Homelessness and associated factors over a 13-year period among psychiatric in-patients in Berlin, Germany: routine data analysis.

BACKGROUND: Homeless patients in psychiatric hospitals are a scarcely studied and there is lack of knowledge about factors associated with homelessness and in-patient treatment. AIMS: To determine the change over time in the number of homeless psychiatric in-patients and to examine factors associated with homelessness. METHOD: Retrospective data analysis of 1205 selected electronic patient files on psychiatric in-patient treatment in a university psychiatric hospital in Berlin, Germany. The rate of patients experiencing homelessness over a 13-year period (2008-2021) and the sociodemographic and clinical factors associated with homelessness are analysed over time. RESULTS: Our study revealed a 15.1% increase in the rate of homeless psychiatric in-patients over the 13-year period. Of the whole sample, 69.3% people lived in secure private housing, 15.5% were homeless and 15.1.% were housed in sociotherapeutic facilities. Homelessness was significantly associated with being male (OR = 1.76 (95% CI 1.12-2.76), born outside of Germany (OR = 2.22, 95% CI 1.47-3.34), lack of out-patient treatment (OR = 5.19, 95% CI 3.35-7.63), psychotic disorders (OR = 2.46, 95% CI 1.16-5.18), reaction to severe stress (OR = 4.19, 95% CI 1.71-10.24), personality disorders (OR = 4.98, 95% CI 1.92-12.91), drug dependency (OR = 3.47, 95% CI 1.5-8.0) and alcohol dependency (OR = 3.57, 95% CI 1.67-7.62). CONCLUSIONS: The psychiatric care system is facing an increasing number of patients in precarious social situations. This should be considered in resource allocation planning in healthcare. Individual solutions for aftercare, along with supported housing, could counteract this trend.

Psychedelic Experiences During the Early COVID-19 Pandemic: Findings From an International Online Survey.

Introduction: The current corona virus disease (COVID-19) pandemic has caused a serious global health crisis that has affected large parts of the public and private life worldwide, including the use of psychoactive substances. In this study, we investigated the effect of the COVID-19 pandemic on the use of serotonergic psychedelics, i.e., the settings in which people use psychedelics, the motives of usage, and the subjective quality of psychedelic experiences. Methods: The study was part of an international, cross-sectional, internet-based survey (N = 5,049) available in five languages (English, German, Spanish, Italian, and Korean) carried out during the early phase of the pandemic from April to August 2020. Participants were asked to retrospectively rate settings and motives of psychedelic substance use before the pandemic and in the last 4 weeks during the pandemic, as well as changes in psychedelic experiences. Results: Of n = 1,375 participants that reported the use psychedelics in 2019 or 2020, n = 642 (46.6%) also took psychedelics during the pandemic. During the pandemic, participants used psychedelics significantly less often in settings that were outside their home. Top motives to use psychedelics were comparable before and during the pandemic, but participants consumed less out of curiosity, to celebrate, or because friends took it, and more out of boredom. An increase in positively connoted, often pro-social experiences was observed. Two thirds of participants who used psychedelics during the pandemic claimed that psychedelics had helped them to deal better with the corona pandemic at least slightly. Discussion: Changes in setting and motives were mostly in line with restrictions caused by control measures to contain the spread of the virus. The unexpected increase in positively connoted experiences possibly reflects a favorable interaction of environmental macro- and individual micro-contexts during the pandemic (e.g., by reducing the use in more uncontrolled recreational settings or by encouraging a strong self-selection of substance users due to the expectation of "bad trips"). Increased pro-social feelings under psychedelics might reflect a desire for social interactions in times of social distancing and pandemic-related stress and anxiety.

[Psychological stress during the COVID-19 pandemic: consequences for psychiatric patients and therapeutic implications]. / Psychische Belastung während der COVID-19-Pandemie: Konsequenzen für psychiatrisch Erkrankte und therapeutische Implikationen.

BACKGROUND: The outbreak of the COVID-19 disease and the rapid spread of the inducing coronavirus SARS-CoV­2 threatens not only people's physical health but also their mental health. Its influence on incidence and course of existing illnesses in the psychiatric outpatient sector in Germany is still unknown. METHODS: The medical reports of 682 persons in psychiatric treatment were retrospectively investigated, regarding their subjective response to this pandemic and its clinical relevance. RESULTS: Of the patients 60.5% (n = 378) experienced greater psychological stress, 14.5% (n = 99) reported fear of the SARS-CoV­2 and the possible danger of infection, 25.5% (n = 174) reported fear resulting from the protective measures taken (lock down) and 4.3% (n = 29) reported fear of both. This differed significantly across diagnoses: people with anxiety disorders reported significantly greater stress as well as greater fear of the virus, whereas people with psychoses were significantly less affected than the other patients. Of the participants 43.7% (n = 132) were so strongly affected that acute treatment had to be implemented and 6.0% (n = 18) had to be referred to inpatient care. DISCUSSION: People with mental illnesses are particularly vulnerable to the psychological strain of the COVID-19 pandemic. Long-term studies on the further course of disease will be necessary. Additional studies that test interventions to build resilience in this population will also be needed.