{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:05:38Z","timestamp":1789538738867,"version":"build-2803163510"},"reference-count":58,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Soc Psychiatry"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Homelessness is closely related to psychiatric disorders, substance abuse, and premature mortality; however, in-depth analyses of long-term trajectories are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>The objective was to analyze psychiatric diagnoses, clinical patterns and survival outcomes of homelessness trajectories during a 20-year follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>\n                      A retrospective sample of 333 psychiatric patients experiencing homelessness in Portugal. Cox survival analyses defined the cohorts: Recent (\u2a7d1\u2009year;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200992), Early-stage (1\u20135\u2009years;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200952), Prolonged (5\u201315\u2009years;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200993), and Persistent (&gt;15\u2009years;\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200996). Analyses included analysis of variance (ANOVA), Chi-square tests, and logistic regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Mortality was 31.2%, decreasing after 18\u2009years of homelessness, indicating a survivor effect. Recent cohort and younger patients, and those with alcohol misuse, anxiety, and personality disorders had minimal hospitalization. Early-stage and Prolonged groups had the highest mortality (50%), linked to alcohol-related disorders and organic psychosis, mainly in Prolonged. Persistent cohort, with the longest psychiatric follow-up (18.8\u2009years), more hospitalizations, and higher comorbidity with drug use and intellectual disability, had the lowest mortality (14.6%) and the highest mean age at death (67.3\u2009years). Unspecified psychosis, substance use, and intellectual disability were the key predictors of Persistent group. Alcohol use, psychosis, and personality disorders influenced survival varying by cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Patient psychiatric homelessness cohorts have heterogeneous trajectories for clinical, sociodemographic, service use, and survival. Early and mid-stages of homelessness show higher mortality. Findings highlight the Persistent cohort as long-term homelessness survivors. It is stressed that the duration of homelessness is a critical determinant of diagnostic patterns, comorbidities, and survival outcomes, which require differentiated psychiatric and social interventions tailored to cohort-specific risks among people experiencing homelessness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00207640261468246","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T17:56:45Z","timestamp":1785347805000},"page":"1485-1498","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["A 20-Year Longitudinal Study of Homelessness Among 333 Psychiatric Patients in Portugal: From Initial Episodes to Chronic Trajectories"],"prefix":"10.1177","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8732-649X","authenticated-orcid":false,"given":"Joana","family":"Henriques-Calado","sequence":"first","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Ci\u00eancia Psicol\u00f3gica (CICPSI), Faculdade de Psicologia, Universidade de Lisboa (FPUL), Portugal, European Union"},{"name":"Faculdade de Psicologia, Universidade de Lisboa (FPUL), Portugal, European Union"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalia","family":"Garcia","sequence":"additional","affiliation":[{"name":"Faculdade de Psicologia, Universidade de Lisboa (FPUL), Portugal, European Union"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0662-5178","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Gama-Marques","sequence":"additional","affiliation":[{"name":"Centro de Investiga\u00e7\u00e3o em Ci\u00eancia Psicol\u00f3gica (CICPSI), Faculdade de Psicologia, Universidade de Lisboa (FPUL), Portugal, European Union"},{"name":"Consulta de Esquizofrenia Resistente (CER), and Homeless Outreach Psychiatric Engagement for Lisboa (HOPE 4 Lisboa), Hospital de J\u00falio de Matos (HJM), Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9 (ULSSJ), Centro Cl\u00ednico Acad\u00e9mico de Lisboa (CCAL), Portugal, European Union"},{"name":"Cl\u00ednica Universit\u00e1ria de Psiquiatra e Psicologia M\u00e9dica (CUPPM), and PsyLab Instituto de Sa\u00fade Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa (FMUL), Centro Acad\u00e9mico de Medicina de Lisboa (CAML), Portugal, European Union"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Backer T. 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