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Problems in Reporting Psychiatric Disorders Among Homeless Adults

Marilyn A. Winkleby, PhD; Michael R. Fischetti, MD
JAMA. 1990;263(6):810-811. doi:10.1001/jama.1990.03440060050017.
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To the Editor.—  In the September 8, 1989, issue of JAMA, Breakey et al1 present data on psychiatric disorders among a sample of 125 homeless men and 78 women from Baltimore, Md, missions, shelters, and jails. While this cross-sectional study uses standardized clinical diagnostic tools and addresses the important issue of comorbidity, it has been misinterpreted by the media and public policy advocates owing to several analytic shortcomings.First, using the Diagnostic and Statistical Manual of Mental Disorders, Third Edition to estimate overall prevalence of psychiatric disorders, the authors report that 91% of men and 80% of women received an Axis I diagnosis—a statistic that was translated into major news by the Sunday New York Times (September 10, 1989) and the Associated Press. These statistics may be accurate estimates of the overall burden of disability associated with homelessness, yet they are of limited value because they aggregate the


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