Post-traumatic stress disorder (PTSD) is common among homeless people and is associated with an increased risk of mortality from suicide, medical causes, and drug-related problems. However, there are no previous systematic review and meta-analysis studies that reported the consolidated magnitude of PTSD among homeless people. A literature search was conducted on PubMed, Embase, and Scopus to discover pertinent studies that determined the prevalence of PTSD among the homeless. Articles were evaluated by titles, abstracts, and full-text. Comprehensive meta-analysis software was used to conduct the meta-analysis. Subgroup and sensitivity analysis were performed and Cochran’s Q- and the I2 test were used to assess heterogeneity. The evidence of publication bias was evaluated by using Egger’s test and visual inspection of the symmetry in funnel plots. From the total, 19 studies with 20,364 participants across seven countries were included in the final analysis. Our meta-analysis revealed that the pooled prevalence of PTSD among homeless people was 27.38% (95% CI; 21.95–33.57). In our subgroup analysis, we found that the prevalence of PTSD was considerably high as measured by the screening instrument (35.93%) than the diagnostic instrument (23.57% %). The prevalence of PTSD among homeless showed a significant variation by the location of the studies, the instruments used to measure PTSD as well as the quality of the included studies. This review showed that the pooled prevalence estimate of PTSD among homeless peoples was remarkably high (27.38%). Early screening and treatment of PTSD among homeless peoples are warranted to alleviate suffering.
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American Psychiatric Association. Diagnostic Stastistical manual of mental disorder (5 th edition). Wahington, DC: American Psychiatric Association; 2013.
Ayano G, Assefa D, Haile K, Chaka A, Solomon H, Hagos P, et al. Mental, neurologic, and substance use (MNS) disorders among street homeless people in Ethiopia. Ann General Psychiatry. 2017;16:40.
Ayers S, Bond R, Bertullies S, Wijma K. The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychol Med. 2016;46:1121–34.
Babidge NC, Buhrich N, Butler T. Mortality among homeless people with schizophrenia in Sydney, Australia: a 10-year follow-up. Acta Psychiatr Scand. 2001;103:105–10.
Barrow SM, Herman DB, Cordova P, Struening EL. Mortality among homeless shelter residents in New York City. Am J Public Health. 1999;89:529–34.
Bender K, Brown SM, Thompson SJ, Ferguson KM, Langenderfer L. Multiple victimizations before and after leaving home associated with PTSD, depression, and substance use disorder among homeless youth. Child Maltreat. 2015;20:115–24.
Borenstein M, Hedges LV, Higgins JP, Rothstein HR. A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods. 2010;1:97–111.
Breakey WR, Fischer PJ, Kramer M, Nestadt G, Romanoski AJ, Ross A, et al. Health and mental health problems of homeless men and women in Baltimore. Jama. 1989;262:1352–7.
Brennan PA, Mednick SA, Hodgins S. Major mental disorders and criminal violence in a Danish birth cohort. Arch Gen Psychiatry. 2000;57:494–500.
Carlson EB, Garvert DW, Macia KS, Ruzek JI, Burling TA. Traumatic stressor exposure and post-traumatic symptoms in homeless veterans. Mil Med. 2013;178:970–3.
Caton CL, Shrout PE, Eagle PF, Opler LA, Felix A. Correlates of codisorders in homeless and never homeless indigent schizophrenic men. Psychol Med. 1994;24:681–8.
Connolly AJ, Cobb-Richardson P, Ball SA. Personality disorders in homeless drop-in center clients. J Personal Disord. 2008;22:573–88.
Crawford DM, Trotter EC, Hartshorn KJ, Whitbeck LB. Pregnancy and mental health of young homeless women. Am J Orthopsychiatry. 2011;81:173–83.
Fazel S, Grann M. The population impact of severe mental illness on violent crime. Am J Psychiatry. 2006;163:1397–403.
Fazel S, Khosla V, Doll H, Geddes J. The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis. PLoS Med. 2008;5:e225.
Fichter MM, Quadflieg N. Prevalence of mental illness in homeless men in Munich, Germany: results from a representative sample. Acta Psychiatr Scand. 2001;103:94–104.
Fischer PJ, Breakey WR. The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychol. 1991;46:1115–28.
Fletcher JB, Reback CJ. Mental health disorders among homeless, substance-dependent men who have sex with men. Drug Alcohol Rev. 2017;36(4):555–9.
Foundation, HWC 2015. Global hoelessness statistics, 2015.
Gelberg L, Linn LS. Demographic differences in health status of homeless adults. J Gen Intern Med. 1992;7:601–8.
Ghose T, Fiellin DA, Gordon AJ, Metraux S, Goetz MB, Blackstock O, et al. Hazardous drinking and its association with homelessness among veterans in care. Drug Alcohol Depend. 2013;132:202–6.
Goldstein G, Luther JF, Haas GL. Medical, psychiatric and demographic factors associated with suicidal behavior in homeless veterans. Psychiatry Res. 2012;199:37–43.
Habánik T. Mental health problems as one of the factors in the development and persistence of homelessness. Kontakt. 2018;20:e171–6.
Heerde JA, Hemphill SA. Sexual risk behaviors, sexual offenses, and sexual victimization among homeless youth: a systematic review of associations with substance use. Trauma Violence Abuse. 2016;17:468–89.
Heerde JA, Scholes-Balog KE, Hemphill SA. Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: a systematic literature review. Arch Sex Behav. 2015;44:181–212.
Herzog R, Alvarez-Pasquin MJ, Diaz C, del Barrio JL, Estrada JM, Gil A. Are healthcare workers' intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. 2013;13:154.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327:557–60.
Hong C, Efferth T. Systematic review on post-traumatic stress disorder among survivors of the Wenchuan earthquake. Trauma Violence Abuse. 2015;17:542–61.
Hwang SW. Mortality among men using homeless shelters in Toronto, Ontario. Jama. 2000;283:2152–7.
Koegel P, Burnam MA, Farr RK. The prevalence of specific psychiatric disorders among homeless individuals in the inner city of Los Angeles. Arch Gen Psychiatry. 1988;45:1085–92.
Landefeld JC, Miaskowski C, Tieu L, Ponath C, Lee CT, Guzman D, et al. Characteristics and factors associated with pain in older homeless individuals: results from the health outcomes in people experiencing homelessness in older middle age (HOPE HOME) study. J Pain. 2017;18:1036–45.
Larney S, Conroy E, Mills KL, Burns L, Teesson M. Factors associated with violent victimisation among homeless adults in Sydney, Australia. Aust N Z J Public Health. 2009;33:347–51.
Mabhala MA, Yohannes A, Griffith M. Social conditions of becoming homelessness: qualitative analysis of life stories of homeless peoples. Int J Equity Health. 2017;16:150.
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.
Morse G, Shields NM, Hanneke CR, Mccall GJ, Calsyn RJ, Nelson B. St. Louis' homeless: mental health needs, services, and policy implications. Psychosocial Rehabilitation Journal. 1986;9:39–50.
Navarro-Mateu F, Salmeron D, Vilagut G, Tormo MJ, Ruiz-Merino G, Escamez T, et al. Post-traumatic stress disorder and other mental disorders in the general population after Lorca's earthquakes, 2011 (Murcia, Spain): a cross-sectional study. PLoS One. 2017;12:e0179690.
Nishio A, Horita R, Sado T, Mizutani S, Watanabe T, Uehara R, et al. Causes of homelessness prevalence: relationship between homelessness and disability. Psychiatry Clin Neurosci. 2017;71:180–8.
Noel F, Moniruzzaman A, Somers J, Frankish J, Strehlau V, Schutz C, et al. A longitudinal study of suicidal ideation among homeless, mentally ill individuals. Soc Psychiatry Psychiatr Epidemiol. 2016;51:107–14.
Pearson CR, Kaysen D, Belcourt A, Stappenbeck CA, Zhou C, Smartlowit-Briggs L, et al. Post-traumatic stress disorder and HIV risk behaviors among rural American Indian/Alaska native women. Am Indian Alsk Native Ment Health Res. 2015;22:1–20.
Petering R. Sexual risk, substance use, mental health, and trauma experiences of gang-involved homeless youth. J Adolesc. 2016;48:73–81.
Prigerson HG, Desai RA, Liu-Mares W, Rosenheck RA. Suicidal ideation and suicide attempts in homeless mentally ill persons: age-specific risks of substance abuse. Soc Psychiatry Psychiatr Epidemiol. 2003;38:213–9.
Prinsloo B, Parr C, Fenton J. Mental illness among the homeless: prevalence study in a Dublin homeless hostel. Ir J Psychol Med. 2012;29:22–6.
Rhoades H, Wenzel SL. Correlates of prescription drug misuse among heterosexually active homeless men. Subst Abus. 2013;34:143–9.
Roze M, Vandentorren S, van der Waerden J, Melchior M. Factors associated with depression among homeless mothers. Results of the ENFAMS survey. J Affect Disord. 2018;229:314–21.
Schinka JA, Schinka KC, Casey RJ, Kasprow W, Bossarte RM. Suicidal behavior in a national sample of older homeless veterans. Am J Public Health. 2012;102(Suppl 1):S147–53.
Scott J. Homelessness and mental illness. Br J Psychiatry. 1993;162:314–24.
Spinelli MA, Ponath C, Tieu L, Hurstak EE, Guzman D, Kushel M. Factors associated with substance use in older homeless adults: results from the HOPE HOME study. Subst Abus. 2017;38(1):88–94.
Strehlau V, Torchalla I, Kathy L, Schuetz C, Krausz M. Mental health, concurrent disorders, and health care utilization in homeless women. J Psychiatr Pract. 2012;18:349–60.
Taylor KM, Sharpe L. Trauma and post-traumatic stress disorder among homeless adults in Sydney. Aust N Z J Psychiatry. 2008;42(3):206–13.
Tian F, Wang J, Huang Y, Guo X, Yun Z, Yang T, et al. Psychological and behavioural impacts of the 2008 China earthquake on blood donors. Vox Sang. 2010;99:142–8.
Topolovec-Vranic J, Schuler A, Gozdzik A, Somers J, Bourque PE, Frankish CJ, et al. The high burden of traumatic brain injury and comorbidities amongst homeless adults with mental illness. J Psychiatr Res. 2017;87:53–60.
Tsai J, Rosenheck RA. Risk factors for homelessness among US veterans. Epidemiol Rev. 2015;37:177–95.
Walsh E, Moran P, Scott C, Mckenzie K, Burns T, Creed F, et al. Prevalence of violent victimisation in severe mental illness. Br J Psychiatry. 2003;183:233–8.
Wang L, Zhang J, Zhou M, Shi Z, Liu P. Symptoms of posttraumatic stress disorder among health care workers in earthquake-affected areas in Southwest China. Psychol Rep. 2010;106:555–61.
Wenzel SL, Rhoades H, Harris T, Winetrobe H, Rice E, Henwood B. Risk behavior and access to HIV/AIDS prevention services in a community sample of homeless persons entering permanent supportive housing. AIDS Care. 2017;29:570–4.
Xi Y, Chen R, Yan F, Ma X, Rakofsky JJ, Tang L, et al. Low post-traumatic stress disorder rate in Chinese in Beijing, China. Asian J Psychiatr. 2017;30:79–83.
Yohannes K, Gebeyehu A, Adera T, Ayano G, Fekadu W. Prevalence and correlates of post-traumatic stress disorder among survivors of road traffic accidents in Ethiopia. Int J Ment Heal Syst. 2018;12:50.
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List of Abbreviations
DSM Diagnostic and Statistical Manual of Mental Disorders
ICD International Classification of Disease
MINI Mini-International Neuropsychiatric Interview
NOS Newcastle-Ottawa Scale
PC-PCL The Primary Care PTSD Checklist
PTSD Post-Traumatic Stress Disorder
SCID Structured Clinical Interview for DSM
TSQ Trauma Screening Questionnaire
USA United States of America
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Ayano, G., Solomon, M., Tsegay, L. et al. A Systematic Review and Meta-Analysis of the Prevalence of Post-Traumatic Stress Disorder among Homeless People. Psychiatr Q 91, 949–963 (2020). https://doi.org/10.1007/s11126-020-09746-1