrument. Among the associations rated with “highly suggestive evidence”, two were not deemed as “convincing” due to high heterogeneity. Overall, 65.2% of the associations covered by the present umbrella review were hampered by high heterogeneity, which held upon controlling for high-quality prospective studies (seven out of eleven associations—63.6%—had an I2>50%).

The differences in definitions of “homelessness” and thus categories of homelessness (for example individuals without permanent housing who may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non-permanent situation) adopted by the authors of the included SRs or MAs could likewise account for the high rates of heterogeneity. Half of the appraised studies lacked a “homelessness” definition, and the remaining half provided a broad definition, as detailed in Table 1. The timeframe for the homelessness definition, or its related labels, varied across the individual studies included by the appraised SRs or MAs, often merging people who were currently homeless with people who were experiencing this condition within varying timeframes (i.e., 30-day, 6-month, or 12-month intervals, as usually documented by the authors of the original studies). Future research should, therefore, rely on consistent operational definitions, or otherwise stratify their results accordingly, especially considering that substantial variability of the adopted definitions exists across different world regions [222].

The limitations of this review include the exclusion of RCTs on the impact of housing interventions (Housing First) on PEH. However, such interventions were not deemed eligible for inclusion according to our a priori criteria since we focused on those interventions directly targeting health outcomes in PEH rather than on interventions aimed at reducing the burden of homelessness. Sensitivity analyses were restricted to high-quality prospective studies. Because of the lack of relevant SRs or MAs, we could not appraise otherwise relevant associations between homelessness and health outcomes such as alcohol-related issues, cancer, or infectious diseases other than HIV or HCV. Mental illness-related issues were only accounted for by three comparisons focusing on children experiencing homelessness [223].

Comparison with previous studies

Considering the two associations reaching “convincing evidence” before sensitivity analysis, the documented hospitalization trend due to any cause in people with HIV is consistent with a recent retrospective cohort study [224]. A significant increase in “falls during the previous year” may be the result of high rates of concurrent geriatric syndromes, alcohol use disorders, and drug abuse as described elsewhere [225].

Hence, upstream (e.g., poverty, poor nutrition, barriers to healthcare, and HIV treatment) and downstream factors (i.e., comorbidities and multimorbidity) significantly affect PEH [5], jeopardize their healthcare, and inflate their hospitalization rates compared to the general population [222].

Although we were unable to include any SR and MA reporting on the relationship between the COVID-19 pandemic and homelessness, PEH could be at higher risk also at developing hospitalization or fatalities due to COVID-19 according to recent evidence [226] although this finding deserves replication, providing evidence for the need of well-designed interventions targeting this vulnerable population.

Conclusions and implications for further research

This review adds weight to arguments about why reducing homelessness should be a priority beyond human rights justification. The evidence that experiencing homelessness leads to worse health outcomes is only a secondary consideration for providing affordable housing albeit an important one. Housing reduces hospitalization rates according to RCTs involving PEH with chronic illnesses [227, 228]. This study demonstrates that a readily treatable illness such as HIV is not adequately managed in PEH resulting in significant downstream healthcare costs in addition to preventable patient suffering. A recent SR identified that housing PEH (in the short term) improves some aspects of health in this population with HIV, anxiety, and depression [229].

However, focusing just on providing housing for this population does not mean that an individual’s health needs are automatically solved. We know from Housing First studies that just providing housing does not result in improvements in mental health or addictions after a year, especially in people who have experienced significant trauma [55]. This umbrella review suggests that the health effects of homelessness are serious, longstanding, and involve all parts of the health system. Finally, while psychological interventions are expected to be more effective than TAU in reducing the burden of the associated health condition among clinical and non-clinical populations [230], the herein reviewed MA focusing on PEH on the matter [220] failed to reach a statistically significant threshold according to our conservative p value set at p=.005, though it could not be excluded the condition of homelessness itself could attenuate the effects of such psychological interventions.

What is needed now are studies that look at better coordination of care for this population that may involve hospitals and community partners as well as programs to address health issues in people recently housed after experiencing homelessness. In addition, it should be reiterated that there is an urgent need for international standardization of housing status to improve research rigor that could improve the external generalizability of this field and hence direct policy. Furthermore, more studies should be conducted in low- and middle-income countries as the vast majority of studies to date on this topic have been performed in developed nations. Such bias related to the geographical region may depend on a variety of issues, including, but not necessarily limited to, public health policies as well as the limited funding in LMICs. Lastly, more SRs and MAs with enhanced methodological quality are an unmet need in this field.

Availability of data and materials

All data generated or analyzed during this study are included in this published article and are available online at https://osf.io/am67d/ and https://osf.io/58mhu/.

The additional file includes the following: material 1 – [search strings]; table S1 - [criteria for the evaluation of the credibility of the evidence of observational studies]; table S2 – [excluded studies with reasons]; table S3 – [quality rating of the included SRs or MAs of observational studies, according to the AMSTAR-2]; table S4 – [sensitivity analysis].

Abbreviations

ADL:

Activities of daily living

AMSTAR-2:

Assessment of Multiple Systematic Reviews 2

AMSTAR-plus:

Assessment of Multiple Systematic Reviews Plus

ART:

Antiretroviral therapy

CI:

Confidence interval

COVID-19:

Coronavirus disease 2019

ES:

Effect size

HCV:

Hepatitis C virus

HIV:

Human immunodeficiency virus

IADL:

Instrumental activities of daily living

LMICs:

Low- and middle-income countries

MA:

Meta-analysis

NOS:

Newcastle-Ottawa Scale

PEH:

People experiencing homelessness

RCT:

Randomized controlled trial

SMR:

Standardized mortality ratio

SR:

Systematic review

SUD:

Substance use disorder

References

  1. Tsai J. Lifetime and 1-year prevalence of homelessness in the US population: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. J Public Health. 2018;40(1):65–74.

    Article  Google Scholar 

  2. Taylor O, Loubiere S, Tinland A, Vargas-Moniz M, Spinnewijn F, Manning R, et al. Lifetime, 5-year and past-year prevalence of homelessness in Europe: a cross-national survey in eight European nations. BMJ Open. 2019;9(11):e033237.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bensken WP. How do we define homelessness in large health care data? Identifying variation in composition and comorbidities. Health Serv Outcomes Res Methodol. 2021;21(1):145–66.

    Article  Google Scholar 

  4. EUROPEAN TYPOLOGY OF HOMELESSNESS AND HOUSING EXCLUSION (ETHOS) [https://www.feantsa.org/download/ethos2484215748748239888.pdf]

  5. Liu M, Hwang SW. Health care for homeless people. Nat Rev Dis Prim. 2021;7(1):1–2.

    Google Scholar 

  6. Gilmer C, Buccieri K. Homeless patients associate clinician bias with suboptimal care for mental illness, addictions, and chronic pain. J Prim Care Commun Health. 2020;11:2150132720910289.

    Article  Google Scholar 

  7. Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med. 2008;5(12):e225.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Beijer U, Wolf A, Fazel S. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. Lancet Infect Dis. 2012;12(11):859–70.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ioannidis JP. Why most published research findings are false. PLoS Med. 2005;2(8):e124.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ojo-Fati O, Joseph AM, Ig-Izevbekhai J, Thomas JL, Everson-Rose SA, Pratt R, et al. Practical issues regarding implementing a randomized clinical trial in a homeless population: strategies and lessons learned. Trials. 2017;18(1):1–10.

    Article  Google Scholar 

  11. Ioannidis JP, Munafo MR, Fusar-Poli P, Nosek BA, David SP. Publication and other reporting biases in cognitive sciences: detection, prevalence, and prevention. Trends Cognit Sci. 2014;18(5):235–41.

    Article  Google Scholar 

  12. Ioannidis JP. Why most discovered true associations are inflated. Epidemiology. 2008;19(5):640–8. https://doi.org/10.1097/EDE.0b013e31818131e7.

  13. Ioannidis JP. Integration of evidence from multiple meta-analyses: a primer on umbrella reviews, treatment networks and multiple treatments meta-analyses. Cmaj. 2009;181(8):488–93.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dragioti E, Evangelou E, Larsson B, Gerdle B. Effectiveness of multidisciplinary programmes for clinical pain conditions: An umbrella review. J Rehabil Med. 2018;50(9):779–91.

    Article  PubMed  Google Scholar 

  15. Tsilidis KK, Kasimis JC, Lopez DS, Ntzani EE, Ioannidis JP. Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies. BMJ. 2015;350:g7607.

  16. Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JP. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ. 2014;348:g2035. https://doi.org/10.1136/bmj.g2035.

  17. DerSimonian R, Laird N. Meta-analysis in clinical trials. Contr Clin Trials. 1986;7(3):177–88.

    Article  CAS  Google Scholar 

  18. IntHout J, Ioannidis JP, Borm GF. The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol. 2014;14(1):1–12.

    Article  Google Scholar 

  19. Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10(1):101–29.

    Article  Google Scholar 

  20. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ. 2011;342:d549. https://doi.org/10.1136/bmj.d549.

  22. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002. https://doi.org/10.1136/bmj.d4002.

  23. Ioannidis JP, Trikalinos TA. An exploratory test for an excess of significant findings. Clin Trials. 2007;4(3):245–53.

    Article  PubMed  Google Scholar 

  24. Tsilidis KK, Papatheodorou SI, Evangelou E, Ioannidis JP. Evaluation of excess statistical significance in meta-analyses of 98 biomarker associations with cancer risk. J Natl Cancer Inst. 2012;104(24):1867–78.

    Article  CAS  PubMed  Google Scholar 

  25. Tsilidis KK, Panagiotou OA, Sena ES, Aretouli E, Evangelou E, Howells DW. Salman RA-S, Macleod MR, Ioannidis JP: Evaluation of excess significance bias in animal studies of neurological diseases. PLoS Biol. 2013;11(7):e1001609.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Dragioti E, Karathanos V, Gerdle B, Evangelou E. Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials. Acta Psychiatrica Scandinavica. 2017;136(3):236–46.

    Article  CAS  PubMed  Google Scholar 

  27. Ioannidis JP. Clarifications on the application and interpretation of the test for excess significance and its extensions. J Math Psychol. 2013;57(5):184–7.

    Article  Google Scholar 

  28. Bellou V, Belbasis L, Tzoulaki I, Evangelou E, Ioannidis JP. Environmental risk factors and Parkinson's disease: an umbrella review of meta-analyses. Parkinson Relat Disord. 2016;23:1–9.

    Article  Google Scholar 

  29. Bortolato B, Köhler CA, Evangelou E, León-Caballero J, Solmi M, Stubbs B, et al. Systematic assessment of environmental risk factors for bipolar disorder: an umbrella review of systematic reviews and meta-analyses. Bipolar Disord. 2017;19(2):84–96.

    Article  PubMed  Google Scholar 

  30. Koletsi D, Solmi M, Pandis N, Fleming PS, Correll CU, Ioannidis JP. Most recommended medical interventions reach P< 0.005 for their primary outcomes in meta-analyses. Int J Epidemiol. 2020;49(3):885–93.

    Article  PubMed  Google Scholar 

  31. Li X, Meng X, Timofeeva M, Tzoulaki I, Tsilidis KK, Ioannidis JP, et al. Serum uric acid levels and multiple health outcomes: umbrella review of evidence from observational studies, randomised controlled trials, and Mendelian randomisation studies. BMJ. 2017;357:j2376.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Correll CU, Rubio JM, Inczedy-Farkas G, Birnbaum ML, Kane JM, Leucht S. Efficacy of 42 pharmacologic cotreatment strategies added to antipsychotic monotherapy in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence. JAMA Psychiatr. 2017;74(7):675–84.

    Article  Google Scholar 

  33. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Oxford: 2000.

  35. Sharmin S, Kypri K, Khanam M, Wadolowski M, Bruno R, Mattick RP. Parental supply of alcohol in childhood and risky drinking in adolescence: systematic review and meta-analysis. Int J Environ Res Public Health. 2017;14(3):287.

    Article  PubMed Central  Google Scholar 

  36. Ontario HQ. Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review. Ont Health Technol Assess Ser. 2016;16(9):1–50.

    Google Scholar 

  37. Abad N, Baack B, O'Leary A, Lyles C. A review of HIV/STD behavioral prevention interventions for female sex workers in the United States. Sexual Transmit Dis. 2014;41:S114.

    Google Scholar 

  38. Adams-Guppy JR, Guppy A. A systematic review of interventions for homeless alcohol-abusing adults. Drugs. 2016;23(1):15–30.

    Google Scholar 

  39. Alividza V, Mariano V, Ahmad R, Charani E, Rawson TM, Holmes AH, et al. Investigating the impact of poverty on colonization and infection with drug-resistant organisms in humans: a systematic review. Infect Dis Poverty. 2018;7(1):76.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Altena AM, Brilleslijper-Kater SN, Wolf JL. Effective interventions for homeless youth: a systematic review. Am J Prev Med. 2010;38(6):637–45.

    Article  PubMed  Google Scholar 

  41. Altena AM, Brilleslijper-Kater SN, Wolf JLM. Effective Interventions for Homeless Youth. A Systematic Review. Am J Prevent Med. 2010;38(6):637–45.

    Article  Google Scholar 

  42. Andrade FMR, Figueiredo AS, Capelas ML, Charepe Z, Deodato S. Experiences of homeless families in parenthood: a systematic review and synthesis of qualitative evidence. Int J Environ Res Public Health. 2020;17(8):2712. https://doi.org/10.3390/ijerph17082712.

  43. Aubry T, Bloch G, Brcic V, Saad A, Magwood O, Abdalla T, et al. Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: a systematic review. Lancet Public Health. 2020;5(6):e342–60.

    Article  PubMed  Google Scholar 

  44. Auerswald C, Woan J, Lin J. The health status of street children in low-and middle-income countries: A systematic review. Turk Pediatri Arsivi. 2013;48:75.

    Google Scholar 

  45. Ayano G, Shumet S, Tesfaw G, et al. A systematic review and meta-analysis of the prevalence of bipolar disorder among homeless people. BMC Public Health. 2020;20:731. https://doi.org/10.1186/s12889-020-08819-x.

  46. Ayano G, Belete A, Duko B, Tsegay L, Dachew BA. Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people. BMJ Open. 2021;11(2):e040061.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ayano G, Shumet S, Tesfaw G, Tsegay L. A systematic review and meta-analysis of the prevalence of bipolar disorder among homeless people. BMC Public Health. 2020;20(1):731.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ayano G, Solomon M, Tsegay L, Yohannes K, Abraha M. A Systematic Review and Meta-Analysis of the Prevalence of Post-Traumatic Stress Disorder among Homeless People. Psychiatr Q. 2020;91(4):949–63.

    Article  PubMed  Google Scholar 

  49. Ayano G, Tesfaw G, Shumet S. The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis. BMC Psychiatry. 2019;19(1):370.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Ayano G, Tsegay L, Abraha M, Yohannes K. Suicidal Ideation and Attempt among Homeless People: a Systematic Review and Meta-Analysis. Psychiatr Q. 2019;90(4):829–42.

    Article  PubMed  Google Scholar 

  51. Bahji A, Bajaj N. Opioids on trial: a systematic review of interventions for the treatment and prevention of opioid overdose. Can J Addict. 2018;9(1):26–33.

    Article  Google Scholar 

  52. Banks S, McHugo GJ, Williams V, Drake RE, Shinn M. A prospective meta-analytic approach in a multisite study of homelessness prevention. New Direct Eval. 2002;2002(94):45–60.

    Article  Google Scholar 

  53. Barajas-Nava L. Oral substitution treatment of injecting opioid users for prevention of HIV infection. J Assoc Nurs AIDS Care. 2017;28(5):832–3.

    Article  Google Scholar 

  54. Batra K, Pharr J, Olawepo JO, Cruz P. Understanding the multidimensional trajectory of psychosocial maternal risk factors causing preterm birth: A systematic review. Asian J Psychiatr. 2020;54:102436.

    Article  PubMed  Google Scholar 

  55. Baxter AJ, Tweed EJ, Katikireddi SV, Thomson H. Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials. J Epidemiol Community Health. 2019;73(5):379–87.

    Article  PubMed  Google Scholar 

  56. Bazzi AR, Drainoni ML, Biancarelli DL, Hartman JJ, Mimiaga MJ, Mayer KH, et al. Systematic review of HIV treatment adherence research among people who inject drugs in the United States and Canada: evidence to inform pre-exposure prophylaxis (PrEP) adherence interventions. BMC Public Health. 2019;19(1):31.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Bazzi AR, Drainoni ML, Biancarelli DL, Hartman JJ, Mimiaga MJ, Mayer KH, et al. Systematic review of HIV treatment adherence research among people who inject drugs in the United States and Canada: Evidence to inform pre-exposure prophylaxis (PrEP) adherence interventions 11 Medical and Health Sciences 1117 Public Health and Health Services. BMC Public Health. 2019;19(1):1.

    Google Scholar 

  58. Behzadifar M, Gorji HA, Rezapour A, Bragazzi NL. Prevalence of hepatitis C virus among street children in Iran. Infect Dis Poverty. 2018;7(1):88.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Benston EA. Housing Programs for Homeless Individuals With Mental Illness: Effects on Housing and Mental Health Outcomes. Psychiatr Serv. 2015;66(8):806–16.

    Article  PubMed  Google Scholar 

  60. Bernstein RS, Meurer LN, Plumb EJ, Jackson JL. Diabetes and hypertension prevalence in homeless adults in the United States: a systematic review and meta-analysis. Am J Public Health. 2015;105(2):e46–60.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Blanquet M, Legrand A, Pélissier A, Mourgues C. Socio-economics status and metabolic syndrome: A meta-analysis. Diab Metab Syndr. 2019;13(3):1805–12.

    Article  CAS  Google Scholar 

  62. Bonner A, Luscombe C. Suicide and homelessness. J Public Mental Health. 2009;8(3):7–19.

    Article  Google Scholar 

  63. Borkhoff CM, Wieland ML, Myasoedova E, Ahmad Z, Welch V, Hawker GA, et al. Reaching those most in need: a scoping review of interventions to improve health care quality for disadvantaged populations with osteoarthritis. Arthritis Care Res (Hoboken). 2011;63(1):39–52.

    Article  Google Scholar 

  64. Brownfield NR, Thielking M, Bates G, Morrison F. Does poverty impact student academic outcomes and wellbeing in australian universities? A systematic review. J Soc Inclusion. 2020;11(2):4–19.

    Google Scholar 

  65. Bryant J, Bonevski B, Paul C, McElduff P, Attia J. A systematic review and meta-analysis of the effectiveness of behavioural smoking cessation interventions in selected disadvantaged groups. Addiction. 2011;106(9):1568–85.

    Article  PubMed  Google Scholar 

  66. Burra TA, Stergiopoulos V, Rourke SB. A systematic review of cognitive deficits in homeless adults: implications for service delivery. Can J Psychiatr. 2009;54(2):123–33.

    Article  Google Scholar 

  67. Byrne T, Montgomery AE, Dichter ME. Homelessness among female veterans: a systematic review of the literature. Women Health. 2013;53(6):572–96.

    Article  PubMed  Google Scholar 

  68. Campos-Matos I, Russo G, Perelman J. Connecting the dots on health inequalities - A systematic review on the social determinants of health in Portugal. Int J Equity Health. 2016;15(1):26.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Carver H, Ring N, Miler J, Parkes T. What constitutes effective problematic substance use treatment from the perspective of people who are homeless? A systematic review and meta-ethnography. Harm Reduct J. 2020;17(1):10.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Cassone A. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. Pathog Glob Health. 2012;106(7):377.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Chandler CE, Austin AE, Shanahan ME. Association of Housing Stress With Child Maltreatment: A Systematic Review. Trauma Violence Abuse. 2020;23:639–59.

    Article  PubMed  Google Scholar 

  72. Chant C, Smith O, Wang A, Burns K, Dos Santos CC, Friedrich JO, et al. Critical illness in homeless persons: A systematic review of the literature. Intens Care Med. 2013;39:S512.

    Google Scholar 

  73. Chant C, Smith O, Wang A, Hwang S, Friedrich JO, Burns KEA, et al. Homelessness and critical care: a systematic review of the literature. Intensive Care Med. 2014;40(1):123–5. https://doi.org/10.1007/s00134-013-3124-4.

  74. Chant C, Wang A, Burns KE, dos Santos CC, Hwang SW, Friedrich JO, et al. Critical illness in homeless persons is poorly studied: a systematic review of the literature. Intensive Care Med. 2014;40(1):123–5.

    Article  PubMed  Google Scholar 

  75. Charron CB, Hayes T, Pakhale S. A systematic review of interventions for smoking tobacco in low socio-economic populations. Am J Respir Crit Care Med. 2018;197. https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2018.197.1_MeetingAbstracts.A6253.

  76. Clark NC, Lintzeris N, Gijsbers A, Whelan G, Dunlop A, Ritter A, et al. LAAM maintenance vs methadone maintenance for heroin dependence. Cochrane Database Syst Rev. 2002;2:CD002210.

    Google Scholar 

  77. Coldwell CM, Bender WS. The effectiveness of assertive community treatment for homeless populations with severe mental illness: a meta-analysis. Am J Psychiatry. 2007;164(3):393–9.

    Article  PubMed  Google Scholar 

  78. Conn VS, Ruppar TM. Medication adherence outcomes of 771 intervention trials: Systematic review and meta-analysis. Prev Med. 2017;99:269–76.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Constance J, Lusher JM. Diabetes management interventions for homeless adults: a systematic review. Int J Public Health. 2020;65(9):1773–83.

    Article  PubMed  Google Scholar 

  80. Coren E, Hossain R, Pardo JP, Veras MM, Chakraborty K, Harris H, et al. Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people. Evid Based Child Health. 2013;8(4):1140–272.

    Article  PubMed  Google Scholar 

  81. Costa F, Hagan JE, Calcagno J, Kane M, Torgerson P, Martinez-Silveira MS, et al. Global Morbidity and Mortality of Leptospirosis: A Systematic Review. PLoS Negl Trop Dis. 2015;9(9):e0003898.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Coufopoulos A, McDowell G, Roe B, Maden M. Interventions to improve nutrition and nutrition related health amongst homeless mothers and their children: a systematic review. Proceed Nutr Soc. 2012;71(OCE2):E161. https://doi.org/10.1017/S0029665112002182.

  83. Cumber SN, Tsoka-Gwegweni JM. The Health Profile of Street Children in Africa: A Literature Review. J Public Health Afr. 2015;6(2):566.

    PubMed  PubMed Central  Google Scholar 

  84. Curtis J. Impact of x-ray screening programmes for active tuberculosis in homeless populations: a systematic review of original studies. J Public Health (Oxf). 2016;38(1):106–14.

    Article  Google Scholar 

  85. da Silva TFC, Lovisi GM, Verdolin LD, Cavalcanti MT. Adherence to drug treatment among schizophrenic spectrum patients: A systematic review of the literature. Jornal Brasileiro de Psiquiatria. 2012;61(4):242–51.

    Article  Google Scholar 

  86. Dalton-Locke C, Marston L, McPherson P, Killaspy H. The Effectiveness of Mental Health Rehabilitation Services: A Systematic Review and Narrative Synthesis. Front Psychiatry. 2020;11:607933.

    Article  PubMed  Google Scholar 

  87. de Vet R, van Luijtelaar MJ, Brilleslijper-Kater SN, Vanderplasschen W, Beijersbergen MD, Wolf JR. Effectiveness of case management for homeless persons: a systematic review. Am J Public Health. 2013;103(10):e13–26.

    Article  PubMed  PubMed Central  Google Scholar 

  88. De Vet R, Van Luijtelaar MJA, Brilleslijper-Kater SN, Vanderplasschen W, Beijersbergen MD, Wolf JRLM. Effectiveness of case management for homeless persons: A systematic review. Am J Public Health. 2013;103(10):e13–26.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, Vickerman P, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017;5(12):e1192–207.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Doran KM, Ragins KT, Gross CP, Zerger S. Medical respite programs for homeless patients: a systematic review. J Health Care Poor Underserved. 2013;24(2):499–524.

    Article  PubMed  Google Scholar 

  91. Dorney-Smith S, Thomson E, Hewett N, Burridge S, Khan Z. Homeless medical respite service provision in the UK. House Care Support. 2019;22(1):40–53.

    Article  Google Scholar 

  92. Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD, Swan T. Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology. 2015;62(5):1353–63.

    Article  CAS  PubMed  Google Scholar 

  93. El Baba R, Colucci E. Post-traumatic stress disorders, depression, and anxiety in unaccompanied refugee minors exposed to war-related trauma: a systematic review. Int J Cult Mental Health. 2018;11(2):194–207.

    Article  Google Scholar 

  94. Embleton L, Mwangi A, Vreeman R, Ayuku D, Braitstein P. The epidemiology of substance use among street children in resource-constrained settings: a systematic review and meta-analysis. Addiction. 2013;108(10):1722–33.

    Article  PubMed  Google Scholar 

  95. Ennis N, Roy S, Topolovec-Vranic J. Memory impairment among people who are homeless: a systematic review. Memory. 2015;23(5):695–713.

    Article  PubMed  Google Scholar 

  96. Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, Ciliska D, Kouyoumdjian F, Hwang SW. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review. BMC Public Health. 2011;11:638.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Flach Y, Razza TS. Suicidality in homeless children and adolescent: a systematic review. Aggress Violent Behav. 2022;64:101575.

  98. Folsom D, Jeste DV. Schizophrenia in homeless persons: a systematic review of the literature. Acta Psychiatr Scand. 2002;105(6):404–13.

    Article  CAS  PubMed  Google Scholar 

  99. Formosa EA, Kishimoto V, Orchanian-Cheff A, Hayman K. Emergency department interventions for homelessness: a systematic review. Cjem. 2021;23(1):111–22.

    Article  PubMed  Google Scholar 

  100. Formosa EA, Kishimoto V, Orchanian-Cheff A, Hayman KG. 302 Emergency Department Interventions for Homelessness: A Systematic Review. Ann Emerg Med. 2019;74(4):S119.

    Article  Google Scholar 

  101. Fry CE, Langley K, Shelton KH. A systematic review of cognitive functioning among young people who have experienced homelessness, foster care, or poverty. Child Neuropsychol. 2017;23(8):907–34.

    Article  PubMed  Google Scholar 

  102. Gentry S, Forouhi NG, Notley C. Are Electronic Cigarettes an Effective Aid to Smoking Cessation or Reduction Among Vulnerable Groups? A Systematic Review of Quantitative and Qualitative Evidence. Nicotine Tob Res. 2019;21(5):602–16.

    Article  PubMed  Google Scholar 

  103. Getty CA, Morande A, Lynskey M, Weaver T, Metrebian N. Mobile telephone-delivered contingency management interventions promoting behaviour change in individuals with substance use disorders: a meta-analysis. Addiction. 2019;114(11):1915–25.

    Article  PubMed  PubMed Central  Google Scholar 

  104. Gulati G, Keating N, O'Neill A, Delaunois I, Meagher D, Dunne CP. The prevalence of major mental illness, substance misuse and homelessness in Irish prisoners: systematic review and meta-analyses. Ir J Psychol Med. 2019;36(1):35–45.

    Article  CAS  PubMed  Google Scholar 

  105. Hamilton K, Tolfree R, Mytton J. A systematic review of active case-finding strategies for tuberculosis in homeless populations. Int J Tuberc Lung Dis. 2018;22(10):1135–44.

    Article  CAS  PubMed  Google Scholar 

  106. Hamilton K, Tolfree R, Mytton J. Impact and implementation of active case finding for tuberculosis in homeless populations: a systematic review. Lancet. 2019;394:S48.

    Article  Google Scholar 

  107. Hanlon P, Yeoman L, Gibson L, Esiovwa R, Williamson AE, Mair FS, et al. A systematic review of interventions by healthcare professionals to improve management of non-communicable diseases and communicable diseases requiring long-term care in adults who are homeless. BMJ Open. 2018;8(4):e020161.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Heerde JA, Hemphill SA. A systematic review of associations between perpetration of physically violent behaviors and property offenses, victimization and use of substances among homeless youth. Children Youth Serv Rev. 2014;44:265–77.

    Article  Google Scholar 

  109. Heerde JA, Hemphill SA. Is Substance Use Associated with Perpetration and Victimization of Physically Violent Behavior and Property Offences Among Homeless Youth? A Systematic Review of International Studies. Child Youth Care Forum. 2015;44(2):277–307.

    Article  Google Scholar 

  110. Heerde JA, Hemphill SA. The role of risk and protective factors in the modification of risk for sexual victimization, sexual risk behaviors, and survival sex among homeless youth: A meta-analysis. J Investig Psychol Offend Profil. 2017;14(2):150–74.

    Article  Google Scholar 

  111. Heerde JA, Hemphill SA. Associations between individual-level characteristics and exposure to physically violent behavior among young people experiencing homelessness: A meta-analysis. Aggress Violent Behav. 2019;47:46–57.

    Article  Google Scholar 

  112. Heerde JA, Scholes-Balog KE, Hemphill SA. Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: a systematic literature review. Arch Sex Behav. 2015;44(1):181–212.

    Article  PubMed  Google Scholar 

  113. Herrman H. Mental disorders among homeless people in western countries. PLoS Med. 2008;5(12):e237.

    Article  PubMed  PubMed Central  Google Scholar 

  114. Heuvelings CC, de Vries SG, Greve PF, Visser BJ, Bélard S, Janssen S, et al. Effectiveness of interventions for diagnosis and treatment of tuberculosis in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review. Lancet Infect Dis. 2017;17(5):e144–58.

    Article  PubMed  Google Scholar 

  115. Heuvelings CC, Greve PF, de Vries SG, Visser BJ, Bélard S, Janssen S, et al. Effectiveness of service models and organisational structures supporting tuberculosis identification and management in hard-to-reach populations in countries of low and medium tuberculosis incidence: a systematic review. BMJ Open. 2018;8(9):e019642.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Hino P, Yamamoto TT, Bastos SH, Beraldo AA, Figueiredo T, Bertolozzi MR. Tuberculosis in the street population: a systematic review. Rev Esc Enferm USP. 2021;55:e03688.

    Article  PubMed  Google Scholar 

  117. Hino P, Yamamoto TT, Bastos SH, Beraldo AA, Figueiredo TMRM, Bertolozzi MR. Tuberculosis in the street population: a systematic review. Revista da Escola de Enfermagem da U S P. 2021;55:e03688.

    Article  PubMed  Google Scholar 

  118. Hodgson KJ, Shelton KH, van den Bree MB, Los FJ. Psychopathology in young people experiencing homelessness: a systematic review. Am J Public Health. 2013;103(6):e24–37.

    Article  PubMed  PubMed Central  Google Scholar 

  119. Hodgson KJ, Shelton KH, Van Den Bree MBM, Los FJ. Psychopathology in young people experiencing homelessness: A systematic review. Am J Public Health. 2013;103(6):e24–37.

    Article  PubMed  PubMed Central  Google Scholar 

  120. Hoell A, Franz M, Salize HJ. Healthcare for homeless people with mental illness-A review of results of current interventions. Psychiatrie. 2017;14(2):75–85.

    Google Scholar 

  121. Hoffberg AS, Spitzer E, Mackelprang JL, Farro SA, Brenner LA. Suicidal Self-Directed Violence Among Homeless US Veterans: A Systematic Review. Suicide Life Threat Behav. 2018;48(4):481–98.

    Article  PubMed  Google Scholar 

  122. Hossain MM, Purohit N, Sultana A, Ma P, McKyer ELJ, Ahmed HU. Prevalence of mental disorders in South Asia: An umbrella review of systematic reviews and meta-analyses. Asian J Psychiatr. 2020;51:102041.

    Article  PubMed  Google Scholar 

  123. Hwang SW, Tolomiczenko G, Kouyoumdjian FG, Garner RE. Interventions to improve the health of the homeless: a systematic review. Am J Prev Med. 2005;29(4):311–9.

    Article  PubMed  Google Scholar 

  124. Ijaz S, Jackson J, Thorley H, Porter K, Fleming C, Richards A, et al. Nutritional deficiencies in homeless persons with problematic drinking: a systematic review. Int J Equity Health. 2017;16(1):71.

    Article  PubMed  PubMed Central  Google Scholar 

  125. Ijaz S, Thorley H, Porter K, Fleming C, Jones T, Kesten J, et al. Interventions for preventing or treating malnutrition in homeless problem-drinkers: a systematic review. Int J Equity Health. 2018;17(1):8.

    Article  PubMed  PubMed Central  Google Scholar 

  126. Karki P, Shrestha R, Huedo-Medina TB, Copenhaver M. The impact of methadone maintenance treatment on HIV risk behaviors among high-risk injection drug users: a systematic review. Evid Based Med Public Health. 2016;2:e1229.

    PubMed  PubMed Central  Google Scholar 

  127. Kenworthy J, Ayyub R, Rtveladze K, Wright D, Xia A, Fordham R. A systematic literature review of the societal costs and consequences of heroin addiction. Value Health. 2017;20(9):A497.

    Article  Google Scholar 

  128. Klop HT, de Veer AJE, van Dongen SI, Francke AL, Rietjens JAC, Onwuteaka-Philipsen BD. Palliative care for homeless people: a systematic review of the concerns, care needs and preferences, and the barriers and facilitators for providing palliative care. BMC Palliat Care. 2018;17(1):67.

    Article  PubMed  PubMed Central  Google Scholar 

  129. Krahn J, Caine V, Chaw-Kant J, Singh AE. Housing interventions for homeless, pregnant/parenting women with addictions: a systematic review. J Soc Distress Homeless. 2018;27(1):75–88.

    Article  Google Scholar 

  130. Kyle T, Dunn JR. Effects of housing circumstances on health, quality of life and healthcare use for people with severe mental illness: a review. Health Soc Care Community. 2008;16(1):1–15.

    Article  PubMed  Google Scholar 

  131. Leaver CA, Bargh G, Dunn JR, Hwang SW. The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS Behav. 2007;11(6 Suppl):85–100.

    Article  PubMed  Google Scholar 

  132. Leibler JH, Zakhour CM, Gadhoke P, Gaeta JM. Zoonotic and Vector-Borne Infections Among Urban Homeless and Marginalized People in the United States and Europe, 1990-2014. Vector Borne Zoonotic Dis. 2016;16(7):435–44.

    Article  PubMed  Google Scholar 

  133. Lowrie R, Stock K, Lucey S, Knapp M, Williamson A, Montgomery M, et al. Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness: a non- randomised feasibility study. Int J Equity Health. 2021;20(1):19.

    Article  PubMed  PubMed Central  Google Scholar 

  134. Luong CT, Rew L, Banner M. Suicidality in Young Men Who Have Sex with Men: A Systematic Review of the Literature. Issues Ment Health Nurs. 2018;39(1):37–45.

    Article  PubMed  Google Scholar 

  135. Ly A, Latimer E. Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature. Can J Psychiatry. 2015;60(11):475–87.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Ly TDA, Castaneda S, Hoang VT, Dao TL, Gautret P. Vaccine-preventable diseases other than tuberculosis, and homelessness: A scoping review of the published literature, 1980 to 2020. Vaccine. 2021;39(8):1205–24.

    Article  PubMed  Google Scholar 

  137. Maglione MA, Raaen L, Chen C, Azhar G, Shahidinia N, Shen M, et al. Effects of medication assisted treatment (MAT) for opioid use disorder on functional outcomes: a systematic review. J Subst Abuse Treatment. 2018;89:28–51.

    Article  Google Scholar 

  138. Magwood O, Salvalaggio G, Beder M, Kendall C, Kpade V, Daghmach W, et al. The effectiveness of substance use interventions for homeless and vulnerably housed persons: A systematic review of systematic reviews on supervised consumption facilities, managed alcohol programs, and pharmacological agents for opioid use disorder. PLoS One. 2020;15(1):e0227298.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  139. Martinez O, Wu E, Sandfort T, Dodge B, Carballo-Dieguez A, Pinto R, et al. Evaluating the Impact of Immigration Policies on Health Status Among Undocumented Immigrants: A Systematic Review. J Immigrant Minor Health. 2015;17(3):947–70.

    Article  Google Scholar 

  140. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009;3:CD002209.

    Google Scholar 

  141. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2:CD002207.

    Google Scholar 

  142. McInnes DK, Li AE, Hogan TP. Opportunities for engaging low-income, vulnerable populations in health care: a systematic review of homeless persons' access to and use of information technologies. Am J Public Health. 2013;103(Suppl 2):e11–24.

    Article  PubMed  PubMed Central  Google Scholar 

  143. McPherson P, Krotofil J, Killaspy H. Mental health supported accommodation services: a systematic review of mental health and psychosocial outcomes. BMC Psychiatry. 2018;18(1):128.

    Article  PubMed  PubMed Central  Google Scholar 

  144. Mendes KT, Ronzani TM, de Paiva FS. Homeless population, vulnerabilities and drugs: a systematic review. Psicol Soc. 2019;31:e169056. https://doi.org/10.1590/1807-0310/2019v31169056.

  145. Moe J, Kirkland SW, Rawe E, Ospina MB, Vandermeer B, Campbell S, et al. Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review. Acad Emerg Med. 2017;24(1):40–52.

    Article  PubMed  Google Scholar 

  146. Momsen AM, Rasmussen JO, Nielsen CV, Iversen MD, Lund H. Multidisciplinary team care in rehabilitation: An overview of reviews. J Rehabil Med. 2012;44(11):901–12.

    Article  PubMed  Google Scholar 

  147. Moniruzzaman A, Kazanjian A, Wong H, Chowdhury MM, Elwood RK, Fitzgerald JM. A systematic review on risk factors of mortality among Tb patients. Am J Respir Crit Care Med. 2010;181. https://doi.org/10.1164/ajrccm-conference.2010.181.1_MeetingAbstracts.A5460.

  148. Morton MH, Kugley S, Epstein R, Farrell A. Interventions for youth homelessness: A systematic review of effectiveness studies. Child Youth Serv Rev. 2020;116:105096.

    Article  Google Scholar 

  149. Murray RL, Bauld L, Hackshaw LE, McNeill A. Improving access to smoking cessation services for disadvantaged groups: a systematic review. J Public Health (Oxf). 2009;31(2):258–77.

    Article  Google Scholar 

  150. Muzzey FK, Fortenberry JD, Maas MK, Holtrop K, McCauley H. 169. Sexual and Gender Minority Homeless Youth and Their Sexual Relationships: A Systematic Review of Recent Literature. J Adolesc Health. 2020;66(2):S86.

    Article  Google Scholar 

  151. Nevard I, Green C, Bell V, Gellatly J, Brooks H, Bee P. Conceptualising the social networks of vulnerable children and young people: a systematic review and narrative synthesis. Soc Psychiatry Psychiatr Epidemiol. 2021;56(2):169–82.

    Article  PubMed  Google Scholar 

  152. Nilsson S, Nordentoft M, Hjorthoj C. Psychiatric predictors for becoming homeless and exiting homelessness: A systematic review and meta-analysis. Schizophrenia Bull. 2020;46:S278.

    Article  Google Scholar 

  153. Noh D. Psychological Interventions for Runaway and Homeless Youth. J Nurs Scholar. 2018;50(5):465–72.

    Article  Google Scholar 

  154. Omerov P, Craftman Å, Mattsson E, Klarare A. Homeless persons' experiences of health- and social care: A systematic integrative review. Health Soc Care Community. 2020;28(1):1–11.

    Article  PubMed  Google Scholar 

  155. Paisi M, March-McDonald J, Burns L, Snelgrove-Clarke E, Withers L, Shawe J. Perceived barriers and facilitators to accessing and utilising sexual and reproductive healthcare for people who experience homelessness: a systematic review. BMJ Sex Reprod Health. 2020;47:211–20.

    Article  PubMed  Google Scholar 

  156. Paisi MD, March-Mcdonald J, Burns L, Snelgrove-Clarke E, Withers L, Shawe J. Perceived barriers and facilitators to accessing and utilising sexual and reproductive healthcare for people who experience homelessness: A systematic review. BMJ Sex Reprod Health. 2020;47:211–20.

    Article  PubMed  Google Scholar 

  157. Paquette K, Cheng MP, Kadatz MJ, Cook VJ, Chen W, Johnston JC. Chest radiography for active tuberculosis case finding in the homeless: a systematic review and meta-analysis. Int J Tuberc Lung Dis. 2014;18(10):1231–6.

    Article  CAS  PubMed  Google Scholar 

  158. Parks RW, Stevens RJ, Spence SA. A systematic review of cognition in homeless children and adolescents. J R Soc Med. 2007;100(1):46–50.

    Article  PubMed  PubMed Central  Google Scholar 

  159. Parriott A, Malekinejad M, Miller AP, Marks SM, Horvath H, Kahn JG. Care Cascade for targeted tuberculosis testing and linkage to Care in Homeless Populations in the United States: a meta-analysis. BMC Public Health. 2018;18(1):485.

    Article  PubMed  PubMed Central  Google Scholar 

  160. Peng Y, Hahn RA, Finnie RKC, Cobb J, Williams SP, Fielding JE, et al. Permanent Supportive Housing With Housing First to Reduce Homelessness and Promote Health Among Homeless Populations With Disability: A Community Guide Systematic Review. J Public Health Manag Pract. 2020;26(5):404–11.

    Article  PubMed  PubMed Central  Google Scholar 

  161. Polcin DL. Co-occurring substance abuse and mental health problems among homeless persons: Suggestions for research and practice. J Soc Distress Homeless. 2016;26(1):1–10.

    Article  Google Scholar 

  162. Polillo A, Gran-Ruaz S, Sylvestre J, Kerman N. The use of eHealth interventions among persons experiencing homelessness: A systematic review. Digit Health. 2021;7:2055207620987066.

    PubMed  PubMed Central  Google Scholar 

  163. Ponka D, Agbata E, Kendall C, Stergiopoulos V, Mendonca O, Magwood O, et al. The effectiveness of case management interventions for the homeless, vulnerably housed and persons with lived experience: A systematic review. PLoS One. 2020;15(4):e0230896.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  164. Rajendran M, Zaki RA, Aghamohammadi N. Contributing risk factors towards the prevalence of multidrug-resistant tuberculosis in Malaysia: A systematic review. Tuberculosis (Edinb). 2020;122:101925.

    Article  Google Scholar 

  165. Rezaei O, Ghiasvand H, Higgs P, Noroozi A, Noroozi M, Rezaei F, et al. Factors associated with injecting-related risk behaviors among people who inject drugs: a systematic review and meta-analysis study. J Addict Dis. 2020;38(4):420–37.

    Article  PubMed  Google Scholar 

  166. Richter D, Hoffmann H. Independent housing and support for people with severe mental illness: systematic review. Acta Psychiatr Scand. 2017;136(3):269–79.

    Article  CAS  PubMed  Google Scholar 

  167. Riquelme-Miralles D, Palazón-Bru A, Sepehri A, Gil-Guillén VF. A systematic review of non-pharmacological interventions to improve therapeutic adherence in tuberculosis. Heart Lung. 2019;48(5):452–61.

    Article  PubMed  Google Scholar 

  168. Roy L. Criminal behavior and victimization among homeless individuals with severe mental illness: A systematic review (Psychiatric Services (2014)). Psychiatr Serv. 2014;65(7):896.

    Google Scholar 

  169. Roy L, Crocker AG, Nicholls TL, Latimer EA, Ayllon AR. Criminal behavior and victimization among homeless individuals with severe mental illness: a systematic review. Psychiatr Serv. 2014;65(6):739–50.

    Article  PubMed  Google Scholar 

  170. Sandgren A, Vonk Noordegraaf-Schouten M, van Kessel F, Stuurman A, Oordt-Speets A, van der Werf MJ. Initiation and completion rates for latent tuberculosis infection treatment: a systematic review. BMC Infect Dis. 2016;16:204.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  171. Saulle R, Vecchi S, Gowing L. Supervised dosing with a long-acting opioid medication in the management of opioid dependence. Cochrane Database Syst Rev. 2017;4:CD011983.

    PubMed  Google Scholar 

  172. Sayal AP, Slomovic J, Bhambra NS, Popovic MM, Lichter M. Visual impairment and the prevalence of ocular pathology in homeless children and adults globally: a systematic review. Can J Ophthalmol. 2020;56:158–65.

    Article  PubMed  Google Scholar 

  173. Scappaticci ALSS, Blay SL. Homeless adolescent mothers: A systematic review of the literature. Revista de Psiquiatria do Rio Grande do Sul. 2010;32(1):3–15.

    Google Scholar 

  174. Schneider JA, Skaathun B, Michaels S, Young L, Green K, Morgan E, et al. Drivers of HIV treatment success among a population-based sample of younger black MSM. Top Antiviral Med. 2015;23:494–5.

    Google Scholar 

  175. Schreiter S, Bermpohl F, Krausz M, Leucht S, Rössler W, Schouler-Ocak M, et al. The Prevalence of Mental Illness in Homeless People in Germany. Dtsch Arztebl Int. 2017;114(40):665–72.

    PubMed  PubMed Central  Google Scholar 

  176. Schreiter S, Bermpohl F, Krausz M, Leucht S, Rössler W, Schouler-Ocak M, et al. The prevalence of mental illness in homeless people in Germany - A systematic review and meta-analysis. Deutsches Arzteblatt Int. 2017;114(40):665–72.

    Google Scholar 

  177. Schumacher JE, Milby JB, Wallace D, Meehan DC, Kertesz S, Vuchinich R, et al. Meta-analysis of day treatment and contingency-management dismantling research: Birmingham Homeless Cocaine Studies (1990-2006). J Consult Clin Psychol. 2007;75(5):823–8.

    Article  PubMed  Google Scholar 

  178. Shortt SE, Hwang S, Stuart H, Bedore M, Zurba N, Darling M. Delivering primary care to homeless persons: a policy analysis approach to evaluating the options. Healthc Policy. 2008;4(1):108–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  179. Silva EN, da Silva Pereira ACE, de Araújo WN, Elias FTS. A systematic review of economic evaluations of interventions to tackle tuberculosis in homeless people. Revista Panamericana de Salud Publica/Pan Am J Public Health. 2018;42:e40.

    Google Scholar 

  180. Silva EN, Pereira A, de Araújo WN, Elias FTS. A systematic review of economic evaluations of interventions to tackle tuberculosis in homeless people. Rev Panam Salud Publica. 2018;42:e40.

    PubMed  PubMed Central  Google Scholar 

  181. Simmonds M, Simmonds K, Weleff J. Prevalence and problems of pain in the homeless: A systematic review. J Pain. 2016;17(4):S12–3.

    Article  Google Scholar 

  182. Simoens S, Matheson C, Bond C, Inkster K, Ludbrook A. The effectiveness of community maintenance with methadone or buprenorphine for treating opiate dependence. Br J Gen Pract. 2005;55(511):139–46.

    PubMed  PubMed Central  Google Scholar 

  183. Soar K, Dawkins L, Robson D, Cox S. Smoking amongst adults experiencing homelessness: A systematic review of prevalence rates, interventions and the barriers and facilitators to quitting and staying quit. J Smok Cessation. 2020;15:94–108.

    Article  Google Scholar 

  184. Speirs V, Johnson M, Jirojwong S. A systematic review of interventions for homeless women. J Clin Nurs. 2013;22(7-8):1080–93.

    Article  PubMed  Google Scholar 

  185. Spence S, Stevens R, Parks R. Cognitive dysfunction in homeless adults: a systematic review. J R Soc Med. 2004;97(8):375–9.

    Article  PubMed  PubMed Central  Google Scholar 

  186. Strang J, Groshkova T, Uchtenhagen A, Van Den Brink W, Haasen C, Schechter MT, et al. Heroin on trial: systematic review and meta-analysis of randomised trials of diamorphine-prescribing as treatment for refractory heroin addiction. Br J Psychiatr. 2015;207(1):5–14.

    Article  Google Scholar 

  187. Stubbs JL, Thornton AE, Sevick JM, Silverberg ND, Barr AM, Honer WG, et al. Traumatic brain injury in homeless and marginally housed individuals: a systematic review and meta-analysis. Lancet Public Health. 2020;5(1):e19–32.

    Article  PubMed  Google Scholar 

  188. Sudarsanam TD, Tharyan P. Rifampicin compared to isoniazid for preventing active TB in HIV-negative people at risk of developing active TB: Implications for public health. Clin Epidemiol Global Health. 2014;2(1):28–36.

    Article  Google Scholar 

  189. Sumalinog R, Harrington K, Dosani N, Hwang SW. Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review. Palliat Med. 2017;31(2):109–19.

    Article  PubMed  Google Scholar 

  190. Sundin EC. Homelessness and experiences of psychological trauma in the western world: A research review and a qualitative study. Eur Psychiatry. 2011;26:1811.

    Article  Google Scholar 

  191. Tankimovich M. Barriers to and interventions for improved tuberculosis detection and treatment among homeless and immigrant populations: a literature review. J Community Health Nurs. 2013;30(2):83–95.

    Article  PubMed  Google Scholar 

  192. Thomas CP, Fullerton CA, Kim M, Montejano L, Lyman DR, Dougherty RH, et al. Medication-assisted treatment with buprenorphine: assessing the evidence. Psychiatric Serv. 2014;65(2):158–70.

    Article  Google Scholar 

  193. Thomas Y, Gray M, McGinty S. A systematic review of occupational therapy interventions with homeless people. Occup Ther Health Care. 2011;25(1):38–53.

    Article  PubMed  Google Scholar 

  194. Thorley H, Porter K, Fleming C, Jones T, Kesten J, Marques E, et al. Interventions for preventing or treating malnutrition in problem drinkers who are homeless or vulnerably housed: protocol for a systematic review. Syst Rev. 2015;4:131.

    Article  PubMed  PubMed Central  Google Scholar 

  195. To MJ, Brothers TD, Van Zoost C. Foot Conditions among Homeless Persons: A Systematic Review. PLoS One. 2016;11(12):e0167463.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  196. Topolovec-Vranic J, Ennis N, Colantonio A, Cusimano MD, Hwang SW, Kontos P, et al. Traumatic brain injury among people who are homeless: a systematic review. BMC Public Health. 2012;12:1059.

    Article  PubMed  PubMed Central  Google Scholar 

  197. Tsai J, Rosenheck RA. Risk factors for homelessness among US veterans. Epidemiol Rev. 2015;37:177–95.

    Article  PubMed  Google Scholar 

  198. Twyman L, Bonevski B, Paul C, Bryant J. Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature. BMJ Open. 2014;4(12):e006414.

    Article  PubMed  PubMed Central  Google Scholar 

  199. Vijayaraghavan M, Elser H, Frazer K, Lindson N, Apollonio D. Interventions to reduce tobacco use in people experiencing homelessness. Cochrane Database Syst Rev. 2020;12:CD013413.

    PubMed  Google Scholar 

  200. Wang JZ, Mott S, Magwood O, Mathew C, McLellan A, Kpade V, et al. The impact of interventions for youth experiencing homelessness on housing, mental health, substance use, and family cohesion: a systematic review. BMC Public Health. 2019;19(1):1528.

    Article  PubMed  PubMed Central  Google Scholar 

  201. Weber JJ. A systematic review of nurse-led interventions with populations experiencing homelessness. Public Health Nurs. 2019;36(1):96–106.

    Article  PubMed  Google Scholar 

  202. White BM, Newman SD. Access to primary care services among the homeless: a synthesis of the literature using the equity of access to medical care framework. J Prim Care Community Health. 2015;6(2):77–87.

    Article  PubMed  Google Scholar 

  203. Whitney B, Kruszka B, Lorvick J, Lucas GM, Wechsberg W, Kuo I, et al. Association between housing stability and new HIV diagnosis in seek and test studies. Topics Antiviral Med. 2017;25(1):362s–3s.

    Google Scholar 

  204. Wilson MG, Aidala A, Gogolishvili D, Shubert V, Rueda S, Bozack A, et al. Housing status and the health of people living with HIV/AIDS: A systematic review. Can J Infect Dis Med Microbiol. 2012;23:40A–1A.

    Google Scholar 

  205. Woan J, Lin J, Auerswald C. The health status of street children and youth in low- and middle-income countries: a systematic review of the literature. J Adolesc Health. 2013;53(3):314–321.e312.

    Article  PubMed  Google Scholar 

  206. Wright N, Walker J. Homelessness and drug use - A narrative systematic review of interventions to promote sexual health. AIDS Care Psycholog Socio Med Aspects AIDS/HIV. 2006;18(5):467–78.

    Article  Google Scholar 

  207. Wright NM, Walker J. Homelessness and drug use - a narrative systematic review of interventions to promote sexual health. AIDS Care. 2006;18(5):467–78.

    Article  PubMed  Google Scholar 

  208. Xiang J, Kaminga AC, Wu XY, Lai Z, Yang J, Lian Y, et al. Lifetime prevalence of suicidal attempt among homeless individuals in North America: a meta-analysis. J Affect Disord. 2021;287:341–9.

    Article  PubMed  Google Scholar 

  209. Yadee J, Bangpan M, Thavorn K, Welch V, Tugwell P, Chaiyakunapruk N. Assessing evidence of interventions addressing inequity among migrant populations: A two-stage systematic review. Int J Equity Health. 2019;18(1):64.

    Article  PubMed  PubMed Central  Google Scholar 

  210. Zlotnick C, Tam T, Zerger S. Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review. Health Soc Care Community. 2012;20(5):449–76.

    Article  PubMed  Google Scholar 

  211. Tweed EJ, Thomson RM, Lewer D, Sumpter C, Kirolos A, Southworth PM, et al. Health of people experiencing co-occurring homelessness, imprisonment, substance use, sex work and/or severe mental illness in high-income countries: a systematic review and meta-analysis. J Epidemiol Community Health. 2021;75:1010–8.

    Article  PubMed  Google Scholar 

  212. Arum C, Fraser H, Artenie AA, Bivegete S, Trickey A, Alary M, et al. Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Public Health. 2021;6:e309–23.

    Article  PubMed  PubMed Central  Google Scholar 

  213. Suh K, Beck J, Katzman W, Allen DD. Homelessness and rates of physical dysfunctions characteristic of premature geriatric syndromes: systematic review and meta-analysis. Physiother Theory Pract. 2020;38:1–10.

    Google Scholar 

  214. Al-Shakarchi NJ, Evans H, Luchenski SA, Story A, Banerjee A. Cardiovascular disease in homeless versus housed individuals: a systematic review of observational and interventional studies. Heart. 2020;106(19):1483–8.

    Article  PubMed  Google Scholar 

  215. van Draanen J, Tsang C, Mitra S, Karamouzian M, Richardson L. Socioeconomic marginalization and opioid-related overdose: A systematic review. Drug Alcohol Depend. 2020;214:108127.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  216. Lin D, Zhang CY, He ZK, Zhao XD. How does hard-to-reach status affect antiretroviral therapy adherence in the HIV-infected population? Results from a meta-analysis of observational studies. BMC Public Health. 2019;19(1):789.

    Article  PubMed  PubMed Central  Google Scholar 

  217. Aldridge RW, Story A, Hwang SW, Nordentoft M, Luchenski SA, Hartwell G, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet. 2018;391(10117):241–50.

    Article  PubMed  PubMed Central  Google Scholar 

  218. Bassuk EL, Richard MK, Tsertsvadze A. The prevalence of mental illness in homeless children: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2015;54(2):86–96.e82.

    Article  PubMed  Google Scholar 

  219. Aidala AA, Wilson MG, Shubert V, Gogolishvili D, Globerman J, Rueda S, et al. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review. Am J Public Health. 2016;106(1):e1–e23.

    Article  PubMed  PubMed Central  Google Scholar 

  220. Hyun M, Bae SH, Noh D. Systematic review and meta-analyses of randomized control trials of the effectiveness of psychosocial interventions for homeless adults. J Adv Nurs. 2020;76(3):773–86.

    Article  PubMed  Google Scholar 

  221. Dragioti E, Solmi M, Favaro A, Fusar-Poli P, Dazzan P, Thompson T, et al. Association of antidepressant use with adverse health outcomes: a systematic umbrella review. JAMA Psychiatry. 2019;76(12):1241–55.

    Article  PubMed  PubMed Central  Google Scholar 

  222. Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014;384(9953):1529–40.

    Article  PubMed  PubMed Central  Google Scholar 

  223. Smartt C, Prince M, Frissa S, Eaton J, Fekadu A, Hanlon C. Homelessness and severe mental illness in low-and middle-income countries: scoping review. BJPsych Open. 2019;5(4):e57.

    Article  PubMed  PubMed Central  Google Scholar 

  224. Clemenzi-Allen A, Neuhaus J, Geng E, Sachdev D, Buchbinder S, Havlir D, et al. Housing instability results in increased acute care utilization in an urban HIV clinic cohort. In: Open forum infectious diseases: Oxford University Press US; 2019. p. ofz148.

  225. Brown RT, Kiely DK, Bharel M, Mitchell SL. Factors associated with geriatric syndromes in older homeless adults. J Health Care Poor Underserved. 2013;24:456–68.

    Article  PubMed  Google Scholar 

  226. Culhane D, Treglia D, Steif K, Kuhn R, Byrne T. Estimated emergency and observational/quarantine capacity need for the US homeless population related to COVID-19 exposure by county; projected hospitalizations, intensive care units and mortality. 2020. https://endhomelessness.org/wp-content/uploads/2020/03/COVID-paper_clean-636pm.pdf.

  227. Buchanan D, Kee R, Sadowski LS, Garcia D. The health impact of supportive housing for HIV-positive homeless patients: a randomized controlled trial. Am J Public Health. 2009;99(S3):S675–80.

    Article  PubMed  PubMed Central  Google Scholar 

  228. Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. Jama. 2009;301(17):1771–8.

    Article  CAS  PubMed  Google Scholar 

  229. Onapa H, Sharpley CF, Bitsika V, McMillan ME, MacLure K, Smith L, et al. The physical and mental health effects of housing homeless people: A systematic review. Health Soc Care Community. 2021;30:448–68.

    Article  PubMed  Google Scholar 

  230. van Agteren J, Iasiello M, Lo L, Bartholomaeus J, Kopsaftis Z, Carey M, et al. A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Human Behav. 2021;5(5):631–52.

    Article  Google Scholar 

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Acknowledgments

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Funding

Open access funding provided by Linköping University. This study received no funding.

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Authors and Affiliations

  1. Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy

    Michele Fornaro, Michele De Prisco, Martina Billeci, Anna Maria Mondin & Andrea de Bartolomeis

  2. Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden

    Elena Dragioti

  3. Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy

    Raffaella Calati

  4. Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029, Nimes, France

    Raffaella Calati

  5. Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK

    Lee Smith

  6. Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada

    Simon Hatcher, Mark Kaluzienski, Jess G. Fiedorowicz & Marco Solmi

  7. Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada

    Simon Hatcher, Mark Kaluzienski, Jess G. Fiedorowicz & Marco Solmi

  8. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Simon Hatcher, Jess G. Fiedorowicz & Marco Solmi

  9. Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK

    Marco Solmi

  10. Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK

    Marco Solmi

  11. UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy

    Andrea de Bartolomeis

  12. IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia

    André F. Carvalho

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  1. Michele Fornaro
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Contributions

MF and AFC conceived the study together with MS. MS and AFC provided input over the study process. MDP, MB, and AM extracted the data, assisting in manuscript drafting under MF guidance. ED performed the analyses. AdB, LS, RC, SH, JGF, ED, and MK provided expert input over the review process and final drafting. The authors read and approved the final manuscript.

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Correspondence to Elena Dragioti.

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Supplementary Information

Additional file 1: Material 1.

adopted search strings. Table S1. criteria for the evaluation of the credibility of the evidence of observational studies. Please note that criterion n.1 (sample size of cases) was purposely waived as outlined in the main-text, methods section. Table S2. List of the 179 excluded records, with the reason(s). Note: duplicate records may appear multiple times for consistency issues. Table S3. Included SRs or MAs of observational studies; quality rating according to the AMSTAR-2. Table S4. Sensitivity analysis of evidence from SRs or MAs of observational studies for the association between homelessness and any health outcome.

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Fornaro, M., Dragioti, E., De Prisco, M. et al. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 20, 224 (2022). https://doi.org/10.1186/s12916-022-02423-z

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Keywords

  • Homeless
  • Health outcomes
  • Severe mental illness
  • Umbrella review

BMC Medicine

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