Homeless individuals and their vulnerability to pain, depression, and sleep: narrative review
Pessoas em situação de rua e sua vulnerabilidade à dor, depressão e sono: revisão narrativa
Natália Tavares Braga; Lucas Soares Brito; João Batista Santos Garcia
Abstract
Keywords
Resumo
JUSTIFICATIVA E OBJETIVOS: A pesquisa se origina da escassez de dados oficiais sobre a população em situação de rua e das desafiadoras realidades enfrentadas por esse grupo, como a invisibilidade social e o acesso precário aos serviços de saúde. O objetivo principal foi conduzir uma revisão narrativa para compreender a interconexão entre a dor crônica (DC), a depressão e distúrbios do sono nessa população, identificando fatores-chave que desempenham um papel nessas condições.
CONTEÚDO: O estudo empregou uma revisão narrativa qualitativa, realizando uma busca abrangente nas bases de dados Web of Science e Scopus sem restrições temporais. Utilizou-se descritores em inglês relacionados à situação de rua, depressão e distúrbios do sono. Mais de 100 milhões de pessoas estão em situação de rua globalmente, sendo o Brasil especialmente impactado por esse fenômeno devido à crise econômica. A prevalência de DC nesse grupo está vinculada às condições precárias de vida, discriminação e exposição à violência. O prejuízo da qualidade do sono, a depressão e a relação bidirecional entre DC e transtornos depressivos são destacadas. A vulnerabilidade social, a falta de acesso a recursos de saúde e as adversidades das condições de vida contribuem para a complexidade dos desafios enfrentados por essa população em situação de rua, impactando negativamente na saúde geral.
CONCLUSÃO: Pessoas em situação de rua enfrentam maior vulnerabilidade a lesões, depressão e distúrbios do sono. A relação entre dor e depressão é bidirecional, agravada pelas adversidades vivenciadas. É crucial implementar políticas de saúde específicas e eficazes para melhorar as condições de vida, promovendo equidade e justiça social para essa população vulnerável e fragilizada.
Palavras-chave
References
1 Andrade LP, Costa SL, Marquetti FC. A rua tem um ímã, acho que é a liberdade: potência, sofrimento e estratégias de vida entre moradores de rua na cidade de Santos, no litoral do Estado de São Paulo. Saúde Soc. 2014;23(4):1248-61.
2 Varanda W, Adorno RC. Descartáveis urbanos: discutindo a complexidade da população de rua e o desafio para políticas de saúde. Saúde Soc. 2004;56-69P.
3 Cunha JV, Rodrigues M. Rua: aprendendo a contar. Pesquisa nacional sobre população em situação de rua. Bvs Alud Org. 2023;233-3.
4 Natalino MA. Estimativa da população em situação de rua no Brasil. Econstor. 2016.
5 Natalino M. Estimativa da População em situação de rua no Brasil (2012-2022). Instituto de Pesquisa Econômica Aplicada. 2022;(1):11-2.
6 Hungaro AA, Gavioli A, Christóphoro R, Marangoni SR, Altrão RF, Rodrigues AL, et al. Pessoas em situação de rua: caracterização e contextualização por pesquisa censitária. Rev Bras Enferm. 2020;73:e20190236.
7 Silva GF, Giacomelli ET, Campos TA, Davantel IA, Schroeder TM. Pessoas em situação de rua: estratégias adotadas na pandemia. Cuad Educ. 2020.
8 Leibler JH, Nguyen DD, León C, Gaeta JM, Pérez D. Personal hygiene practices among urban homeless persons in Boston, MA. Int J Environ Res Public Health. 2017;14(8):928-8.
9 Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014;384(9953):1529-40.
10 Aguiar MM, Iriart JA. Significados e práticas de saúde e doença entre a população em situação de rua em Salvador, Bahia, Brasil. Cad Saude Publica. 2012;28(1):115-24.
11 Campos AG, Victor ES, Seeley M, Leão ER. Pain in Brazilian people experiencing homelessness. Pain Rep. 2019;4(6):e792-2.
12 Hino P, Santos JO, Rosa ADS. People living on the street from the health point of view. Rev Bras Enferm. 2018;71(Suppl 1):684-692.
13 Botti NC, Castro CG, Silva MF, Silva AK, Oliveira LC, Castro AC, et al. Prevalência de depressão entre homens adultos em situação de rua em Belo Horizonte. J Bras Psiquiatr. 2010;59(1):10-6.
14 Chan S, Wong H, Chen Y, Tang MV. Determinants of depression and anxiety in homeless people: a population survey of homeless people in Hong Kong - Siu-Ming Chan, Hung Wong, Yikang Chen, Mun-Yu Vera Tang, 2023. Int J Soc Psychiatry. 2023;1-12.
15 Toro PA, Tompsett CJ, Lombardo S, Philippot P, Nachtergael H, Galand B, et al. Homelessness in Europe and the United States: a comparison of prevalence and public opinion. J Soc Issues. 2007;63(3):505-24.
16 Dahlhamer JM, Lucas JW, Zelaya C, Nahin RL, Mackey S, DeBar L, et al. Prevalence of chronic pain and high-impact chronic pain among adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001-6.
17 Schopflocher D, Taenzer P, Jovey RD. The prevalence of chronic pain in Canada. Pain Res Manage. 2011;16(6):445-50.
18 Yongjun Z, Tingjie Z, Xiaoqiu Y, Zhiying F, Feng Q, Guangke X, Jinfeng L, Fachuan N, Xiaohong J, Yanqing L. A survey of chronic pain in China. Libyan J Med. 2020;15(1):1730550.
19 Saxena AK, Jain PN, Bhatnagar S. The prevalence of chronic pain among adults in India. Indian J Palliat Care. 2018;24(4):472-2.
20 Aguiar DP, Souza CP, Barbosa WJ, Santos-Júnior FF, Oliveira AS. Prevalence of chronic pain in Brazil: systematic review. BrJP. 2021;4(3):257-67.
21 Vieira EB, Garcia JB, Silva AA, Araújo RL, Jansen RC. Prevalence, characteristics, and factors associated with chronic pain with and without neuropathic characteristics in São Luís, Brazil. J Pain Symptom Manage. 2012;44(2):239-51.
22 Elzahaf RA, Tashani OA, Unsworth BA, Johnson MI. The prevalence of chronic pain with an analysis of countries with a Human Development Index less than 0.9: a systematic review without meta-analysis. Curr Med Res Opin. 2012;28(7):1221-9.
23 Hallais JA, Barros NF. Consultório na rua: visibilidades, invisibilidades e hipervisibilidade. Cad Saude Publica. 2015;31(7):1497-504.
24 Matter R, Kline S, Cook KF, Amtmann D. Measuring pain in the context of homelessness. Quality Life Res. 2009;18(7):863-72.
25 Klein JW, Reddy S. Care of the Homeless Patient. Med Clin North Am. 2015;99(5):1017-38.
26 Vogel M, Choi F, Westenberg JN, Cabanis M, Nikoo N, Nikoo M, Hwang SW, Somers J, Schütz CG, Krausz M. Chronic pain among individuals experiencing homelessness and its interdependence with opioid and other substance use and mental illness. Int J Environ Res Public Health. 2021;19(1):5.
27 Bicket MC, Park JN, Torrie A, Allen ST, Weir BW, Sherman SG. Factors associated with chronic pain and non-medical opioid use among people who inject drugs. Addict Behav. 2020;102:106172.
28 Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain. 2020;161(9):1976-82
29 Vogel M, Frank A, Choi F, Strehlau V, Nikoo N, Nikoo M, Hwang SW, Somers J, Krausz MR, Schütz CG. Chronic pain among homeless persons with mental illness. Pain Med. 2017;18(12):2280-8.
30 Treede RD, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Kosek E, Lavand’homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang SJ. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003-7.
31 Fisher R, Ewing J, Garrett A, Harrison EK, Lwin KK, Wheeler DW. The nature and prevalence of chronic pain in homeless persons: an observational study. F1000Res. 2013;2:164
32 Hwang SW, Wilkins E, Chambers C, Estrabillo E, Berends J, MacDonald A. Chronic pain among homeless persons: characteristics, treatment, and barriers to management. BMC Fam Pract. 2011;12:73.
33 Landefeld JC, Miaskowski C, Tieu L, Ponath C, Lee CT, Guzman D, Kushel M. Characteristics and factors associated with pain in older homeless individuals: results from the health outcomes in people experiencing homelessness in older middle age (HOPE HOME) study. J Pain. 2017;18(9):1036-45.
34 Fraser KA, Nguyen H, Kim S, Park F, Bernal J, Westberg AD, Podawiltz A. Perceptions of nonopioid treatment for pain in a homeless population. J Osteopath M. 2021;121(7):643-9.
35 Barata RB, Carneiro N, Ribeiro MC, Silveira C. Desigualdade social em saúde na população em situação de rua na cidade de São Paulo. Saúde Soc. 2015;24(Suppl 1):219-32.
36 Carneiro N, Nogueira EA, Lanferini GM, Ali DA, Martinelli M. Serviços de saúde e população de rua: contribuição para um debate. Saúde Soc. 1998;7(2):47-62.
37 Bauer LK, Brody JK, León C, Baggett TP. Characteristics of homeless adults who died of drug overdose: a retrospective record review. J Health Care Poor Underserved. 2016;27(2):846-59.
38 Reuven SM, Chen TA, Zvolensky MJ, Businelle MS, Kendzor DE, Reitzel LR. Examining the moderating effect of anxiety sensitivity on past-month pain severity and heaviness of smoking among adult smokers experiencing homelessness. Addict Behav. 2021;112:106610-0.
39 Fishbain DA, Lewis JE, Cole B, Cutler RB, Rosomoff HL, Rosomoff RS. Variables associated with current smoking status in chronic pain patients. Pain Med. 2007;8(4):301-11.
40 Helme RD, Gibson SJ. The epidemiology of pain in elderly people. Clin Geriatr Med. 2001;17(3):417-31.
41 Miller LR, Caño A. Comorbid chronic pain and depression: who is at risk? J Pain. 2009;10(6):619-27.
42 Culhane DP, Metraux S, Byrne T, Stino M, Bainbridge J. The age structure of contemporary homelessness: evidence and implications for public policy. Analyses Social Issues Public Policy. 2013;13(1):228-44.
43 Brown RT, Kiely DK, Bharel M, Mitchell SL. Geriatric syndromes in older homeless adults. J Gen Intern Med. 2011;27(1):16-22.
44 Lim GY, Tam WW, Lu Y, Ho CS, Zhang MW, Ho RC. Prevalence of depression in the community from 30 countries between 1994 and 2014. Sci Rep. 2018;8(1):2861. Erratum in: Sci Rep. 2022;12(1):14856.
45 Fiske A, Wetherell JL, Gatz M. Depression in older adults. Annu Rev Clin Psychol. 2009;5:363-89.
46 Currie SR, Wang J. Chronic back pain and major depression in the general Canadian population. Pain. 2004;107(1):54-60.
47 Munce SE, Stewart DE. Gender differences in depression and chronic pain conditions in a national epidemiologic survey. Psychosomatics. 2007;48(5):394-9.
48 Zimmerman FJ, Katon W. Socioeconomic status, depression disparities, and financial strain: what lies behind the income-depression relationship? Health Econ. 2005;14(12):1197-215.
49 Pangarkar SS, Chang LE. Chronic pain management in the homeless population. Springer eBooks. 2021;41-68.
50 Yao C, Zhang Y, Lu P, Xiao B, Sun P, Tao J, Cheng Y, Kong L, Xu D, Fang M. Exploring the bidirectional relationship between pain and mental disorders: a comprehensive Mendelian randomization study. J Headache Pain. 2023;24(1):82.
51 Lépine J, Briley M. The epidemiology of pain in depression. Hum Psychopharmacol. 2004;19(S1):S3-7.
52 Nolen-Hoeksema S, Ahrens C. Age differences and similarities in the correlates of depressive symptoms. Psychol Aging. 2002;17(1):116-24.
53 Poleshuck EL, Green CR. Socioeconomic disadvantage and pain. Pain. 2008;136(3):235-8.
54 Rustøen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Gender differences in chronic pain-findings from a population-based study of Norwegian adults. Pain Manag Nurs. 2004;5(3):105-17.
55 Rustøen T, Wahl AK, Hanestad BR, Lerdal A, Paul S, Miaskowski C. Age and the experience of chronic pain. Clin J Pain. 2005;21(6):513-23.
56 de Heer EW, Gerrits MM, Beekman AT, Dekker J, van Marwijk HW, de Waal MW, Spinhoven P, Penninx BW, van der Feltz-Cornelis CM. The association of depression and anxiety with pain: a study from NESDA. PLoS One. 2014;9(10):e106907.
57 Fond G, Tinland A, Boucekine M, Girard V, Loubière S, Boyer L, Auquier P; French Housing First Study Group. The need to improve detection and treatment of physical pain of homeless people with schizophrenia and bipolar disorders. Results from the French Housing First Study. Prog Neuropsychopharmacol Biol Psychiatry. 2019;88:175-180.
58 Travaglini LE, Kuykendall L, Bennett ME, Abel EA, Lucksted A. Relationships between chronic pain and mood symptoms among veterans with bipolar disorder. J Affect Disord. 2020;277:765-71.
59 Kim YJ, Boyas JF, Lee KH, Jun JS. Suicidality among homeless people: testing the mediating effects of self-efficacy and depression. J Hum Behav Soc Environ. 2019.
60 Brewer-Smyth K, Kafonek K, Koenig HG. A pilot study on sleep quality, forgiveness, religion, spirituality, and general health of women living in a homeless mission. Holist Nurs Pract. 2020;34(1):49-56.
61 Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017;32:246-56.
62 Pines A. Sleep duration and midlife women’s health. Climacteric. 2017;20(6):528-30.
63 Gonzalez A, Tyminski Q. Sleep deprivation in an American homeless population. Sleep Health. 2020;6(4):489-94.
64 Léger D, Beck F, Richard JB. Sleep Loss in the Homeless-an additional factor of precariousness. JAMA Intern Med. 2017;177(2):278-8.
65 Kamaleri Y, Natvig B, Ihlebæk CM, Jūratė SB, Bruusgaard D. Number of pain sites is associated with demographic, lifestyle, and health-related factors in the general population. Eur J Pain. 2008;12(6):742-8.
66 Ninditi AA. Street P. Contextualization of social conditions and public policies through a descriptive review. Ijaerscom. 2022;9(11).
67 SC. Disaster planning for homeless populations: analysis and recommendations for communities. Prehosp Disaster Med. 2020;35(3):322-5.
68 Amieva H, Ouvrard-Brouillou C, Dartigues JF, Pérès K, Tabue Teguo M, Avila-Funes A. Social vulnerability predicts frailty: towards a distinction between fragility and frailty? J Frailty Aging. 2022;11(3):318-23.
69 Mah JC, Penwarden JL, Pott H, Theou O, Andrew MK. Social vulnerability indices: a scoping review. BMC Public Health. 2023;23(1):1253.
70 Reitzel LR, Chinamuthevi S, Daundasekara SS, Hernandez DC, Chen TA, Harkara Y, Obasi EM, Kendzor DE, Businelle MS. Association of problematic alcohol use and food insecurity among homeless men and women. Int J Environ Res Public Health. 2020;17(10):3631.
71 Alessandrini G, Ciccarelli R, Battagliese G, Cereatti F, Gencarelli S, Messina MP, Vitali M, De Rosa F, Ledda R, Mancini S, Attilia ML; Interdisciplinary Study Group CRARL - SITAC - SIPaD - SITD - SIPDip. Treatment of alcohol dependence. Alcohol and homelessness: social point of view. Rev Psichiatr. 2018;53(3):107-12.
Submitted date:
11/22/2023
Accepted date:
04/22/2024