{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T15:35:38Z","timestamp":1770132938139,"version":"3.49.0"},"reference-count":43,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001663","name":"Volkswagen Foundation","doi-asserted-by":"crossref","award":["99269"],"award-info":[{"award-number":["99269"]}],"id":[{"id":"10.13039\/501100001663","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["493624519"],"award-info":[{"award-number":["493624519"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"name":"German Red Cross district association Hamburg Altona"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objective: Homeless individuals are vulnerable, and a high burden of mental health problems is suspected. We aim to identify the prevalence and key predictors of probable depression and anxiety among homeless individuals in Germany during the Coronavirus disease-2019 (COVID-19) pandemic. Study Design: Nationwide multicentre cross-sectional study including clinical, laboratory, and questionnaire-based data on the health of homeless individuals in Germany. Methods: Data were used from the National Survey on the psychiatric and somatic health of homeless individuals during the COVID-19 pandemic. Probable depression and anxiety were determined using the Patient Health Questionnaire 9 and the General Anxiety Disorder 2 questionnaire. Logistic regression analysis was used to identify key predictors of probable depression and anxiety. Results: A high prevalence of probable depression (26.8% [95% CI: 23.2\u201330.3]) and anxiety (27.2% [95% CI: 23.7\u201330.7]) was found. Logistic regressions showed both probable depression and anxiety associated with being female (depression: OR 1.80 [95% CI: 1.06\u20133.03]; anxiety: OR: 1.69 [95% CI: 1.03\u20132.76]), daily use of any illegal substances (depression: OR 3.20 [95% CI: 1.87\u20135.49]; anxiety: OR 2.04 [95% CI: 1.21\u20133.45]), and fear of contracting COVID-19 (little fear, depression: OR: 1.81 [95% CI 1.01\u20133.23], some fear, anxiety: OR: 2.52 [95% CI: 1.31\u20134.83]). Probable depression was associated with longer durations of homelessness (OR: 1.004, [95% CI: 1.001\u20131.007]. Conclusions: Probable depression and anxiety are highly prevalent in homeless individuals throughout. Key predictors may help to identify individuals in need and design targeted interventions.<\/jats:p>","DOI":"10.3390\/ijerph23020154","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T15:48:30Z","timestamp":1769442510000},"page":"154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and Correlates of Probable Depression and Anxiety Among Homeless Individuals During the COVID-19 Pandemic in Germany"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0948-5074","authenticated-orcid":false,"given":"Veronika","family":"Kowalski","sequence":"first","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6886-2745","authenticated-orcid":false,"given":"Andr\u00e9","family":"Hajek","sequence":"additional","affiliation":[{"name":"Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Van R\u00fcth","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wiebke","family":"Graf","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Dost","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Brennecke","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5711-6862","authenticated-orcid":false,"given":"Hans-Helmut","family":"K\u00f6nig","sequence":"additional","affiliation":[{"name":"Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"P\u00fcschel","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Ondruschka","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2922-4863","authenticated-orcid":false,"given":"Fabian","family":"Heinrich","sequence":"additional","affiliation":[{"name":"Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany"},{"name":"Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"},{"name":"Centre for Data and Statistical Science for Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franziska","family":"Stallbaum","sequence":"additional","affiliation":[{"name":"I. Department of Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"ref_1","unstructured":"Bundesarbeitsgemeinschaft Wohnungslosenhilfe e.V (2023). Mindestens 607.000 Menschen in Deutschland Wohnungslos: BAG Wohnungslosenhilfe Stellt Aktuelle Hochrechnungsergebnisse Vor, Bundesarbeitsgemeinschaft Wohnungslosenhilfe e.V. Available online: https:\/\/www.bagw.de\/fileadmin\/bagw\/media\/Doc\/PRM\/PRM_2021_12_21_BAGW_Schaetzung.pdf."},{"key":"ref_2","unstructured":"World Health Organization (2021). COVID-19 and the Social Determinants of Health and Health Equity: Evidence Brief, World Health Organization."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1001\/jamapsychiatry.2024.0426","article-title":"Prevalence of Mental Health Disorders Among Individuals Experiencing Homelessness: A Systematic Review and Meta-Analysis","volume":"81","author":"Barry","year":"2024","journal-title":"JAMA Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1016\/S0140-6736(14)61132-6","article-title":"The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations","volume":"384","author":"Fazel","year":"2014","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1001\/jamainternmed.2022.3697","article-title":"Factors Associated With Mortality Among Homeless Older Adults in California: The HOPE HOME Study","volume":"182","author":"Brown","year":"2022","journal-title":"JAMA Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2205","DOI":"10.1016\/S0140-6736(11)60747-2","article-title":"Psychiatric disorders and mortality among people in homeless shelters in Denmark: A nationwide register-based cohort study","volume":"377","author":"Nielsen","year":"2011","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1038\/s41380-019-0595-x","article-title":"Depression and anxiety in relation to cancer incidence and mortality: A systematic review and meta-analysis of cohort studies","volume":"25","author":"Wang","year":"2020","journal-title":"Mol. Psychiatry"},{"key":"ref_8","first-page":"673","article-title":"The Medical Treatment of Homeless People","volume":"114","author":"Kaduszkiewicz","year":"2017","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1055\/a-1498-1581","article-title":"Inanspruchnahme von Gesundheitsleistungen bei Obdachlosen: Ergebnisse der Hamburger Obdachlosenbefragung","volume":"84","author":"Hajek","year":"2022","journal-title":"Gesundheitswesen"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/phn.13027","article-title":"Services for homeless people in Germany during the COVID-19-pandemic: A descriptive study","volume":"39","author":"Koppe","year":"2022","journal-title":"Public Health Nurs."},{"key":"ref_11","unstructured":"Bundesministerium f\u00fcr Gesundheit (BMG) (2024, February 27). Infektionsradar: Infektionsgeschehen: 7-Tage-Inzidenz. Available online: https:\/\/infektionsradar.gesund.bund.de\/de\/covid\/inzidenz."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1093\/aje\/kwf182","article-title":"Socioeconomic inequalities in depression: A meta-analysis","volume":"157","author":"Lorant","year":"2003","journal-title":"Am. J. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"114350","DOI":"10.1016\/j.psychres.2021.114350","article-title":"Prevalence and determinants of depression and anxiety measured by the PHQ-4 among homeless individuals during the COVID-19 pandemic. Evidence from the Hamburg survey of homeless individuals","volume":"308","author":"Hajek","year":"2022","journal-title":"Psychiatry Res."},{"key":"ref_14","unstructured":"COVID-19 Mental Disorders Collaborators (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet, 398, 1700\u20131712."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a Brief Depression Severity Measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection","volume":"146","author":"Kroenke","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"ref_17","first-page":"613","article-title":"An Ultra-Brief Screening Scale for Anxiety and Depression: The PHQ\u20134","volume":"50","author":"Kroenke","year":"2009","journal-title":"Psychosomatics"},{"key":"ref_18","first-page":"19","article-title":"The ETHOS Definition and Classification of Homelessness: An Analysis","volume":"5","author":"Amore","year":"2011","journal-title":"Eur. J. Homelessness"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00127-003-0627-2","article-title":"Social inequalities and the common mental disorders: A systematic review of the evidence","volume":"38","author":"Fryers","year":"2003","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1353\/hpu.2010.0926","article-title":"Mental health correlates of past homelessness in the National Comorbidity Study Replication","volume":"21","author":"Greenberg","year":"2010","journal-title":"J. Health Care Poor Underserved"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Hajek, A., and K\u00f6nig, H.-H. (2021). The Prevalence and Correlates of Probable Major Depressive Disorder and Probable Generalized Anxiety Disorder during the COVID-19 Pandemic. Results of a Nationally Representative Survey in Germany. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182312302"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hajek, A., and K\u00f6nig, H.-H. (2020). Prevalence and Correlates of Individuals Screening Positive for Depression and Anxiety on the PHQ-4 in the German General Population: Findings from the Nationally Representative German Socio-Economic Panel (GSOEP). Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17217865"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"D\u2018Urso, G., Pomes, M.V., Magliacano, A., Iuliano, C., Lamberti, H., Manzo, M., Mariniello, T.S., Iasevoli, F., and de Bartolomeis, A. (2023). Depression and Anxiety Symptoms \u201cAmong the Waves\u201c of the COVID-19 Pandemic in Obsessive Compulsive Disorder and Adjustment Disorder Patients. Healthcare, 11.","DOI":"10.3390\/healthcare11091261"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.jad.2022.09.142","article-title":"Longitudinal impact of the COVID19 pandemic on mental health in a general population sample in France: Evidence from the COMET Study","volume":"320","author":"Moulin","year":"2023","journal-title":"J. Affect. Disord."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Fazel, S., Khosla, V., Doll, H., and Geddes, J. (2008). The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS Med., 5.","DOI":"10.1371\/journal.pmed.0050225"},{"key":"ref_26","first-page":"100243","article-title":"Depression during the COVID-19 pandemic amongst residents of homeless shelters in France","volume":"6","author":"Scarlett","year":"2021","journal-title":"J. Affect. Disord. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e2117035","DOI":"10.1001\/jamanetworkopen.2021.17035","article-title":"Factors Associated With Symptoms of Depression and Anxiety Among Women Experiencing Homelessness and Unstable Housing During the COVID-19 Pandemic","volume":"4","author":"Riley","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_28","first-page":"665","article-title":"The Prevalence of Mental Illness in Homeless People in Germany","volume":"114","author":"Schreiter","year":"2017","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1017\/S003329171200147X","article-title":"Global prevalence of anxiety disorders: A systematic review and meta-regression","volume":"43","author":"Baxter","year":"2013","journal-title":"Psychol. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1001\/archgenpsychiatry.2009.36","article-title":"Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys","volume":"66","author":"Seedat","year":"2009","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_31","first-page":"76","article-title":"Mental illness in homeless men and women in Munich","volume":"26","author":"Fichter","year":"1999","journal-title":"Psychiatr. Prax."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S282","DOI":"10.2105\/AJPH.2013.301302","article-title":"Substance-use disorders and poverty as prospective predictors of first-time homelessness in the United States","volume":"103","author":"Thompson","year":"2013","journal-title":"Am. J. Public Health"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Grinman, M.N., Chiu, S., Redelmeier, D.A., Levinson, W., Kiss, A., Tolomiczenko, G., Cowan, L., and Hwang, S.W. (2010). Drug problems among homeless individuals in Toronto, Canada: Prevalence, drugs of choice, and relation to health status. BMC Public Health, 10.","DOI":"10.1186\/1471-2458-10-94"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Gutwinski, S., Schreiter, S., Deutscher, K., and Fazel, S. (2021). The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLoS Med., 18.","DOI":"10.1371\/journal.pmed.1003750"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1034\/j.1600-0447.2001.00217.x","article-title":"Prevalence of mental illness in homeless men in Munich, Germany: Results from a representative sample","volume":"103","author":"Fichter","year":"2001","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Moussaoui, S., Vignier, N., Guillaume, S., Jusot, F., Marsaudon, A., Wittwer, J., and Dourgnon, P. (2024). Pain as a Symptom of Mental Health Conditions Among Undocumented Migrants in France: Results From a Cross-Sectional Study. Int. J. Public Health, 69.","DOI":"10.3389\/ijph.2024.1607254"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Chinchilla, M., Lulla, A., Agans, D., Chassman, S., Gabrielian, S.E., and Young, A.S. (2024). Pathways to social integration among homeless-experienced adults with serious mental illness: A qualitative perspective. BMC Health Serv. Res., 24.","DOI":"10.1186\/s12913-024-11678-6"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1177\/0020764014522776","article-title":"Homeless and incarcerated: An epidemiological study from Canada","volume":"60","author":"Saddichha","year":"2014","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1016\/S0140-6736(14)61133-8","article-title":"Health interventions for people who are homeless","volume":"384","author":"Hwang","year":"2014","journal-title":"Lancet"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1111\/hsc.13486","article-title":"The physical and mental health effects of housing homeless people: A systematic review","volume":"30","author":"Onapa","year":"2022","journal-title":"Health Soc. Care Community"},{"key":"ref_41","unstructured":"European Comission (2024, January 18). The European Pillar of Social Rights Action Plan. Available online: https:\/\/ec.europa.eu\/social\/main.jsp?catId=1607&langId=en."},{"key":"ref_42","unstructured":"Bundesministerium f\u00fcr Wohnen, Stadtentwicklung und Bauwesen (2026, January 19). Gemeinsam f\u00fcr ein Zuhause: Nationaler Aktionsplan gegen Wohnungslosigkeit 2024. Available online: https:\/\/www.bmwsb.bund.de\/SharedDocs\/downloads\/DE\/publikationen\/wohnen\/NAP.pdf?__blob=publicationFile&v=6."},{"key":"ref_43","first-page":"861","article-title":"The Mental and Physical Health of the Homeless\u2013Evidence from the National Survey on Psychiatric and Somatic Health of Homeless Individuals (the NAPSHI Study)","volume":"119","author":"Bertram","year":"2022","journal-title":"Dtsch. Arztebl. Int."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/2\/154\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T05:13:52Z","timestamp":1770095632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/2\/154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":43,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["ijerph23020154"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23020154","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]}}}