Epidemiologic features of depression and anxiety among homeless adults with healthcare access problems in London, UK: descriptive cross-sectional analysis

TL;DR

This study finds high rates of depression and anxiety among homeless adults in London who struggle to access healthcare.

Contribution

The study provides empirical evidence on mental health symptoms and barriers to healthcare among homeless adults in the UK.

Findings

38% of homeless adults had PHQ-4 scores indicating clinical concern for depression or anxiety.

High PHQ-4 scores were associated with factors like young age, food insecurity, and recent abuse.

Transportation issues were the most common barrier to healthcare access.

Abstract

In England, 354 000 people were homeless on a given night in 2024. It has long been recognised that the physical and mental health of people who are homeless is poorer than for those who are stably housed. There are few peer-reviewed studies to inform health- and social care around depression or anxiety for people who are homeless in this setting.

To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe the distribution of symptoms across sociodemographic, health-related characteristics and indicators of social vulnerability.

We surveyed 311 adults between August and December 2021. We measured anxiety and depression symptoms using the four-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of sociodemographic, social vulnerability and health-related characteristics, and tested for associations with the Kruskal–Wallis test.

The median PHQ-4 score was 7 out of 12, with 38% having scores warranting clinical attention. While PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and marijuana use. The most common barrier to accessing healthcare related to transportation (60%).

People who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support further coordination between health- and social care sectors.

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