Risk factor assessment of homelessness at psychiatric hospital admission: a machine learning approach

ABSTRACT

Despite a persistent link between homelessness, mental illness, and increased psychiatric hospitalizations, there is a dearth of research examining risk factors for higher utilization of mental health treatment among this vulnerable population. This study utilizes machine learning in electronic health record data to examine admissions from 2010 to 2019 at a regional psychiatric safety-net hospital among individuals experiencing homelessness compared to non-homeless individuals. Of the 64 social, demographic, clinical and treatment predictors examined, 12 were identified as the strongest predictors of homelessness status at psychiatric hospital admission. Admissions for patients identified as homeless were driven by social determinants of health. The strongest predictor was having no income (+267% increase in the odds of being homeless). The study results demonstrate how machine learning can be used to explore electronic health record data collected during psychiatric hospital admission, including social determinants of health, to elucidate the clinical and social needs of homeless individuals seeking psychiatric treatment. These findings have implications for the development of targeted prevention/treatment interventions to address homeless patients’ needs during psychiatric hospitalization to improve social and health outcomes.

KEYWORDS:

• Homelessness
• social determinants of health
• psychiatric hospitalization

Acknowledgements

Research involving human participants and/or animals. This was a retrospective study conducted on already available, de-identified electronic health record data. The study was approved by the University of Texas Health Science Center Houston (UTHealth), Center for the Protection of Human Subjects (Institutional Review Board [IRB]). Informed Consent: A formal consent was not required for this study by the UTHealth IRB. All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jane E. Hamilton, PhD, and Robert Suchting, Ph.D. The first draft of the manuscript was written by Jane E. Hamilton, PhD, Tina E. Thomas, M.B.B.S., and David S. Buck, M.D., M.P.H. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Data availability

The data analyzed for this research project were obtained from the electronic health record (EHR) at UTHealth Harris County Psychiatric Hospital in Houston, Texas. Due to the confidential nature of patient medical record data, this data set is not available publicly.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Jane E. Hamilton

Jane Hamilton, PhD, MPH, is an Assistant Professor and Director of the Mental Health Services and Outcomes Research Program at The University of Texas Health Science Center Houston, McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences. She is a mental health services researcher in the areas of health disparities and the use of electronic health records for patient-centered outcomes research. Dr. Hamilton is currently the principal investigator for a 5-year, $2.5 million grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide integrated behavioral health treatment for individuals with serious mental illness experiencing homelessness. Additionally, she is the principal investigator for a policy project funded through the Centers for Medicare and Medicaid Services (CMS) Money Follows the Person Program in which she is collaborating with public health regions in Texas to conduct housing summits to expand housing options for medically vulnerable populations.

Robert Suchting

Robert Suchting, Ph.D. is an Assistant Professor in the Department of Psychiatry and Behavioral Sciences at UTHealth, affiliated with the Center for Neurobehavioral Research on Addiction. Formally trained in social psychology and statistics, he applies quantitative methods to investigate clinical outcomes, including those found among substance abuse populations and individuals with psychiatric disorders. He specializes in data science (i.e. the use of machine learning algorithms to optimize prediction and automate pattern discovery) as well as quantitative methods via Frequentist or Bayesian inference, including generalized linear modeling, structural equation modeling, and multivariate statistics.

Tina E. Thomas

Tina Thomas MBBS, MRCPsych is a PGY3 Psychiatry Resident at The University of Texas Health Science Center Houston, McGovern Medical School, Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences. Prior to moving to the USA from the UK, she completed general psychiatry training in London, and is a member of the Royal College of Psychiatrists, UK. She is an APA Diversity Leadership Fellow, trainee coordinator for the Texas Minority Network and the recipient of the annual resident paper award from the Journal of Psychiatric Practice (2019–2020). She is currently on the research track at her residency program and her interests include forensic and cultural psychiatry and homeless mental health.

David S. Buck

David S. Buck, M.D., M.P.H., is an Associate Dean for Community Health at the University of Houston’s College of Medicine, Professor (Adjunct) at University of Texas School of Public Health – Houston: Management, Policy and Community Health Division and Rice University’s Department of Sociology. He was Professor at Baylor College of Medicine's Department of Family & Community Medicine for 21 years. He began working with the underserved developing medical and dental clinics for the indigent population in Houston in 1984 after working with Mother Teresa in Calcutta, India. In 1999, he founded Healthcare for the Homeless – Houston. He co-founded Doctor's for Change and served as its Chair from 2006–8. He founded the Houston-Galveston Albert Schweitzer Fellowship Program in 2007 and served as its chair 2007–2016. He served on the founding board and later as Chair of the International Street Medicine Institute from 2010–2012. He served on the Consumer Operated and Oriented Plan Advisory Board at the request of the U.S. Secretary of Health and Human Services 2010–2012. Dr. Buck currently serves as board chair of Patient Care Intervention Center, a nonprofit that leverages community-wide care coordination and technology to deliver resources to patients with complex social and medical needs.