Academic journal article Health and Social Work

Assessing Trauma, Substance Abuse, and Mental Health in a Sample of Homeless Men

Academic journal article Health and Social Work

Assessing Trauma, Substance Abuse, and Mental Health in a Sample of Homeless Men

Article excerpt

Although much of the literature on posttraumatic stress and homelessness focuses on women or families (Banyard, Williams, & Siegel, 2001; Bassuk, Buckner, Perloff, & Bassuk, 1998; Bassuk, Dawson, Perloff, & Weinrub, 2001; Bean & Moiler, 2002; Gully, Koller, & Ainsworth, 2001; Ryan, Kilmer, Cauce, Watanabe, & Hoyt, 2000; Tyler & Cauce, 2002), the majority of homeless people are men (U.S. Conference of Mayors, 2002). Men tend to remain homeless longer and report more episodes of homelessness than women (Grimm & Maldonado, 1995; Sumerlin, 1999). Although women are more likely than men to report symptoms consistent with posttraumatic stress disorder (PTSD), men are at higher risk than women for exposure to psychological trauma (Kessler, Sonnega, Brommet, & Nelson, 1995).

Psychological trauma and PTSD may have a substantial negative effect on the lives of already vulnerable homeless men, particularly those who are experiencing serious mental illness or addictive disorders, but a review of the research literature has determined that these questions have not been systematically studied with men (Kim & Ford, 2006). There are many potential reasons why research on mental health and addictions and psychological trauma among homeless people has focused primarily on women and largely excluded men: Compared with homeless women, homeless men tend to more often live in isolation (homeless women often are caring for children or involved in family relationships), to be severely psychiatrically impaired, and to be military veterans with severe PTSD. All of these conditions may make homeless men less readily accessible to or less willing to engage with researchers than homeless women. These factors are directly related to psychological trauma and PTSD in many, if not most, cases, thus making it particularly important to investigate the role of exposure to traumatic stressors and experiencing problems with posttraumatic stress in the fives of homeless men.

Psychological trauma takes many forms and has many sequelae. Although physical injury or harm may occur when psychological trauma is inflicted (for example, physical or sexual assault, domestic violence, vehicular accidents, disasters involving death or fife threats), survivors of psychological trauma often are unhurt physically (for example, witnesses rather than direct victims, sexual abuse survivors who were coerced or manipulated but not physically injured). Psychological trauma often involves intentional violence (for example, rape, combat, community or domestic violence) but may alternatively involve accidental harm (for example, fatal accidents, human-made disasters), natural hazards (for example, weather-related disasters), and death or severe physical harm due to illness. The most widely used definition of psychological trauma was developed by the American Psychiatric Association (2000) for the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) (DSM-IV-TR) and requires the direct experiencing or witnessing of life-threatening events or violation of bodily integrity and a subjective reaction of extreme fear, helplessness, or horror. Psychological trauma, as used in this article, follows this definition, including a range of events and experiences that vary widely in their specifics but have the common feature of exposure to the reality or threat of death or bodily violation in a manner that evokes a reaction of emotional terror or horror.



Etiological research concerning homelessness focuses on risk factors, including poverty, low education, lack of work skills, physical or mental disability, substance abuse problems, minority status, and family dysfunction (that is, divorce, family psychopathology, or conflict) (Fischer & Breakey, 1991; Morrell-Bellai, Goering, & Boydell, 2000; Snow & Anderson, 1993). Tessler, Rosenheck, and Gamache (2001) postulated three interrelated pathways to homelessness: social selection, socioeconomic adversity, and traumatic experiences. …

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