{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T20:30:44Z","timestamp":1789849844811,"version":"4.0.1"},"reference-count":40,"publisher":"American Public Health Association","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2012,12]]},"abstract":"<jats:p> Objectives. We evaluated the impact of a diagnosis of serious mental illness on use of a primary care provider (vs the emergency department [ED]) as a source of care by people who were chronically homeless. <\/jats:p><jats:p> Methods. We used data from 750 chronically homeless adults enrolled in the 11-site Collaborative Initiative to Help End Chronic Homelessness and identified demographic and clinical characteristics independently associated with using a primary care provider rather than an ED. <\/jats:p><jats:p> Results. The factor most strongly associated with using the ED as a regular source of medical care was previous-year lack of health insurance. Despite high rates of serious mental illness, neither a diagnosis of serious mental illness nor increased severity of psychiatric symptoms was associated with such use. <\/jats:p><jats:p> Conclusions. Findings suggest that people who are chronically homeless and have chronic medical illness would be more likely to access care if they had health insurance. Individual states\u2019 deciding not to expand Medicaid coverage will likely have a tremendous impact on the health outcomes and health care costs associated with this and other vulnerable populations. <\/jats:p>","DOI":"10.2105\/ajph.2012.301025","type":"journal-article","created":{"date-parts":[[2012,10,19]],"date-time":"2012-10-19T00:52:00Z","timestamp":1350607920000},"page":"e83-e89","source":"Crossref","is-referenced-by-count":21,"title":["Impact of Health Insurance Status and a Diagnosis of Serious Mental Illness on Whether Chronically Homeless Individuals Engage in Primary Care"],"prefix":"10.2105","volume":"102","author":[{"given":"Lydia","family":"Chwastiak","sequence":"first","affiliation":[{"name":"At the time of the study, Lydia Chwastiak was with the Department of Psychiatry, Yale School of Medicine, New Haven, CT, and the Connecticut Mental Health Center, New Haven. Jack Tsai is with the Department of Psychiatry, Yale School of Medicine, and the Veterans Affairs (VA) New England Mental Illness, Research, Education and Clinical Center (MIRECC), West Haven, CT. Robert Rosenheck is with the Child Study Center, Yale School of Medicine, and the VA New England MIRECC, West Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Tsai","sequence":"additional","affiliation":[{"name":"At the time of the study, Lydia Chwastiak was with the Department of Psychiatry, Yale School of Medicine, New Haven, CT, and the Connecticut Mental Health Center, New Haven. Jack Tsai is with the Department of Psychiatry, Yale School of Medicine, and the Veterans Affairs (VA) New England Mental Illness, Research, Education and Clinical Center (MIRECC), West Haven, CT. Robert Rosenheck is with the Child Study Center, Yale School of Medicine, and the VA New England MIRECC, West Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Rosenheck","sequence":"additional","affiliation":[{"name":"At the time of the study, Lydia Chwastiak was with the Department of Psychiatry, Yale School of Medicine, New Haven, CT, and the Connecticut Mental Health Center, New Haven. Jack Tsai is with the Department of Psychiatry, Yale School of Medicine, and the Veterans Affairs (VA) New England Mental Illness, Research, Education and Clinical Center (MIRECC), West Haven, CT. Robert Rosenheck is with the Child Study Center, Yale School of Medicine, and the VA New England MIRECC, West Haven, CT."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"844","reference":[{"key":"bib3","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.89.4.529"},{"key":"bib4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60747-2"},{"key":"bib5","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.158.13.1454"},{"key":"bib6","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.87.2.217"},{"key":"bib7","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1314"},{"key":"bib8","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.t01-1-00036"},{"key":"bib9","doi-asserted-by":"publisher","DOI":"10.1367\/1539-4409(2001)001<0099:CAQOCF>2.0.CO;2"},{"key":"bib10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199209103271107"},{"key":"bib11","doi-asserted-by":"publisher","DOI":"10.1097\/01.MLR.0000044907.31129.0A"},{"key":"bib12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199806113382406"},{"key":"bib13","doi-asserted-by":"publisher","DOI":"10.1001\/jama.285.2.200"},{"key":"bib14","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318206c50d"},{"key":"bib15","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.92.5.778"},{"key":"bib16","doi-asserted-by":"publisher","DOI":"10.1177\/003335491012500308"},{"key":"bib17","doi-asserted-by":"publisher","DOI":"10.1097\/00124784-200311000-00014"},{"key":"bib18","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-006-9083-0"},{"key":"bib19","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2010.0717"},{"key":"bib20","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2005.06.003"},{"key":"bib21","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1990.00390220069014"},{"key":"bib22","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2010.0675"},{"issue":"6","key":"bib23","first-page":"1273","volume":"34","author":"Gelberg L","year":"2000","journal-title":"Health Serv Res"},{"key":"bib24","doi-asserted-by":"publisher","DOI":"10.1177\/1359105307080612"},{"key":"bib25","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1988.01800360033005"},{"key":"bib26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0050225"},{"key":"bib27","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-008-0786-7"},{"key":"bib28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2011.01246.x"},{"key":"bib29","doi-asserted-by":"publisher","DOI":"10.1007\/s10597-008-9138-7"},{"key":"bib30","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-198001000-00006"},{"key":"bib31","volume-title":"The Brief Symptom Index: Administration, Scoring, and Procedure Manual","author":"Derogatis LR","year":"1982"},{"key":"bib32","volume-title":"Psychiatric Epidemiology Research Interview (PERI)","author":"Dohrenwend B","year":"1982"},{"key":"bib33","volume-title":"How to Score the SF-12 Physical and Mental Health Summary scales","author":"Ware JE","year":"1998","edition":"3"},{"key":"bib34","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.00046"},{"key":"bib35","doi-asserted-by":"publisher","DOI":"10.1016\/0149-7189(88)90033-X"},{"key":"bib36","doi-asserted-by":"publisher","DOI":"10.1002\/1520-6629(198710)15:4<537::AID-JCOP2290150411>3.0.CO;2-C"},{"key":"bib37","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.53.10.1666"},{"key":"bib38","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.94.1.103"},{"key":"bib39","doi-asserted-by":"publisher","DOI":"10.3386\/w17190"},{"key":"bib40","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.0857"},{"key":"bib42","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2010.10060792"},{"key":"bib43","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291700001975"}],"container-title":["American Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ajph.aphapublications.org\/doi\/pdf\/10.2105\/AJPH.2012.301025","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,9]],"date-time":"2022-05-09T22:02:44Z","timestamp":1652133764000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.2012.301025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,12]]},"references-count":40,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2012,12]]}},"alternative-id":["10.2105\/AJPH.2012.301025"],"URL":"https:\/\/doi.org\/10.2105\/ajph.2012.301025","relation":{},"ISSN":["0090-0036","1541-0048"],"issn-type":[{"value":"0090-0036","type":"print"},{"value":"1541-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,12]]}}}