Mental and substance use disorders and food insecurity among homeless adults participating in the At Home/Chez Soi study

Background
Few studies have examined how food insecurity changes over time when living with severe mental disorders or substance use disorders. This study identifies food insecurity trajectories of homeless adults participating in a trial of a housing intervention and examines whether receiving the intervention and having specific mental and substance disorders predict food insecurity trajectories.
Materials and methods
We studied 520 participants in the Toronto site of the At Home/Chez-Soi project. Food insecurity data were collected at seven times during a follow-up period of up to 5.5 years. Mental and substance use disorders were assessed at baseline. Food insecurity trajectories were identified using group based-trajectory modeling. Multinomial logistic regression was used to examine the effects of the intervention and mental and substance use disorders on food insecurity trajectories.
Results
Four food insecurity trajectories were identified: persistently high food insecurity, increasing food insecurity, decreasing food insecurity, and consistently low food insecurity. Receiving the intervention was not a predictor of membership in any specific food insecurity trajectory group. Individuals with major depressive episode, mood disorder with psychotic features, substance disorder, and co-occurring disorder (defined as having at least one alcohol or other substance use disorder and at least one non-substance related mental disorder] were more likely to remain in the persistently high food insecurity group than the consistently low food insecurity group.
Conclusion
A persistently high level of food insecurity is common among individuals with mental illness who have experienced homelessness, and the presence of certain mental health disorders increases this risk. Mental health services combined with access to resources for basic needs, and re-adaptation training are required to enhance the health and well-being of this population.

研究背景
目前鲜有研究探讨重型精神障碍或物质使用障碍患者在病程中食物不安全状况的动态变化。本研究针对参与住房干预试验的无家可归成年人，分析其食物不安全轨迹，并探究接受该干预措施以及合并特定精神障碍与物质使用障碍是否可预测食物不安全轨迹。

材料与方法
本研究纳入了At Home/Chez-Soi项目多伦多站点的520名参与者。在最长达5.5年的随访期内，共7个时间点收集了食物不安全相关数据。基线时对参与者的精神障碍与物质使用障碍状况进行评估。采用基于群体的轨迹建模法识别食物不安全轨迹，并通过多项逻辑回归分析干预措施、精神障碍及物质使用障碍对食物不安全轨迹的影响。

结果
共识别出4类食物不安全轨迹：持续高食物不安全、食物不安全程度上升、食物不安全程度下降以及持续低食物不安全。接受干预措施并不能预测参与者归属某一特定食物不安全轨迹组。相较于持续低食物不安全组，存在重度抑郁发作、伴精神病性特征的心境障碍、物质使用障碍以及共病障碍（定义为至少存在1种酒精或其他物质使用障碍，同时合并1种非物质相关精神障碍）的个体更易留存于持续高食物不安全组。

结论
在曾经历无家可归的精神疾病患者中，持续高水平的食物不安全状况较为普遍，而特定精神健康障碍的存在会升高该风险。为改善这一群体的健康与福祉，需将精神卫生服务与基本需求资源获取渠道、再适应训练相结合。