Review
The Prevalence of Mental Illness in Homeless Children: A Systematic Review and Meta-Analysis

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Objective

The numbers of children experiencing homelessness have increased. To develop responsive interventions, we must understand their mental health/behavioral needs. The purpose of this systematic review was to update the evidence base by identifying, appraising, and summarizing studies on the prevalence of mental health issues among homeless children, comparing these individuals to low-income–housed children, and discussing research, practice, and policy implications.

Method

We searched 3 electronic databases and included empirical studies investigating the prevalence of mental illness in homeless children in the United States (1990–2014). Retrieved publications were screened, data extracted, and study quality appraised by independent reviewers. Evidence synthesis was based on qualitative and quantitative analyses. Prevalence odds ratios (OR) of individual studies were pooled using an inverse-variance random effects model.

Results

Twelve studies were included and reviewed. Overall, 10% to 26% of homeless preschoolers had mental health problems requiring clinical evaluation. This proportion increased to 24% to 40% among homeless school-age children, a rate 2 to 4 times higher than poor children aged 6 to 11 years in the National Survey of America’s Families. According to our meta-analyses, the difference in prevalence measured by Child Behavior Checklist (CBCL) Total Problems (T score ≥60–64) was not significantly different between homeless and housed preschool children (OR = 1.49; 95% CI = 0.97–2.28). School-age homeless children compared to housed children were significantly more likely to have a mental health problem as defined by the CBCL Total Problems subscale (T score ≥60; OR = 1.78; 95% CI = 1.19–2.66).

Conclusion

Evidence-based mental health interventions for children experiencing homelessness are long overdue. Universal screening, treatment plan development, and support of adaptive systems that focus on positive parenting and children’s self-regulation are essential.

Section snippets

Method

This review conforms to recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement14 and the Centre for Reviews and Dissemination’s (CRD) Guidance for Undertaking Reviews.15 The protocol of this review has been registered with the PROSPERO register at the CRD (CRD#42014007519).

Literature Search

Our electronic searches identified 1,608 records (i.e., abstracts). In addition, we identified 13 full-text publications not indexed in the electronic databases (e.g., technical reports, peer-reviewed articles). After removing duplicates, 1,276 abstracts were screened, of which 956 were excluded. Full-text publications of the remaining 320 records were retrieved and examined. Twelve were included in the review (Table 121, 22, 23, 24, 25, 26 and Table 28, 11, 26, 27, 28, 29, 30).

A diagram

Discussion

This systematic review appraised and synthesized the evidence on the prevalence of mental health/behavioral disorders in homeless preschool- and school-age children. It is the first study to present a meta-analysis that compared the risk of having a mental health problem between homeless and low-income–housed school-age children. To our knowledge, no systematic reviews have been conducted on the mental health needs of homeless children. The few systematic reviews of mental illness in the

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    This article was supported by the Center for Social Innovation.

    Disclosure: Dr. Bassuk, Dr. Tsertsvadze, and Ms. Richard report no biomedical financial interests or potential conflicts of interest.

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