Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of childhood abuse among people who are homeless in Western countries: a systematic review and meta-analysis

  • Review
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

This article systematically reviews studies of prevalence of childhood experience of physical and sexual abuse in adult people who are homeless in Western countries.

Methods

Medline, PsychInfo, and the Cochrane Library were searched using the keywords: homeless*, child* abuse, child* trauma, and child* adversity and the bibliographies of identified articles were reviewed. Sources of heterogeneity in the prevalence rates were explored by meta-regression analysis.

Results

Twenty-four reports published between January 1990 and August 2013 in three countries provided estimates obtained from up to 9,730 adult individuals who were homeless. Prevalence of reported childhood physical abuse ranged from 6 to 94 % with average prevalence of 37 %, 95 % CI [25, 51]. Reported sexual abuse ranged from 4 to 62 %, with average prevalence estimated as 32 %, 95 % CI [23, 44] for female and 10 % for male, 95 % CI [6, 17]. Substantial heterogeneity was observed among the studies (I 2 ≥ 98 %). Including moderators greatly reduced but did not eliminate this heterogeneity. Moderator analyses suggested that reported physical abuse tended to be higher for predominately white samples and tended to be lower for younger samples. Sexual abuse was far more prevalent in predominately female samples and slightly higher in non-US samples and convenience samples.

Conclusions

The findings of this study suggest that childhood physical and sexual abuse is more prevalent among the homeless in Western countries than in the global population. Physical abuse appears to be particularly prevalent in younger samples and sexual abuse rates are higher in predominately female samples. Further investigation is needed to advance our understanding of how trauma informed treatment and care for the homeless effectively can take into account the service user’s experiences of childhood abuse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Notes

  1. The protocol is available from: http://www2.ntupsychology.net/~baguley/Sundin_Baguley_protocol_160813.doc.

  2. Unless otherwise stated subsequent reference in the text is to n CSA (which is generally the larger of the two sample sizes). All statistical models use n CPA or n CSA as appropriate.

  3. The non-white category included any sample or subsample identified as not of white European origin (e.g., Afro-Caribbean, Asian, and Latino or Hispanic as well as Aborigine and Native American individuals). In most cases this information was taken from published reports (including other studies using the same data), but for a few samples was taken from relevant census data for the location and year of data collection.

  4. Age data are taken from published reports or estimated from available information (e.g., the median or the proportion of the sample falling into different age categories).

  5. These estimates were obtained from the final model with all other covariates except the indicator for convenience sampling centred. Thus the estimates reflect the average estimate for a random or stratified sample rather than for a convenience sample.

  6. Note however that the definitions of CPA and CSA used in general populations research are less strict than implied by the strict criterion implied by a moderate to severe cut-off with the CTQ [see 26, Table 1].

References

  1. Carlen P (1996) Jigsaw: a political criminology of youth homelessness. Open University Press, Buckingham

    Google Scholar 

  2. Elliott M, Krivo L (1991) Structural determinants of homelessness in U.S. cities. Soc Probl 38:113–131

    Article  Google Scholar 

  3. Philippot P, Lecocq C, Sempoux F, Nachtergael H, Galand B (2007) Psychological research on homelessness in Western Europe: a review from 1970 to 2001. J Soc Issues 13:483–503

    Article  Google Scholar 

  4. Dachner N, Tarasuk V (2002) Homeless ‘‘squeegee kids’’: food insecurity and daily survival. Soc Sci Med 54:1039–1049

    Article  PubMed  Google Scholar 

  5. Fitzpatrick S, Stephens M (2007) An international review of homelessness and social housing policy. Communities and Local Government, London

    Google Scholar 

  6. Kushel MB, Vittinghoff E, Haas JS (2001) Factors associated with the health care utilization of homeless persons. JAMA 285:200–206

    Article  CAS  PubMed  Google Scholar 

  7. Vostanis P, Tischler V, Cumella S, Bellerby T (2001) Mental health problems and social supports among homeless mothers and children victims of domestic and community violence. Int J Soc Psychiatry 47:30–40

    Article  CAS  PubMed  Google Scholar 

  8. Maguire N, Johnson R, Vostanis P, Keats H, Remington RE (2010) Mental health good practice guide: meeting the psychological and emotional needs of homeless people. National Mental Health Development Unit and the Department for Communities and Local Government

  9. Baggett TP, Hwang SW, O’Connell JJ, Porneala BC, Stringfellow EJ et al (2013) Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA Intern Med 173:189–195

    Article  PubMed Central  PubMed  Google Scholar 

  10. Fitzpatrick S, Stephens M (2008) The future of social housing. Shelter, London

    Google Scholar 

  11. Kenway P, Palmer G (2003) How many, how much?. New Policy Institute, London, p 24

    Google Scholar 

  12. U.S. Conference of Mayors (2008) Status report on hunger and homelessness. http://usmayors.org/pressreleases/uploads/2012/1219-report-HH.pdf

  13. Koegel P, Burnham MA, Farr RK (1988) The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Arch Gen Psychiatry 45:1085–1092

    Article  CAS  PubMed  Google Scholar 

  14. North CS, Eyrich KM, Pollio DE, Spitznagel EL (2004) Are rates of psychiatric disorders in the homeless population changing? Am J Public Health 94:103–108

    Article  PubMed Central  PubMed  Google Scholar 

  15. Nielsen SF, Hjorthøj CR, Erlangsen A, Nordentoft M (2011) Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study. Lancet 377:2205–2214

    Article  PubMed  Google Scholar 

  16. Dennis DL, Buckner JC, Lipton FR, Levine IS (1991) A decade of research and services for homeless mentally ill persons: where do we stand? Am Psychol 46:1129–1138

    Article  CAS  PubMed  Google Scholar 

  17. Fazel S, Khosla V, Doll H, Geddes J (2008) The prevalence of mental disorders among the homeless in Western countries: systematic review and meta-regression analysis. PLoS Med 5:1670–1681

    Article  Google Scholar 

  18. Fischer PJ, Breakey WR (1991) The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychol 46:1115–1528

    Article  CAS  PubMed  Google Scholar 

  19. Folsom D, Jeste DV (2002) Schizophrenia in homeless persons: a systematic review of the literature. Acta Psychiatr Scand 105:404–413

    Article  CAS  PubMed  Google Scholar 

  20. Scott J (1993) Homelessness and mental illness. Brit J Psychiatry 162:314–324

    Article  CAS  Google Scholar 

  21. Seligman MEP, Maier SF (1967) Failure to escape traumatic shock. J Exp Psychol 74:1–9

    Article  CAS  PubMed  Google Scholar 

  22. Flannery RB Jr (1987) From victim to survivor: a stress management approach in the treatment of learned helplessness (pp 217–233). In: van der Kolk BA (ed) Psychological trauma. American Psychiatric Press, Washington, DC

    Google Scholar 

  23. Goodman LA, Saxe L, Harvey M (1991) Homelessness as psychological trauma: broadening perspectives. Am Psychol 46:1219–1225

    Article  CAS  PubMed  Google Scholar 

  24. Scaglia O (2008) Homelessness and helplessness: correlating learned helplessness, locus of control, and perceived social support with chronic homelessness. Capella University, Minneapolis

    Google Scholar 

  25. Dallam SJ (2001) The long-term medical consequences of childhood trauma. In: Franey K, Geffner R, Falconer R (eds) The cost of child maltreatment: who pays? We all do. FVSAI Publications, San Diego, pp 1–14

    Google Scholar 

  26. Gilbert R, Spatz Widom C, Browne K, Fergusson D, Webb E et al (2009) Burden and consequences of child maltreatment in high-income countries. Lancet 373:68–81

    Article  PubMed  Google Scholar 

  27. Dubowitz H (2007) Understanding and addressing the “neglect of neglect:” Digging into the molehill. Child Abuse Negl 31:603–606

    Article  PubMed  Google Scholar 

  28. Mayer M, Lavergne C, Tourigny M, Wright J (2007) Characteristics differentiating neglected children from other reported children. J Fam Violence 31:607–614

    Google Scholar 

  29. McSherry D (2007) Commentary: understanding and addressing the “neglect of neglect”: why are we making a mole-hill out of a mountain? Child Abuse Negl 31:607–614

    Article  PubMed  Google Scholar 

  30. McSherry D (2011) Lest we forget: remembering the consequences of child neglect—a clarion call to ‘feisty advocates’. Child Care Pract 17:103–113

    Article  Google Scholar 

  31. Wolock I, Horowitz B (1984) Child maltreatment as a social problem: the neglect of neglect. Am J Orthopsychiatry 54:530–543

    Article  CAS  PubMed  Google Scholar 

  32. Garbarino J, Collins CC (1999) Child neglect: the family with a hole in the middle. In: Dubowitz H (ed) Neglected children: research, practice, and policy. Sage, Thousand Oaks, pp 1–23

    Chapter  Google Scholar 

  33. Mennen FE, Trickett P (2010) Mental health services to urban minority children. Child Youth Serv Rev 29:1220–1234

    Article  Google Scholar 

  34. Davis LA, Winkleby MA (1993) Sociodemographic and health-related risk factors among African-American, Caucasian and Hispanic homeless men: a comparative study. J Soc Distress Homeless 2:83–101

    Article  CAS  Google Scholar 

  35. Winkleby MA, Fleshin D (1993) Physical, addictive, and psychiatric disorders among homeless veterans and nonveterans. Public Health Rep 108:30–36

    CAS  PubMed Central  PubMed  Google Scholar 

  36. Stein JA, Leslie MB, Nyamathi A (2002) Relative contributions of parent substance use and childhood maltreatment to chronic homelessness. Child Abuse Negl 26:1011–1027

    Article  PubMed  Google Scholar 

  37. Nyamathi A, Wenzel SL, Lesser J, Flaskerud J, Leake B (2001) Comparison of psychosocial and behavioral profiles of victimized and nonvictimized homeless women and their intimate partners. Res Nurs Health 24:324–335

    Article  CAS  PubMed  Google Scholar 

  38. Breton M, Bunston T (1992) Physical and sexual violence in the lives of homeless women. Can J Commun Ment Health 11:29–44

    Article  Google Scholar 

  39. Craig TKJ, Hodson S (1998) Homeless youth in London: I. Childhood antecedents and psychiatric disorder. Psychol Med 28:1379–1388

    Article  CAS  PubMed  Google Scholar 

  40. D’Ercole A, Struening E (1990) Victimization among homeless women: implications for service delivery. J Community Psychol 18:141–152

    Article  Google Scholar 

  41. Dietz TL (2009) Drug and alcohol use among homeless older adults. Predictors of reported current and lifetime substance misuse problems in a national sample. J Appl Gerontol 28:235–255

    Article  Google Scholar 

  42. Forde DR, Baron SW, Scheck AC, Stein MB (2012) Factor structure and reliability of the Childhood Trauma Questionnaire and prevalence estimates of trauma for male and female street-youth. J Interpers Violence 27:364–379

    Article  PubMed  Google Scholar 

  43. Gwadz MV, Nish D, Leonard NR, Strauss SM (2007) Gender differences in traumatic events and rates of post-traumatic stress disorder among homeless youth. J Adolesc 30:117–129

    Article  PubMed  Google Scholar 

  44. Herman DB, Susser ES, Struening EL, Link BL (1997) Adverse childhood experiences: are they risk factors for adult homelessness? Am J Public Health 87:249–255

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  45. Johnson R, Rew L, Sternglanz RW (2006) The relationship between childhood sexual abuse and sexual health practices of homeless adolescents. Adolescence 41:221–234

    PubMed  Google Scholar 

  46. Keeshin BR, Campbell K (2011) Screening homeless youth for histories of abuse: prevalence, enduring effects, and interest in treatment. Child Abuse Negl 35:401–407

    Article  PubMed  Google Scholar 

  47. Kim MM, Ford JD, Howard DL, Bradford DW (2010) Assessing trauma, substance abuse, and mental health in a sample of homeless men. Health Soc Work 35:39–48

    Article  PubMed  Google Scholar 

  48. Koegel P, Melamid E, Burnam A (1995) Childhood risk factors for homelessness among homeless adults. Am J Public Health 85:1642–1649

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  49. Melander LA, Tyler KA (2010) The effect of early maltreatment, victimization, and partner violence on HIV risk behavior among homeless young adults. J Adolesc Health 47(2010):575–581

    Article  PubMed  Google Scholar 

  50. Morrell-Bellai T, Goering PN, Boydell KM (2000) Becoming and remaining homeless: a qualitative investigation. Issues Ment Health Nurs 21:581–604

    Article  CAS  PubMed  Google Scholar 

  51. North CS, Smith EM, Spitznagel EL (1994) Violence and the homeless: an epidemiologic study of victimization and aggression. J Trauma Stress 7:95–110

    Article  CAS  PubMed  Google Scholar 

  52. Pluck G, Lee KW, David R, Macleod DC, Spence SA et al (2011) Neurobehavioural and cognitive function is linked to childhood trauma in homeless adults. Brit J Clin Psychol 50:33–45

    Article  Google Scholar 

  53. Rayburn NR, Wenzel SL, Elliott MN, Hambarsoomians K, Marshall JN et al (2005) Trauma, depression, coping, and mental health service seeking among impoverished women. J Consult Clin Psychol 73:667–677

    Article  PubMed  Google Scholar 

  54. Shelton KH, Taylor P, Bonner A, van den Bree MB (2009) Risk factors for homelessness: evidence from a population-based study. Psychiatr Services 60:465–472

    Article  Google Scholar 

  55. Sumerlin JR (1999) Cognitive-affective preparation for homelessness: quantitative and qualitative analyses of childhood out-of-home placement and child abuse in a sample of homeless men. Psychol Rep 85:553–573

    Article  CAS  PubMed  Google Scholar 

  56. Tam TW, Zlotnick C, Robertson MJ (2003) Longitudinal perspective: adverse childhood events, substance use, and labor force participation among homeless adults. Am J Drug Alcohol Abuse 29:829–846

    Article  PubMed  Google Scholar 

  57. Torchalla I, Strehlau V, Li K, Schuetz C, Krausz M (2012) The association between childhood maltreatment subtypes and current suicide risk among homeless men and women. Child Maltreat 17:132–143

    Article  PubMed  Google Scholar 

  58. Tyler KA (2006) A qualitative study of early family histories and transitions of homeless youth. J Interpers Violence 21:1385–1393

    Article  PubMed  Google Scholar 

  59. Zlotnick C, Robertson MJ, Wright MA (1999) The impact of childhood foster care and other out-of-home placement on homeless women and their children. Child Abuse Negl 23:1057–1068

    Article  CAS  PubMed  Google Scholar 

  60. Viechtbauer W (2010) metafor: meta-analysis package for R. R package version 1.0-1. http://CRAN.R-project.org/package=metafor

  61. R Development Core Team (2012) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  62. Knapp G, Hartung J (2003) Improved tests for a random effects meta-regression with a single covariate. Stat Med 22:2693–2710

    Article  PubMed  Google Scholar 

  63. Baguley T (2012) Serious stats: a guide to advanced statistics for the behavioral sciences. Palgrave, Basingstoke, p 864p

    Google Scholar 

  64. Aloe AM, Becker J, Pigott TD (2010) An alternative to R2 for assessing linear models of effect size. Res Syn Meth 1:272–283

    Article  Google Scholar 

  65. Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L et al (2010) Assessing publication bias in meta-analyses in the presence of between-study heterogeneity. J R Stat Soc Ser A Stat Soc 173:575–591

    Article  Google Scholar 

  66. Sutton AJ, Higgins JPT (2008) Recent developments in meta-analysis. Stat Med 27:625–650

    Article  PubMed  Google Scholar 

  67. Moreno S, Sutton A, Ades AE, Stanley T, Abrams K et al (2009) Assessment of regression-based methods to adjust for publication bias through a comprehensive simulation study. BMC Med Res Methodol 9:2. doi:10.1186/1471-2288-9-2

    Article  PubMed Central  PubMed  Google Scholar 

  68. Herman JL (1992) Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. J Trauma Stress 5:377–391

    Article  Google Scholar 

  69. Roth S, Newman E, Pelcovitz D, Van Der Kolk B, Mandel FS (1997) Complex PTSD in victims exposed to sexual and physical abuse: results from the DSM-IV Field Trial for Posttraumatic Stress Disorder. J Trauma Stress 10:539–555

    CAS  PubMed  Google Scholar 

  70. Briere J, Lanktree CB (2013) Integrative treatment of complex trauma for adolescents (ITCT-A): A guide for the treatment of multiply-traumatized youth, 2nd edn. USC Adolescent Trauma Treatment Training Center, National Child Traumatic Stress Network, U.S. Department of Substance Abuse and Mental Health Services Administration, Los Angeles

  71. Guarino K (2012) Developing a trauma-informed approach to serving young homeless families. The National Center on Family Homelessness, Needham

    Google Scholar 

  72. Hopper EK, Bassuk EL, Olivet J (2010) Shelter from the storm: trauma-informed care in homeless service settings. Open Health Services Policy J 3:80–100

    Article  Google Scholar 

  73. Hutchinson S, Page A, Sample E (2014) Rebuilding shattered lives: the final report—getting the right help at the right time to women who are homeless or at risk. St. Mungo’s, London

    Google Scholar 

  74. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta analyses: the PRISMA statement. PLoS Med 6(6):e1000097. doi:10.1371/journal.pmed1000097

Download references

Acknowledgments

The authors wish to thank the anonymous reviewers for their valuable comments and suggestions to improve the quality of the paper. The authors also wish to thank Helen Baldwin for her assistance in reviewing the literature.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Psychology, Nottingham Trent University, Nottingham, NG1 4BU, UK

    Eva C. Sundin & Thom Baguley

Authors
  1. Eva C. Sundin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thom Baguley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva C. Sundin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sundin, E.C., Baguley, T. Prevalence of childhood abuse among people who are homeless in Western countries: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 50, 183–194 (2015). https://doi.org/10.1007/s00127-014-0937-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-014-0937-6

Keywords

Search

Navigation