Sinhogarismo y salud mental durante la Gran Recesión (2008-2017): el efecto de la inmigración

espanolFundamentos: El sinhogarismo, grave problema social en toda Europa y en aumento durante la ultima decada, esta estrechamente vinculado a problemas organicos y de salud mental. Frente a la ausencia de estudios de analisis diagnostico en territorio espanol, esta investigacion pretendio conocer las caracteristicas sociodemograficas de una muestra de personas en situacion de sinhogarismo (PESS), determinar la prevalencia de diagnosticos de trastorno por uso de sustancias psicoactivas, patologia dual y otros trastornos mentales y analizar la existencia de diferencias diagnosticas entre PESS nacidas en el pais y PESS inmigrantes. Metodos: Se realizo un estudio transversal, observacional y analitico a partir del analisis de los diagnosticos de salud mental de las historias clinicas de una muestra de 1.072 PESS (453 autoctonas y 619 inmigrantes), atendidas durante 2008 y 2017 en los Servicios de Salud Mental de Girona (noreste de Espana). Para el analisis estadistico se utilizo t de Student para la comparacion de medias y el jicuadrado para el analisis de variables categoricas. Se efectuo un analisis de regresion logistica binaria para establecer las variables predictoras del diagnostico de drogodependencias y patologia dual. Resultados: El 44% de la muestra estaba historiado en la Red de Salud Mental y Adicciones. Las PESS mostraron elevados indices de trastornos mentales, especialmente trastornos por uso de sustancias psicoactivas (82,6% de las personas diagnosticadas). El 43,9% de las PESS diagnosticadas lo fueron por dependencia al alcohol, seguidos de la dependencia a cocaina y a opiaceos. Las PESS inmigrantes tuvieron mas diagnosticos por dependencia al alcohol y menos por dependencia a los opiaceos o patologia dual que las PESS autoctonas. Conclusiones: Aunque las PESS inmigrantes presentan mas diagnosticos en dependencia al alcohol, las PESS nacidas en Espana muestran una mayor vulnerabilidad y reciben mas diagnosticos de salud mental que las PESS inmigrantes. El proceso migratorio establece pues diferencias en el tipo de trastornos mentales y por uso de sustancias en la poblacion de PESS. EnglishBackground: Homelessness, which is a severe social problem across Europe and on the rise over the past decade, is closely linked to organic and mental health problems. In front of the lack of diagnostic analysis studies in the Spanish territory, this research aimed to determine the sociodemographic characteristics of a sample of individuals experiencing homelessness (IEH), to determine the prevalence of diagnoses of substance use disorders, dual pathology and other mental disorders and to analyze the existence of diagnostic differences between IEH born in the country and immigrant IEH. Methods: A transversal and observational study was carried out, based on the analysis of mental health diagnostics of the medical histories of a sample of 1,072 IEH (453 locals and 619 immigrants) assisted between 2008 and 2017 in mental health services in Girona, northeastern Spain. For the statistical analysis, Student’s t test was used to compare means and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression analysis was carried out to establish the predictor variables for the diagnosis of drug addiction and dual pathology. Results: IEH showed high rates of mental disorders, especially psychoactive substances (82.6% of diagnosed people). 43.9% of IEH showed alcohol dependence as the reason for their diagnosis, followed by cocaine addiction and opiates. Foreign born IEH had more diagnoses for alcohol dependence and less for opiates or dual pathology than spanish born IEH. IEH born in Spain showed a higher vulnerability and received more mental health diagnoses than immigrant IEH. Conclusions: Even though immigrant PESS show more diagnoses for alcohol dependence, PESS born in Spain show a higher vulnerability and receive more mental health diagnoses than immigrant PESS. The process of migrating seems to establish a difference in the kind of mental disorders and addictions the PESS collective is prone to.