Examining the influence victimization and resiliency factors in Posttraumatic Stress Disorder among homeless emerging adults

Transcription

1 Examining the influence victimization and resiliency factors in Posttraumatic Stress Disorder among homeless emerging adults Sanna J. Thompson, PhD University of Texas at Austin School of Social Work

2 Approximately 1.6 to 2 million adolescents run away, are forced to leave their homes or are abandoned each year only 21% are reported missing to police/missing children s agency. 8% of adolescents will run away from parental homes before they turn 18 years of age. The reason for running away is frequently identified with family conflict, including running away from parental abuse and maltreatment or being forced to leave. Nearly two-thirds will return home following a runaway episode and stay away from home less than one week. Others remain on the streets, couch surfing, and/or traveling. The act of prematurely exiting or being forcibly removed from the home is a traumatizing event that has many implications for the psychological health of these young people.

3 Homeless, street-involved young adults Nighttime residence often includes emergency shelters, public places (highway underpasses & parks), abandoned buildings, couch-surfing with friends or strangers that may include trading favors for food/shelter These young people engage in behaviors that alienate them from societal norms. Substance use Association with substance-using street peers Risky sexual behaviors/survival sex Criminal involvement Academic failure High transience Continuing victimization & traumatizing experiences

4 Experiencing victimization and traumatic events play a major role in the daily lives of homeless young adults. Limited research has examined factors related to posttraumatic stress disorder among street-involved young adults. No interventions have been developed to meet the needs of these highly vulnerable young adults.. This study examined the relationship between maltreatment (physical, sexual, neglect) during childhood, victimization while on the streets, and levels of resiliency and optimism in relation to posttraumatic stress disorder among homeless young adults from three U.S. cities.

5 Multi-city study Survey administered in Los Angeles, California; Denver, Colorado; Austin, Texas Face-to-face Interviews with 200 homeless young adults at each site (n=600) years of age and more than 2 weeks away from home. Participants recruited from multi-service, non-profit organizations that offer homeless, young people comprehensive services: street outreach, meals, shelter, health care, counseling, education/employment services. Following informed consent, youth completed a minute structured retrospective interview using validated and reliable measures. 50 at each site also completed a qualitative semi-structured interviews.

6 Measures PTSD Mini International Neuropsychiatry Interview (MINI) (Sheehan et al., 1998). Respondents were asked questions, based on DSM-IV-TR criteria, regarding trauma-related symptoms experienced during the past 12 months. Child Maltreatment Childhood Trauma Questionnaire (Bernstein & Fink, 1998) retrospectively assesses physical, emotional and sexual abuse experiences. Traumatic Life Events Traumatic Life Events Questionnaire (Kubany et al., 2000) measures direct (robbed, assaulted) and indirect (witness to severe assault, friend overdose) events of victimization. Self-efficacy & Social connectedness Self Efficacy Scale (Joe, Broome, Rowan-Szal, & Simpson, 2002) measures perceived ability to control events and environment and being connected with pro-social peers and others. Resiliency Resilience Scale (Wagnild & Young, 1993) measures various components of resiliency including self reliance, life meaning, perseverance, and acceptance of hardship. Optimism Optimistic Mastery (Heimberg, 1963) measures hope and enthusiasm for the future.

7 Full and City-Level Sample Characteristics Variables Full Sample (n=601) Austin Denver LA Age 20 (1.6) 20.8 (1.7) 19.9 (1.6) 19.4 (1.1) Gender (male) 385 (64.1) 128 (64.0) 129 (64.2) 128 (64.0) Ethnicity White 240 (39.9) 152 (76.0) 70 (34.8) 18 (9.0) Black 152 (25.3) 6 (3.0) 54 (26.9) 92 (46.0) Latino 107 (17.8) 18 (9.0) 37 (18.4) 52 (26.0) Average Months homeless 32.2 (30.9) 42.8 (33.9) 31.6 (29.6) 22.3 (25.3)

8 Variables Full and City-Level Sample Characteristics Full Sample (n=601) Mean (SD) Austin Mean (SD) Denver Mean (SD) LA Mean (SD) Meets criteria for PTSD 136 (22.6) 32 (16.0) 39 (19.4) 65 (32.5) Trauma symptoms 437 (72.7) 149 (74.5) 139 (69.2) 149 (74.5) Self-efficacy 26.2 (4.3) 26.4 (4.3) 26.3 (4.1) 26.0 (4.3) Social connectedness 33.2 (9.3) 32.2 (9.1) 34.2 (9.5) 33.1 (9.5) Resilient (19.4) (19.4) (19.5) (18.9) Optimistic 19.4 (3.5) 18.3 (3.8) 19.8 (3.4) 20.2 (2.9)

9 Variables Full and City-Level Sample Characteristics Full Sample (n=601) Austin Denver LA Childhood Maltreatment Physical Neglect 520 (86.5) 171 (85.5) 179 (89.7) 170 (85.0) Physical Abuse 481 (80.0) 163 (81.5) 164 (81.5) 154 (77.0) Sexual Abuse 206 (34.3) 61 (30.5) 76 (37.8) 69 (34.5) Emotional Neglect Victimization on Street Direct victimization Indirect victimization 556 (92.5) 185 (92.5) 182 (90.5) 189 (94.5) 2.2 (1.7) 2.5 (1.7) 2.1 (1.6) 1.1 (1.1) 1.5 (1.1) 1.9 (1.1) 1.5 (1.1) 1.2 (1.1)

10 Logistic Regression to predict PTSD Predictor variables B (SE) OR 95% C.I. Location (city) -.72 (.16).48*** Age. 01 (.08) Gender -.41 (.25) Months homeless.02 (.01) Childhood Maltreatment Physically Neglected.49 (.48) Physically Abused.63 (.35) 1.87* Sexually Abused.63 (.25) 1.89** Emotionally Neglected.31 (.37) Victimization on Street Direct victimization.22 (.08) 1.26** Indirection victimization.15 (.12) Self-efficacy -.09 (.03) 1.10** Social connectedness -.04 (.01) 1.05** Resilient.01 (.04) Optimistic -.01 ( Model χ (df=14), p <.001 Pseudo R 2 =.29 * <.05, ** <.01, ***<.001

11 Results All sites exceeded prevalence rates for PTSD among young adults across the U.S. (7.8% lifetime) Austin (16%) Denver (19%) Los Angeles (32%) Being in Austin or Denver, significantly decreased the likelihood of being identified as meeting criteria for PTSD (OR =.45). Respondent reports of at least two trauma symptoms were more consistent across cities Austin (75%) Denver (69%) Los Angeles (75%)

12 Logistic Regression Results Homeless young adults who had been physically abused as a child were 87% more likely to meet criteria for PTSD. Those who had been sexually abused as a child were 89% more likely to meet criteria for PTSD. Being directly victimized on the streets (robbed, assaulted, etc.) increased the likelihood of meeting PTSD diagnostic criteria by 26% Higher self-efficacy scores decreased likelihood of PTSD by 10% Higher levels of social connectedness decreased likelihood of PTSD by 5%.

13 Implications/Conclusions Results provide insight into the factors associated with Posttraumatic Stress disorder among homeless young adults and highlight the need for services to address these challenges. Existing interventions to address trauma symptoms utilize exposure-based approaches that require discontinuation of abuse and long-term engagement. For homeless youth who live in dangerous street environments and are highly transient, these approaches are not feasible and even harmful. Intervention development must recognize the level of trauma experiences of homeless young adults experience before and after entering the street. More empirical research is needed to assist practitioners in recognizing the important issues concerning trauma experiences of these young people, including both risks factors and protective mechanisms. Effective treatment methodologies must be developed and tested with this highly transient population in order to help them address their psychological trauma and move off the streets.

14 Acknowledgement of collaborators: Kimberly Bender, PhD University of Denver, School of Social Work Kristin Ferguson, PhD Silberman School of Social Work at Hunter College Homeless young adults who provided their time and thoughtful perspectives from Austin, Denver and Los Angeles. Questions?