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Introduction: From the perspective of social determinants, homelessness perpetuates poor health and creates barriers to effective chronic disease management, necessitating frequent use of emergency department (ED) services. In this study we developed a screening algorithm (checklist) from common comorbidities observed in the homeless population in the United States. The result was a theoretical screening tool (checklist) to aid healthcare workers in the ED, including residents, medical students, and other trainees, to provide more efficacious treatment and referrals for discharge.Methods: In this retrospective cohort study we used the Nationwide Emergency Department Sample (NEDS) to investigate comorbidities and ED utilization patterns relating to 23 injury-related, psychiatric, and frequent chronic medical conditions in the US adult (≥18 years of age) homeless population. Cases were identified from the NEDS database for 2014–2017 using International Classification of Diseases, 9th and 10 revisions, and Clinical Classification Software diagnosis codes. We performed a two-step cluster analysis including pathologies with ≥10% prevalence in the sample to identify shared comorbidities. We then compared the clusters by sociodemographic and ED-related characteristics, including age, gender, primary payer, and patient disposition from the ED. Chi-square analysis was used to evaluate categorical variables (ie, gender, primary payer, patient disposition from the ED), and analysis of variance for continuous variables (age).Results: The study included 1,715,777 weighted cases. The two-step cluster analysis identified nine groups denominated by most prevalent disease: 1) healthy; 2) mixed psychiatric; 3) major depressive disorder (MDD); 4) psychosis; 5) addiction; 6) essential hypertension; 7) chronic obstructive pulmonary disease (COPD); 8) infectious disease; and (9) injury. The MDD, COPD, infectious disease, and Injury clusters demonstrated the highest prevalence of co-occurring disease, with the MDD cluster displaying the highest proportion of comorbidities. Although the addiction cluster existed independently, substance use was pervasive in all except the healthy cluster (prevalence 36-100%). We used the extracted screening algorithm to establish a screening tool (checklist) for ED healthcare workers, with physicians as the first point of contact for the initial use of the screening tool.Conclusion: Healthcare workers in the ED, including residents, medical students, and other trainees, provide services for homeless ED users. Screening tools (checklists) can help coordinate care to improve treatment, referrals, and follow-up care to reduce hospital readmissions. The screening tool may expedite targeted interventions for homeless patients with commonly occurring patterns of disease.

People living with HIV/AIDS (PHA) often concurrently cope with mental health disorders that may greatly influence HIV and other health-related outcomes. The objective of this study was to examine the prevalence and correlates of self-reported mental health disorder diagnosis among a cohort of harder-to-reach HIV-positive individuals in British Columbia, Canada. Between 2007 and 2010, 1000 PHA who had initiated ART were enrolled in the Longitudinal Investigation into Supportive and Ancillary health services (LISA) study. Socio-demographic, behavioral, health-care utilization and psychosocial information was collected through interviewer-led questionnaires and linked to longitudinal clinical variables through the provincial Drug Treatment Program at the BC Centre for Excellence in HIV/AIDS. We identified the prevalence of all-type and specific mental health disorders among this population. Of the 916 participants included in this analysis, 494 (54%) reported ever having a mental health disorder diagnosis. Mood (85%) and anxiety (65%) disorders were the two most frequently reported mental health conditions. Self-reported all-type mental health disorder was independently associated with decreased overall functioning (adjusted odds ratio [AOR] = 0.90, 95% confidence interval [CI] = 0.83-0.98) and life satisfaction (AOR = 0.81, 95% CI = 0.74-0.89), and having higher stigma score (AOR = 1.11, 95%CI = 1.02-1.21). Participants reporting any mental health disorder were more likely to report a history of sexual assault (AOR = 2.45, 95% CI = 1.75-3.43) and to have used case management services (AOR = 1.63, 95%CI = 1.17-2.27). Our findings uncovered a high burden of mental health disorders among harder-to-reach PHA and suggest that PHA with at least one mental health disorder diagnosis are disproportionately impacted by sexual violence and stigma.

Autism spectrum disorder (ASD) is a common comorbid condition in people with fragile X syndrome (FXS). It has been assumed that ASD symptoms reflect the same underlying psychological and neurobiological impairments in both FXS and non-syndromic ASD, which has led to the claim that targeted pharmaceutical treatments that are efficacious for core symptoms of FXS are likely to be beneficial for non-syndromic ASD as well. In contrast, we present evidence from a variety of sources suggesting that there are important differences in ASD symptoms, behavioral and psychiatric correlates, and developmental trajectories between individuals with comorbid FXS and ASD and those with non-syndromic ASD. We also present evidence suggesting that social impairments may not distinguish individuals with FXS with and without ASD. Finally, we present data that demonstrate that the neurobiological substrates of the behavioral impairments, including those reflecting core ASD symptoms, are different in FXS and non-syndromic ASD. Together, these data suggest that there are clinically important differences between FXS and non-syndromic ASD that are masked by reliance on the categorical diagnosis of ASD. We argue for use of a symptom-based approach in future research, including studies designed to evaluate treatment efficacy.