The relationship between childhood abuse and violent victimization in homeless and marginally housed women: The role of dissociation as a potential mediator

Childhood Maltreatment and Revictimization: A Systematic Literature Review

There is established evidence that childhood/adolescent victimization is associated with victimization in adulthood although the underlying mechanisms are not still clear. The current study aimed to systematically review empirical studies examining potential psychological factors linking childhood maltreatment to victimization in adulthood and the gaps in the literature. Following PRISMA protocol, 71 original studies consisting of a total sample of n = 31,633 subjects were analyzed. Symptom severity for various trauma-related disorders, dissociation, emotion dysregulation, and risky sexual behaviors emerged as potential predictors of revictimization. While these potential risk factors mediate the relationship between childhood maltreatment and adulthood victimization, evidence for additional factors such as social support, attachment styles, maladaptive schemas, and risk detection is very limited. Addressing these intrapersonal risk factors, found by prior studies, in interventions and preventive programs might decrease the probability of revictimization. The interactions between the identified risk factors have not been studied well yet. Hence, more research on mediating risk factors of revictimization is needed.

The Effects of Traumatic Events on Mental Health Among Women Experiencing Homelessness: A Longitudinal Study

In this longitudinal study, we aim to evaluate the prevalence and impact of interpersonal and non-interpersonal traumatic events among women experiencing homelessness in Madrid (Spain) (N  =  136). The information was collected through a structured interview and standardized instruments at baseline and at a 12-month follow-up. The most prevalent events were physical assaults, intimate partner violence, and severe illnesses or accidents. Path analysis revealed that personal and non-interpersonal traumatic events had direct effects on mental health, but also had differential indirect effects. Greater efforts are needed to address the effects of various types of potentially traumatic events and to design effective trauma-informed interventions for women experiencing homelessness.

A revised and extended systematic review and meta-analysis of the relationship between childhood adversity and adult psychiatric disorder

This study aimed to systematically review the evidence for an association between adversity experienced in childhood (≤ 17 years old), and the diagnosis of psychiatric disorder in adulthood. Electronic databases (Scopus, Medline (for Ovid), EMBASE, and PsychINFO) were searched for peer-reviewed, longitudinal cohort studies examining child or adolescent exposure to adversity, and adult-diagnosed depression, anxiety, psychotic disorder, eating disorders, substance abuse disorder, illness anxiety disorder, somatoform disorder, or personality disorder. A total of 39 manuscripts were retained. Results revealed a significant association between the following childhood exposures and adult mental disorder (1.24 ≤ Odds ratios ≤ 2.09): bullying (victimhood, and frequency); emotional abuse; neglect; physical abuse; parental loss; and general maltreatment (unspecified and/or multiple adversity exposure). There were opposing results for being a victim and perpetrator of bullying, and the result for sexual abuse was not statistically significant. There was some evidence of a dose-response relationship with those exposed to multiple forms of maltreatment having more two and a half times odds of developing a mental disorder (Odds ratio = 2.59). The result for sexual abuse is likely an artefact of the prospective assessment of this adversity. In summary, there was strong evidence of an association between childhood adversity and later mental illness, and this supports previously reported meta-analyses. The evidence suggests that childhood and adolescence is an important time for risk for later mental illness, and an important period in which to focus intervention strategies for those known to have been exposed to adversity, particularly multiple adversities.

More than a house: Women's recovery from homelessness in Australia

Recovery from homelessness for women is often a long, complex and highly individualised journey. This study investigated women's experiences of exiting homelessness and examined the factors that influenced recovery. The qualitative interpretive study involved auto-driven photo elicitation and in-depth interviews with 11 women who had previously been homeless. It took place in Australia between August 2018 and August 2019. Women took photographs that represented their experiences of exiting homelessness to guide discussion during interviews. Data were analysed using thematic analysis. Findings indicate that recovery from homelessness involves more than becoming housed. Recovery from homelessness is the overarching theme being presented, described using five subthemes: Finding the right house, Making a house a home, Connection, Building confidence and Helping others. Housing was only the starting point for recovery from homelessness for women. The women drew on their own self determination to create factors necessary for recovery from the experience of homelessness. We conclude that ongoing support is necessary to empower and assist women recovering from the traumatic experiences of homelessness. Trauma-informed care offers service providers a framework for supporting women who have lived through homelessness. Services can draw on this framework to provide support beyond the point of securing a house and assist women to create a home environment, build confidence in themselves and form connections to their community as they transition out of homelessness.

Homelessness and Vulnerably-Housed Defined: A Synthesis of the Literature

There is no single accepted definition used in policy or research for the concepts of homelessness and vulnerably housed. Neuman's systems model (NSM) was the framework for this mixed-studies review, with the client system defined as these social issues and categorized as environmental stressors. Eighteen unique definitions of the concepts were identified in 30 studies. Extrapersonal stressors included housing history, interpersonal stressors included dependence on others for housing, and intrapersonal stressors included self-identification. Each level of stressor should be considered when defining these populations for inclusion in future research. Proposed definitions were formulated from the analysis of the results.

Intimate partner sexual violence and violent victimisation among women living homeless in Madrid (Spain)

The purpose of this paper is to discover the extent to which women living homeless in Madrid (Spain) have been victims of intimate partner sexual violence (IPSV), analysing the connection between stressful life events (SLE) relating to violent victimisation and having suffered sexual assault by a partner. This study took place using a sample of women living homeless in Madrid (n = 136). The results obtained show that a high percentage of the women living homeless who were questioned had been victims of IPSV. The women interviewed, who had been victims of IPSV, had suffered, to a greater extent, SLEs relating to situations of violent victimisation, both during childhood and adolescence as well as in adulthood. The episodes of violent victimisation that seem to be the most common forerunners to IPSV are incidents of sexual abuse in childhood and adolescence.

A qualitative exploration of women's resilience in the face of homelessness

The aim of this study was to examine the experiential perspectives of women becoming and experiencing homelessness. Situated in the qualitative interpretative tradition, data were collected using auto-driven photo-elicitation and in-depth face-to-face interviews. Eleven Australian women used photographs that represented their experiences of being homeless to guide their interview discussion. The findings revealed that homelessness for women is a period often preceded by a series of adverse incidents in their lives, characterised by progressive resilience building in the face of trauma, finding hope and building strength to work towards exiting homelessness. After becoming homeless, five stages of resilience transition emerged: The trauma of homelessness, Finding hope and surviving, Finding help, Finding connection and Taking control. Women experiencing homelessness are resilient and capable of enacting competence and autonomy in seeking help to exit homelessness. Changes to service delivery are recommended to improve trauma-informed, person-centred housing and social services that are integrated and easy to navigate.

Combining Self-Determination Theory and Photo-Elicitation to Understand the Experiences of Homeless Women

Homelessness is a complex and gendered experience. To understand this complexity, novel theoretical frameworks and appropriate research methods are required. Most women living without homes have experienced some form of abuse or mental health issues before becoming, being or exiting homelessness and there is high prevalence of trauma in this vulnerable population. Researchers investigating women's homelessness need to ensure the research process is not retraumatising. This paper proposes a theoretical framework that combines self-determination theory (SDT) and photo-elicitation to support and guide research conducted with women who are at risk of negative effects of power imbalances and retraumatisation in research. The framework offers new opportunities to sensitively study women's homelessness by leveraging a strengths-based premise and empowering procedures to increase women's control in the research process. Embedding this method within the SDT research framework repositions women from objects of research to being competent, autonomous, active and empowered agents in the research process.

Trauma and healing in the underserved populations of homelessness and corrections: Forgiveness Therapy as an added component to intervention

The purpose of this article is to begin applying the principles of the psychology of forgiveness to people who are without homes and people who are in prisons. A review of the literature shows trauma for both groups. When the trauma is caused by unjust treatment by others, then excessive anger can result, compromising one's psychological and physical health. We review the interventions that have been offered for those without homes and the imprisoned to examine which existing programmes address such anger. Forgiveness Therapy, although untried in these two settings, may be one beneficial approach for substantially reducing unhealthy anger. Forgiveness interventions have shown a cause-and-effect relationship between learning to forgive and overcoming psychological compromise such as strong resentment and clinical levels of anxiety and depression. The literature review here suggests that forgiveness therapy for those without homes and the imprisoned may be a new and important consideration for ameliorating anger and aiding in a changed life pattern.

Individuals experiencing chronic homelessness: A 10-year follow-up of a cohort in Spain

With the start of the great economic recession in 2007, homelessness increased fivefold in some regions of southern Europe. Larger numbers of people experiencing homelessness, compounded by a lowered capacity for social and health services to respond to their needs, precipitated an increase in so-called 'chronic homelessness'. The aim of this study was to establish the presence of chronic homelessness in a defined geographical area of Spain, and to determine the prevalence of diagnosed mental disorders within both the chronic and non-chronic homeless population. A prospective and descriptive study was designed to monitor a cohort of 826 individuals experiencing homelessness who constituted the entire identified homeless population in the relevant territory in 2006. This sample was followed until 2016 and sociodemographic as well as clinical information was collected, including the time spent homeless. The results obtained indicated that one in 10 participants met the criteria for chronic homelessness, a rate that is lower than in the US, where the definition of chronicity that was applied originates from. Alcohol use disorder was the most common mental health disorder that contributed to the chronicity associated with homelessness. Being born in the country (Spain) where the study was conducted and being older were the main other variables associated with chronicity. People defined as chronically homeless in Spain were on average younger than in the US, but women were present in the chronic subgroup at a similar rate. We also reflect on the limitations of the study and in particular the appropriateness of the concept of chronicity as applied to homelessness.

Causal connection between dissociation and ongoing interpersonal violence: A systematic review

OBJECTIVE

To identify evidence for dissociation as a cause of ongoing interpersonal violence.

METHOD

A systematic review of the literature retrieved from ten databases.

RESULTS

Fifteen studies yielded from our search strategy have been included in the review; eleven of these were longitudinal and four were experimental. The evidence indicates that pathological dissociation may contribute towards enduring interpersonal violence. Thus, dissociation may account for instances of repeated victimisation. There are similar indications concerning offenders, but study designs in this area allow one to draw fewer causal conclusions. There is some evidence that dissociation decreases information processing from the limbic system, which may be one underlying neurofunctional mechanism of persistent violence.

CONCLUSION

There is growing evidence for dissociation as a cause of interpersonal violence. However, the available evidence is still limited, and our review rather reveals an important research gap. Future longitudinal and experimental studies aimed at clarifying the role of dissociation in the context of violence should take into account the theoretical and empirical complexity around the concept of dissociation.

Condomless Sex and Psychiatric Comorbidity in the Context of Constrained Survival Choices: A Longitudinal Study Among Homeless and Unstably Housed Women

We sought to identify the prevalence and independent correlates of condomless sex within a cohort of community-recruited homeless and unstably housed cisgender adult women who were followed biannually for 3 years (N = 143 HIV+ , N = 139 HIV-). Nearly half (44%) of participants reported condomless sex in the 6 months before baseline, which increased to 65% throughout the study period. After adjusting for having a primary partner, longitudinal odds of condomless sex among women with HIV were significantly higher among those reporting < daily use of alcohol or cannabis (AOR = 2.09, p =.002, and 1.88, p =.005, respectively) and PTSD (AOR = 1.66, p =.034). Among women without HIV, adjusted longitudinal odds of condomless sex were significantly higher for those reporting < daily methamphetamine use (AOR = 2.02, p =.012), panic attack (AOR = 1.74, p =.029), and homelessness (AOR = 1.67, p = .006). Associations were slightly attenuated when adjusting for sex exchange. Targeted HIV/STI programs for unstably housed women should address anxiety and trauma disorders, infrequent substance use, and housing challenges.