Complex Trauma and PTSD

Literature Search

Complex trauma and PTSD

Literature reviews

(Bassuk, Melnick et al. 1998) / US / Americans have started to recognize interpersonal violence as a major health care issue. Increasingly, clinicians are beginning to recognize both the high rate of victimization among extremely poor women and its health consequences. However, most clinical responses focus on the immediate effects of child abuse, partner abuse, and rape. The long-term medical and mental health consequences and the relationship between early victimization and adult problems are still largely ignored. This article focuses on medical and mental health needs of extremely poor women survivors of interpersonal violence. It begins by documenting the extent and nature of violence against low-income women. Special attention is focused on the long-term sequelae of childhood abuse and on identifying and managing complex trauma responses in these women. The article concludes by discussing obstacles to care and the necessity of advocating for increased resources to respond to women living in extreme poverty.
(Kim and Ford 2006) / US / As the prevalence of homelessness among men increases, the impact of trauma and post-traumatic stress disorder in the lives of homeless men warrants attention. We will review research and clinical reports on the impact of traumatic event exposure, the antecedents and consequences of traumatic events, and homelessness among males in order to begin to develop scientific, public health, and social policy answers to several questions. The nascent clinical and scientific literature provides evidence of the need for prospective studies of the etiology, epidemiology, course, and prevention of post-traumatic stress disorder among males who are at risk for or in the early stages of homelessness. We attempt to summarize, categorize, and suggest important variables and causal relationships that can inform future research studies and interventions in order to contribute to the growth of this underdeveloped and important knowledge base
(Tischler, Edwards et al. 2009) / UK / Homelessness is recognised to be a traumatic event in itself and is often preceded by the experience of violence. More recent research has indicated that homelessness can function to enact growth and resilience in women with dependent children. This review paper draws together findings from a series of studies involving women with dependent children who experience homelessness. It identifies key psychosocial and health priorities in this population and how findings related to resilience and growth can be harnessed in therapeutic work. Pragmatic service developments and examples of good practice in therapeutic and multi-agency interventions from the domestic violence and homelessness literature are described and recommendations are made for developing services and working therapeutically with marginalised and transient populations. Therapists need to work in a flexible and integrated way with other key services, so that the crisis and long term needs of this population are met
(Thompson and Carll 2007) -youth homelessness including why youth become homeless and trauma and homeless youth / US / Homeless adolescents are some of this nation's most vulnerable and underserved youth and comprise approximately one-quarter of all people who are homeless (Cauce et al., 2000). Homelessness among youth populations has serious consequences for public health. Topics discussed in this chapter include why youth become homeless; homeless youth victimization; trauma and homeless youth; homeless youth case vignettes; intervention options and recommendations; and social policy implications.

Research Articles suggesting link between complex trauma/ PTSD and homelessness

Reference / n / Country / Population / Method/measures / type / Outcome
(Andres-Lemay, Jamieson et al. 2005) / 3760 / Canada / adolescent / Survey / Age of homelessness correlated with child trauma / Respondents who reported physical abuse only, sexual abuse only, and physical abuse with sexual abuse were 2 to 4 times more likely to report running away from home before age 16 years. Parental psychiatric disorder, respondent psychiatric disorder, respondent age, and income were also significant correlates of running away.
(Bassuk, Dawson et al. 2001) / 425 / US / Women
Shelter / Longitudinal study / Homeless vs poor / We found that extremely poor women with lifetime PTSD were more likely to have grown up in family environments of violence, threat, and anger than those without PTSD. The strongest risk factor for PTSD was childhood sexual abuse with threat. Many low-income women have difficulty using medical care appropriately because of childhood histories of physical and sexual abuse, the subsequent development of post-trauma responses, and structural barriers to care. Given these factors, it is critical that health care clinicians routinely screen for histories of violence and PTSD and develop treatment plans that ensure safety, link current symptoms with prior experiences, and provide support as necessary. A team approach coordinated by a case manager may be the best strategy. Without routine screening for PTSD and sensitive treatment, many extremely poor women will receive compromised health care and may even be retraumatized.
(Bearsley-Smith, Bond et al. 2008) / H- 137
a-r
766
n-r
4844 / Australia / adolescent / Chamberlain and Mackenzies self-report scale / Homeless (H) vs at-risk(a-r) vs students (n-r) / In multivariate analyses, homeless and at risk adolescents reported equivalent levels of family conflict, early problem behaviour and low opportunities and rewards for family involvement. Compared to adolescents not at risk, at risk adolescents were more likely to be female and to show poorer social skills/assertiveness and depressive symptoms. Compared to at risk adolescents, homeless adolescents showed additional family, school, peer and individual risks, but lower depressive symptomatology.
(Belcher, Greene et al. 2001) / US / No abstract
(Blankertz, Cnaan et al. 1993) / US / Adults, dual diagnosis / Risk factors / This article examines the prevalence of these five childhood risk factors among dually diagnosed (mentally ill and substance abusing) homeless adults in rehabilitation programs. It further assesses the impact of each risk factor individually and in combinations of two on the social functioning skills and rehabilitation progress of these multiply disadvantaged clients.
(Browne 1993) / US / women / prevalence / Higher lifetime rates of childhood physical and sexual abuse. This can increase vulnerability to homelessness Some of the manifestations of traumatic victimization can be systematized in terms of posttraumatic stress disorder (PTSD).
(Browne and Bassuk 1997) / h-220
p-216 / US / Women / Prevalence abuse homeless (h) vs poor / nearly two-thirds reported severe physical violence by a childhood caretaker, 42% reported childhood sexual molestation, and 61% reported severe violence by a male partner. Comparisons of homeless and housed women are presented, and implications for prevention and intervention are discussed in light of recent welfare reform legislation
(Buhrich, Hodder et al. 2000) / 157 / Australia / Composite International Diagnostic interview / prevalence / All women and over 90% of men reported at least one event of trauma in their life. Fifty-eight per cent suffered serious physical assault and 55% witnessed someone being badly injured or killed. Half the women and 10% of men reported that they had been raped. CONCLUSION: The experience of at least one lifetime event of trauma is almost universal among homeless people in Sydney and is considerably higher than for the USA general population. Reasons for such high prevalence rates are discussed. Depression and posttraumatic stress disorder are associated with a history of trauma. Health professionals need to be aware of past events of trauma among individuals who are homeless.
(Cauce, Paradise et al. 2000) / 364 / US / adolescents / Diagnostic interview and self-report measures / reasons / Results of analyses suggest that homeless youth come from generally troubled backgrounds and have elevated rates of psychiatric disorders. For boys, their histories typically include physical abuse during childhood, physical assault on the street, and elevated rates of externalizing disorders. For girls, histories are more often marked by sexual abuse during childhood, sexual victimization on the streets, and elevated rates of internalizing disorders. Implications of these results for service delivery are discussed.
(Craig and Hodson 1998) / 268 / UK / Young people (under 22 years) / Homeless vs. domiciled / The evidence presented in this paper supports the hypotheses that characterize the young homeless population as experiencing higher rates of childhood adversity and psychiatric disorder than their domiciled contemporaries. A tentative model is suggested whereby childhood experiences, educational attainment and the prior presence of psychiatric disorder all independently increase the likelihood of homelessness in a youthful population
(Davies-Netzley, Hurlburt et al. 1996) / 120 / US / Women, severe mental illness / prevalence / The prevalence of childhood abuse in this sample of women was substantially higher than among homeless women in general. The experience of childhood abuse was related to increased suicidality, and resulted in symptoms of posttraumatic stress disorder for some women. Women who had suffered abuse were also much more likely to become homeless during childhood and it is suggested that this is an important precursor to homelessness for many homeless women with chronic and severe mental illness.
(Goodman, Saxe et al. 1991) / n/a / US / Risk factors / Homelessness is a risk factor for psychological trauma, including implications of trauma theory improving psychosocial conditions of homelessness.
(Goodman 1991) / 50 each / US / mothers / Homeless vs housed / The only between-group difference was that a significantly higher proportion of housed mothers had experienced sexual abuse in adulthood. However, both groups had high lifetime prevalence rates for all forms of abuse. Data suggest that mental health services are urgently needed for both populations because of the traumatic psychological effects produced by homelessness and abuse.
(Gwadz, Nish et al. 2007) / 85 / US / Youth
Drop-in Centre / Structured interview / prevalence / Rates of childhood maltreatment were substantial. Further, almost all youth experienced at least one traumatic event, with most experiencing multiple types of trauma. Gender differences were found in the types, but not prevalence or magnitude, of childhood maltreatment and traumatic events experienced. Partial symptomatology of PTSD was common for females but not males. Symptoms of depression and anxiety were found to co-occur with PTSD for females, which may complicate treatment efforts.
(Feitel, Margetson et al. 1992) / 150 / US / Youth
Shelter / Interview DSM-IIIR / prevalence / Most of the respondents came from backgrounds characterized by severe emotional deprivation and physical or sexual abuse. Of the 140 who completed the full interview, 90 percent fulfilled DSM-III-R criteria for an emotional or behavioral disorder. Fifty-nine percent had conduct disorder, three-quarters were depressed, 41 percent had considered suicide, and more than one-quarter had attempted suicide
(Heffron, Skipper et al. 1995) / US / Health clinic / Homeless vs 2 other groups / Significant differences in families of origin among these three groups were identified. On univariate analysis, homeless persons were found to have an increased prevalence of alcoholism in the family of origin, earlier departure from the home, minority status, a self-described negative childhood, experiences of abuse as a child, high birth order in large families, less parental education, less-skilled parental occupations, less feeling of love in the childhood family, less likelihood of the father being in the home, more risk of the father having been in jail, and less identification with a religious group. Multivariate analysis revealed that compared to the study groups, the following family of origin factors were associated with homelessness: ethnic group, alcoholism, feeling loved as a child, and having one's father in jail.
(Herman, Susser et al. 1997) / h-92 nh-395 / US / adult / Structured interview including scale for lack of care from parents and single items for abuse Validated scale / Risk factors
Homeless(h) vs non-homeless(nh) / Lack of care from a parent during childhood sharply increased the likelihood of subsequent homelessness (odds ratio [OR] = 13), as did physical abuse (OR = 16). Sexual abuse during childhood was associated with a nonsignificant trend toward homelessness (OR = 1.7). The risk of subsequent homelessness among individuals who experienced both lack of care and either type of abuse was dramatically increased compared with subjects reporting neither of these adversities (OR = 26). CONCLUSIONS: Adverse childhood experiences are powerful risk factors for adult homelessness. Effectively reducing child abuse and neglect may ultimately help prevent critical social problems including homelessness.
(Hyde 2005) / 50 / US / Young people / Life history interviews / Why became homeless / In professional discourses, homeless young people are often portrayed as victims of physical abuse and emotional neglect. Although participants' narratives reveal that abuse and neglect play a central role in their decisions to leave home, many maintain a sense of agency in the recounting of how they became homeless.
(Jainchill, Hawke et al. 2000) / US / Adult
Shelter-based therapeutic community / prevalence / The sample presents with extensive psychopathology and a history of physical and sexual abuse. Gender differences indicate that, except for antisocial personality, females yield higher rates on measures of both psychiatric disturbance and abuse. The relationship between psychopathology and abuse also appears to be much stronger for females than for males. However, the relationship between abuse and adult homelessness appears to be similar for men and women. The gender differences in the relationship between histories of abuse and manifestations of psychiatric disturbance support a hypothesis that has been proposed elsewhere: Females internalize the trauma associated with abusive experience, while males externalize it. The findings suggest that, although there may be a need for gender-specific targeted interventions, treatment providers must also recognize that the impact of abuse seems to transcend gender within this population.
(Janus, Archambault et al. 1995) / 195 / Canada / adolescents / Descriptive investigation / prevalence / In this sample, 86% of the population (74% of the males and 90% of the females) reported at least one physically abusive experience. The data reported suggest that this population of adolescents have been the victims of chronic, extreme abuse, experienced at a young age, often perpetrated by the biological parent (most often the mother), and was initiated prior to the first runaway episode. Female runaways were at greater risk than males for all types of abuse experience. Once youths left home, the physical abuse experiences decreased in frequency, but grew in severity, particularly for males