Victimization and posttraumatic stress disorder in homeless women with mental illness are associated with depression, suicide, and quality of life

Abstract

ObjectiveThis study aimed to determine the following: 1) the proportion of women in the homeless population with schizophrenia (SZ) or bipolar disorder (BD), in addition to the trajectory of their homelessness (ie, homelessness history, number of nights spent without home during the 180 past nights) and the characteristics of their illnesses compared to men (ie, illness severity, suicide risk, physical health status, and quality of life [QoL]); 2) whether these women were victimized more frequently than similarly situated men; 3) the impact of victimization on these women in terms of illness severity, suicide risk, physical health status, and QoL; and lastly 4) the differences and overlap of homeless women with SZ and BD.MethodsThis study employed data at baseline from a multicenter randomized controlled trial conducted in the following four large French cities: Lille, Marseille, Paris, and Toulouse. Mobile mental health outreach teams recruited SZ/BD homeless patients in the street, emergency shelters, hospitals, and jails from August 2011 to April 2014. Evaluations were performed during face-to-face interviews by psychiatrists and research assistants in the offices of mobile mental health outreach teams that were located in the downtown area of each city. The quantitative data were analyzed using descriptive analyses, chi-square and Student’s t-tests, generalized estimating equation regression models, and path analysis.ResultsA total of 703 patients were included in this study. The proportion of women in the SZ/BD homeless population was 123/703 (17.5%). In this population, women were more likely than men to declare that they were subjected to physical or sexual assault during the past 6 months, that they had been diagnosed with posttraumatic stress disorder (PTSD), and that they had experienced more severe depressive symptoms. Moreover, these women presented a higher suicide risk, worse physical health status, and lower QoL than similarly situated men. Homeless women with BD were more vulnerable than women with SZ. A path analysis revealed that PTSD and violent victimization might explain the higher levels of depression and suicide risk and the lower levels of physical health status and QoL in homeless women.ConclusionSZ/BD homeless women experience more PTSD and victimization than men, which are both associated with poor clinical outcomes. These results confirm the vulnerability of homeless women in this high need population and should be considered by public health policy.

Cycle of Perpetual Vulnerability for Women Facing Homelessness near an Urban Library in a Major U.S. Metropolitan Area

“…Another study found comorbidity between psychiatric conditions and violence among unstably housed women, reporting that those with dual diagnoses experienced higher risk for violent acts [26]. In another study sampling 703 homeless women, those who experienced violent victimization struggled with severe negative mental health outcomes, and often reported poorer quality of life compared to their male counterparts [27]. The study corresponds with our findings where women who experienced sexual assault and had a history of childhood abuse had also reported suicide ideation and negative mental health outcomes.…”

Post-Traumatic Stress Disorder in Homeless Migrant Mothers of the Paris Region Shelters

“…PTSD in homeless populations is very prevalent [3], specifically in women, with 25.7% in 123 homeless women included in the French Housing First Program [4] suffering from PTSD, versus almost 7% in women of the overall population in France in 2003 [5]. Most studies to date have explored whether homeless people have had an elevated level of exposure to traumatic events and cumulate risk factors which brought on PTSD (e.g., witnessing or being the victim of an attack, sexual assault) [6][7][8], but less is known about the role of homelessness itself as a traumatic experience that leads to exposure to factors predicting PTSD.…”

Post-traumatic stress disorder in train crash survivors in Italy: the role of mood spectrum dysregulations and intrusiveness

“…To the best of our knowledge, this is the first study exploring the specific mediating effects of mood spectrum signs and symptoms on the relationship between PTSD and intrusiveness, using a path analysis in a clinical sample of subjects exposed to the same isolated severe traumatic event, such as the train crash in Viareggio. Previously, other studies analyzed the potential relationships among traumatic events, PTSD and depression in groups of subjects exposed to completely different types of recurrent or chronic traumatic events, including student military veterans, 43 homeless women with mental illnesses, 44 refugees and asylum seekers, 45 or Korean fire fighters. 46 Other studies highlighted clinical similarities between PTSD and depression, as demonstrated in samples of inpatients with PTSD, 47 community samples, 48 Vietnam veterans, 49 underground train drivers, 50 military members, veterans, and first responders (eg, police, fire, and paramedics) with probable PTSD, 51 or survivors of a chemical warfare.…”