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A systematic review and meta-analysis of mental disorders in homeless children, adolescents and youths

Nature Mental Health (2026)Cite this article

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Abstract

Global homelessness is a rapidly increasing humanitarian crisis, affecting 120 million individuals worldwide. However, the prevalence of mental disorders in homeless young people globally is unknown; our study aimed to address this gap. In this systematic review and meta-analysis, we searched PubMed, Embase, Scopus and Web of Science from January 1990 to 16 October 2024 for research articles in any language that reported any mental disorders for the homeless under the mean age of 24 years by reliable diagnostic methods. Studies with a response rate <50%, a sample size <50 and those that did not report the original data were excluded. Subgroup analyses and meta-regression were conducted to examine the potential factors influencing heterogeneity of prevalence. The study was registered with PROSPERO (CRD42024570399). Of the 33,600 reports identified, 45 from nine countries (73.3% from the USA) were included in this systematic review and meta-analyses. The studies encompassed 25,320 participants: 50.5% male and 48.3% female. The random-effects meta-analysis of mental disorders indicated that substance use disorders had the highest pooled point prevalence among homeless children, adolescents and youth (29.2% (95% CI 17.7–42.3%)), followed by conduct disorder (24.4% (95% CI 8.3–45.4%)), depressive disorders (21.3% (95% CI 16.7–26.4%)), anxiety disorders (16.3% (95% CI 9.9–23.9%)), posttraumatic stress disorder (14.8% (95% CI 10.8–19.3%)), bipolar and related disorders (13.0% (95% CI 4.8–24.2%)), ADHD (12.9% (95% CI 7.5–19.5%)) and schizophrenia spectrum disorders (5.4% (95% CI 1.8–10.6%)). The lifetime prevalence ranged from 12.5% (anxiety disorders) to 71.5% (conduct disorder). Subgroup and meta-regression analyses revealed key gaps: small samples, few post 2020 studies and major underrepresentation of Asian and African populations. Individuals aged 18–24 were at higher clinical risk. Conduct, anxiety and substance use disorders were more common in males; depressive disorders were more common in females. Overall, homeless children, adolescents and youth face markedly elevated risks for mental disorders, especially substance use and conduct disorders. Urgent, integrative tertiary prevention interventions and further research are needed to support this vulnerable group.

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Fig. 1: PRISMA flow diagram of study selection.
Fig. 2: Tertiary strategies of public health tiers of prevention and policy based on meta-analysis.

Data availability

This is a systematic review and meta-analysis article based on findings in published literature and did not involve analysis of newly generated data. The extracted data are available via GitHub at https://github.com/tuoyanghesuan/meta-homeless/tree/main.

Code availability

The code used for data analysis is available via GitHub at https://github.com/tuoyanghesuan/meta-homeless/tree/main.

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Acknowledgements

S.C. was supported by grants from the National Programs for Brain Science and Brain-like Intelligence Technology-National Science and Technology Major Project (grant no. 2021ZD0200800), the National Natural Science Foundation of China (grant no. 32170613) and the Clinical Medicine Plus X - Young Scholars Projects, Peking University, the Fundamental Research Funds for the Central Universities.

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  1. These authors contributed equally: Lingxue Luo, Kangpeng Li.

Authors and Affiliations

  1. NHC Key Laboratory of Mental Health, Institute of Mental Health, Peking University, Beijing, China

    Lingxue Luo, Lin Lu & Suhua Chang

  2. National Clinical Research Center for Mental Disorders, Peking University Sixth Hospital, Beijing, China

    Lingxue Luo, Lin Lu & Suhua Chang

  3. Peking University Third Hospital, Beijing, China

    Kangpeng Li

  4. Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Xinyu Zhou

  5. National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China

    Yanping Bao & Lin Lu

  6. School of Public Health, Peking University, Beijing, China

    Yanping Bao

  7. Henan Collaborative Innovation Center of Prevention and Treatment of Mental Disorder, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China

    Suhua Chang

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Contributions

L. Luo and K.L. contributed equally in first authorship. L. Luo and K.L. screened the literature, extracted the data and performed the statistical analyses. S.C. and L. Lu managed and coordinated research planning and execution. S.C., L. Lu, Y.B. and X.Z. reviewed the data. All authors interpreted the results, critically reviewed and commented on the article, and approved the final version. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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Correspondence to Lin Lu or Suhua Chang.

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Luo, L., Li, K., Zhou, X. et al. A systematic review and meta-analysis of mental disorders in homeless children, adolescents and youths. Nat. Mental Health (2026). https://doi.org/10.1038/s44220-026-00616-6

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