Effects of Housing First approaches on health and wellbeing of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials

Baxter, A. J. , Tweed, E. J. , Katikireddi, S. V. and Thomson, H. (2019) Effects of Housing First approaches on health and wellbeing of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials. Journal of Epidemiology and Community Health, 73, pp. 379-387. (doi:10.1136/jech-2018-210981) (PMID:30777888) (PMCID:PMC6581117)

[img]
Preview
Text
177791.pdf - Published Version
Available under License Creative Commons Attribution.

1MB

Abstract

Background: Homelessness is associated with poor health. A policy approach aiming to end homelessness across Europe and North America, the ‘Housing First’ (HF) model, provides rapid housing, not conditional on abstinence from substance use. We aimed to systematically review the evidence from randomised controlled trials for the effects of HF on health and well-being. Methods: We searched seven databases for randomised controlled trials of interventions providing rapid access to non-abstinence-contingent, permanent housing. We extracted data on the following outcomes: mental health; self-reported health and quality of life; substance use; non-routine use of healthcare services; housing stability. We assessed risk of bias and calculated standardised effect sizes. Results: We included four studies, all with ‘high’ risk of bias. The impact of HF on most short-term health outcomes was imprecisely estimated, with varying effect directions. No clear difference in substance use was seen. Intervention groups experienced fewer emergency department visits (incidence rate ratio (IRR)=0.63; 95% CI 0.48 to 0.82), fewer hospitalisations (IRR=0.76; 95% CI 0.70 to 0.83) and less time spent hospitalised (standardised mean difference (SMD)=−0.14; 95% CI −0.41 to 0.14) than control groups. In all studies intervention participants spent more days housed (SMD=1.24; 95% CI 0.86 to 1.62) and were more likely to be housed at 18–24 months (risk ratio=2.46; 95% CI 1.58 to 3.84). Conclusion: HF approaches successfully improve housing stability and may improve some aspects of health. Implementation of HF would likely reduce homelessness and non-routine health service use without an increase in problematic substance use. Impacts on long-term health outcomes require further investigation. Trial registration number: CRD42017064457.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Katikireddi, Dr Vittal and Tweed, Dr Emily and Baxter, Andrew and Thomson, Dr Hilary
Authors: Baxter, A. J., Tweed, E. J., Katikireddi, S. V., and Thomson, H.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:Journal of Epidemiology and Community Health
Publisher:BMJ Publishing Group
ISSN:0143-005X
ISSN (Online):1470-2738
Published Online:18 February 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Journal of Epidemiology and Community Health 73:379-387
Publisher Policy:Reproduced under a Creative Commons License

University Staff: Request a correction | Enlighten Editors: Update this record

Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU
SPHSU13
SPHSU15
699162Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiChief Scientist office (CSO)SCAF/15/02IHW - MRC/CSO SPHU
3011470Morbidity and mortality among people experiencing severe and multiple disadvantage: a cohort study using cross-sectoral data linkageEmily TweedChief Scientist Office (CSO)CAF/17/11HW - MRC/CSO Social and Public Health Sciences Unit

Downloads per month over past year

View more statistics