# Prevalence and Correlates of Probable Depression and Anxiety Among Homeless Individuals During the COVID-19 Pandemic in Germany

## TL;DR

This study found high rates of depression and anxiety among homeless people in Germany during the pandemic, with factors like substance use and fear of infection playing a role.

## Contribution

The study provides new epidemiological data on mental health in homeless populations during the pandemic and identifies key predictors for depression and anxiety.

## Key findings

- 26.8% of homeless individuals had probable depression and 27.2% had probable anxiety.
- Female gender, substance use, and fear of contracting COVID-19 were significant predictors of mental health issues.
- Longer duration of homelessness was linked to higher odds of depression.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Homeless individuals constitute a vulnerable population with elevated risk for depression and anxiety, particularly during public health crises such as the COVID-19 pandemic.This multicentre study provides epidemiological evidence on mental health outcomes among homeless populations in Germany.

Homeless individuals constitute a vulnerable population with elevated risk for depression and anxiety, particularly during public health crises such as the COVID-19 pandemic.

This multicentre study provides epidemiological evidence on mental health outcomes among homeless populations in Germany.

Public health significance—Why is this work of significance to public health?
A considerable proportion of homeless individuals screened positive for probable depression and anxiety using validated instruments.Sociodemographic, behavioural, and pandemic-related factors were identified as relevant correlates of adverse mental health outcomes.

A considerable proportion of homeless individuals screened positive for probable depression and anxiety using validated instruments.

Sociodemographic, behavioural, and pandemic-related factors were identified as relevant correlates of adverse mental health outcomes.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Results underscore the importance of routine mental health screening within low-threshold and outreach-based services for homeless populations.Integrated public health strategies linking housing provision, mental health care, and substance use services are essential to reduce health inequalities.

Results underscore the importance of routine mental health screening within low-threshold and outreach-based services for homeless populations.

Integrated public health strategies linking housing provision, mental health care, and substance use services are essential to reduce health inequalities.

Objective: Homeless individuals are vulnerable, and a high burden of mental health problems is suspected. We aim to identify the prevalence and key predictors of probable depression and anxiety among homeless individuals in Germany during the Coronavirus disease-2019 (COVID-19) pandemic. Study Design: Nationwide multicentre cross-sectional study including clinical, laboratory, and questionnaire-based data on the health of homeless individuals in Germany. Methods: Data were used from the National Survey on the psychiatric and somatic health of homeless individuals during the COVID-19 pandemic. Probable depression and anxiety were determined using the Patient Health Questionnaire 9 and the General Anxiety Disorder 2 questionnaire. Logistic regression analysis was used to identify key predictors of probable depression and anxiety. Results: A high prevalence of probable depression (26.8% [95% CI: 23.2–30.3]) and anxiety (27.2% [95% CI: 23.7–30.7]) was found. Logistic regressions showed both probable depression and anxiety associated with being female (depression: OR 1.80 [95% CI: 1.06–3.03]; anxiety: OR: 1.69 [95% CI: 1.03–2.76]), daily use of any illegal substances (depression: OR 3.20 [95% CI: 1.87–5.49]; anxiety: OR 2.04 [95% CI: 1.21–3.45]), and fear of contracting COVID-19 (little fear, depression: OR: 1.81 [95% CI 1.01–3.23], some fear, anxiety: OR: 2.52 [95% CI: 1.31–4.83]). Probable depression was associated with longer durations of homelessness (OR: 1.004, [95% CI: 1.001–1.007]. Conclusions: Probable depression and anxiety are highly prevalent in homeless individuals throughout. Key predictors may help to identify individuals in need and design targeted interventions.