The prevalence of mental illness in homeless children: a systematic review and meta-analysis.

Objective: The numbers of children experiencing homelessness have increased. To develop responsive interventions, we must understand their mental health/behavioral needs. The purpose of this systematic review was to update the evidence base by identifying, appraising, and summarizing studies on the prevalence of mental health issues among homeless children, comparing these individuals to low-income-housed children, and discussing research, practice, and policy implications.

Method: We searched 3 electronic databases and included empirical studies investigating the prevalence of mental illness in homeless children in the United States (1990-2014). Retrieved publications were screened, data extracted, and study quality appraised by independent reviewers. Evidence synthesis was based on qualitative and quantitative analyses. Prevalence odds ratios (OR) of individual studies were pooled using an inverse-variance random effects model.

Results: Twelve studies were included and reviewed. Overall, 10% to 26% of homeless preschoolers had mental health problems requiring clinical evaluation. This proportion increased to 24% to 40% among homeless school-age children, a rate 2 to 4 times higher than poor children aged 6 to 11 years in the National Survey of America's Families. According to our meta-analyses, the difference in prevalence measured by Child Behavior Checklist (CBCL) Total Problems (T score ≥60-64) was not significantly different between homeless and housed preschool children (OR = 1.49; 95% CI = 0.97-2.28). School-age homeless children compared to housed children were significantly more likely to have a mental health problem as defined by the CBCL Total Problems subscale (T score ≥60; OR = 1.78; 95% CI = 1.19-2.66).

Conclusion: Evidence-based mental health interventions for children experiencing homelessness are long overdue. Universal screening, treatment plan development, and support of adaptive systems that focus on positive parenting and children's self-regulation are essential.