Childhood adversity in those with lived experiences of homelessness in Wales: a cross-sectional study

Abstract

Background Homelessness is a complex societal and public health issue, with multiple causes and solutions. Efforts to reduce homelessness have tended to focus on crisis, with little attention paid to early intervention and primary prevention. Dealing with homelessness involves both supporting people at risk of homelessness and addressing personal and structural causes throughout the lifecourse, including adverse childhood experiences (ACEs). We examined the relationship between ACEs and homelessness in Wales.Methods We retrospectively analysed data from a 2017 cross-sectional national survey of adults aged 16-69 years, living in Wales (total respondents n=2497), using a stratified random probability sampling methodology. Outcome measures included number of ACEs (0, 1, 2-3, or ≥4) and lived experience of homelessness. The 11 categories of ACEs included childhood abuse (physical, sexual, and emotional); neglect (physical and emotional); parental separation or divorce; exposure to domestic violence; or living in a household affected by alcohol misuse, drug use, mental illness, or where someone is incarcerated. Bivariate analysis, adjusted for sociodemographic variables (age, deprivation, gender, and ethnicity), was used to assess the associations between homelessness and ACEs. FindingsWhen weighted to reflect the Welsh national population using mid-2015 population estimates for lower super output areas by sex, age group, and deprivation quintile, homelessness affected 141 (7•0%) of 2005 people in their lifetime. From the unweighted data (n=2497), of the 2333 participants without lived experience of homelessness, 1259 (54•0%) reported no ACEs, compared with 22 (13•4%) of the 164 with experience of homelessness. By contrast, the proportion of participants who reported four or more ACEs was lower among those without (n=253 [10•8%]) than in those with experience of homelessness (n=82 [50•0%]). Those with four or more ACEs were 16•0 times more likely to report lived experience of homelessness in their adult lives (95% CI 9•73-26•43, p<0•0001). Each ACE type was significantly associated with later homelessness, with the strongest associations seen for physical neglect (adjusted odds ratio 8•0 [95% CI 4•98-12•87], p<0•0001), physical abuse (7•0 [5•00-9•87], p<0•0001), sexual abuse (7•1 [4•69-10•78], p<0•0001), and emotional neglect (6•9 [4•63-10•19], p<0•0001).Interpretation This large study using national, representative data indicates that early intervention that prevents ACEs, combined with a trauma-informed approach that builds resilience in at-risk children and adults, is likely to contribute to reducing and preventing homelessness. Possible limitations include the potential recall bias from retrospective, self-reported data.

Big Ideas in a Micro Village: Evaluating the Potential Efficacy of a Young Person’s supported Housing Concept

“…In relation to homelessness, a Public Health Wales report by Grey and Woodfine (2019) identified a strong correlation between high ACE scores and being homeless, a link that has also been identified in other literature (Barnes et al, 2021;Bullock, 2019;Fitzpatrick et al, 2012; National Health Care for the Homeless Council, 2019;Sekharan, 2016). Key findings from Grey and Woodfine's study are set out in figure 2.2 below.…”

“…In recent years, a growing body of research has identified that homelessness is not simply caused by a lack of food and shelter, but that it is often symptomatic of past trauma and ACEs (Grey and Woodfine, 2019;Johnson and Haigh, 2011;Koh and Montgomery, 2021). Thus, it is from this realisation that the PIE framework was conceptualised (Johnson and Haigh, 2011).…”

“…In relation to homelessness, the Public Health Wales report by Grey and Woodfine (2019), focuses on the role that preventing ACEs, providing trauma informed interventions, and developing resilience can play in tackling homelessness (Grey and Woodfine, 2019). Furthermore, this report identifies how belonging to a community and developing positive, stable, and trusted relationships with an adult can help develop resilience, which can then reduce the likelihood of homelessness occurring (Grey and Woodfine, 2019).…”

The influence of sociodemographic variables and traumatic life events on the alcohol consumption of homeless people in Spain

“…The long-term impact of disadvantages in childhood has been widely documented from an array of life experiences. This includes a cumulative effect where one risk factor increases the likelihood of another and also indirectly increases the risk of homelessness (Grey et al, 2019;Moss & Singh, 2016).…”

Traumatic Stress and Homelessness: A Review of the Literature for Practitioners

“…Comparatively, in the 1998 landmark ACE study, only 52% of the general population indicated at least one ACE (Felitti et al, 1998). Large-scale studies have determined that persons with histories of ACEs are more likely than others to have repeated episodes of sheltered and unsheltered homelessness, are typically younger in age at their first episode of homelessness and are up to 16 times more likely than those without ACE histories to experience homelessness as an adult (Bassuk et al, 2001;Grey et al, 2019;Mar et al, 2014). Other studies have also concluded that ACEs are powerful risk factors and can predict or shed light on pathways into adult homelessness (Caton et al, 2005;Goodman et al, 1991;Hamilton et al, 2011;Hayes et al, 2013;Herman et al, 1997;Roos et al, 2013).…”