Skip to main content

Advertisement

SpringerLink
Log in

A Systematic Review and Meta-Analysis of the Prevalence of Post-Traumatic Stress Disorder among Homeless People

  • Review Article
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

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.

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

Similar content being viewed by others

Data Availability

All data generated or analyzed during this study are included in this article.

References

  1. American Psychiatric Association. Diagnostic Stastistical manual of mental disorder (5 th edition). Wahington, DC: American Psychiatric Association; 2013.

    Google Scholar 

  2. 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.

    Google Scholar 

  3. 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.

    CAS  Google Scholar 

  4. 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.

    CAS  Google Scholar 

  5. 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.

    CAS  PubMed Central  Google Scholar 

  6. 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.

    Google Scholar 

  7. 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.

    Google Scholar 

  8. 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.

    CAS  Google Scholar 

  9. Brennan PA, Mednick SA, Hodgins S. Major mental disorders and criminal violence in a Danish birth cohort. Arch Gen Psychiatry. 2000;57:494–500.

    CAS  Google Scholar 

  10. 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.

    Google Scholar 

  11. 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.

    CAS  Google Scholar 

  12. Connolly AJ, Cobb-Richardson P, Ball SA. Personality disorders in homeless drop-in center clients. J Personal Disord. 2008;22:573–88.

    Google Scholar 

  13. Crawford DM, Trotter EC, Hartshorn KJ, Whitbeck LB. Pregnancy and mental health of young homeless women. Am J Orthopsychiatry. 2011;81:173–83.

    PubMed Central  Google Scholar 

  14. Fazel S, Grann M. The population impact of severe mental illness on violent crime. Am J Psychiatry. 2006;163:1397–403.

    Google Scholar 

  15. 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.

    PubMed Central  Google Scholar 

  16. 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.

    CAS  Google Scholar 

  17. Fischer PJ, Breakey WR. The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychol. 1991;46:1115–28.

    CAS  Google Scholar 

  18. 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.

    Google Scholar 

  19. Foundation, HWC 2015. Global hoelessness statistics, 2015.

  20. Gelberg L, Linn LS. Demographic differences in health status of homeless adults. J Gen Intern Med. 1992;7:601–8.

    CAS  Google Scholar 

  21. 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.

    CAS  Google Scholar 

  22. Goldstein G, Luther JF, Haas GL. Medical, psychiatric and demographic factors associated with suicidal behavior in homeless veterans. Psychiatry Res. 2012;199:37–43.

    Google Scholar 

  23. Habánik T. Mental health problems as one of the factors in the development and persistence of homelessness. Kontakt. 2018;20:e171–6.

    Google Scholar 

  24. 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.

    Google Scholar 

  25. 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.

    Google Scholar 

  26. 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.

    PubMed Central  Google Scholar 

  27. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327:557–60.

    PubMed Central  Google Scholar 

  28. Hong C, Efferth T. Systematic review on post-traumatic stress disorder among survivors of the Wenchuan earthquake. Trauma Violence Abuse. 2015;17:542–61.

    Google Scholar 

  29. Hwang SW. Mortality among men using homeless shelters in Toronto, Ontario. Jama. 2000;283:2152–7.

    CAS  Google Scholar 

  30. 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.

    CAS  Google Scholar 

  31. 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.

    PubMed Central  Google Scholar 

  32. 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.

    Google Scholar 

  33. 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.

    PubMed Central  Google Scholar 

  34. 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.

    PubMed Central  Google Scholar 

  35. 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.

    Google Scholar 

  36. 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.

    PubMed Central  Google Scholar 

  37. 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.

    PubMed Central  Google Scholar 

  38. 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.

    PubMed Central  Google Scholar 

  39. 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.

    PubMed Central  Google Scholar 

  40. Petering R. Sexual risk, substance use, mental health, and trauma experiences of gang-involved homeless youth. J Adolesc. 2016;48:73–81.

    PubMed Central  Google Scholar 

  41. 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.

    Google Scholar 

  42. 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.

    Google Scholar 

  43. Rhoades H, Wenzel SL. Correlates of prescription drug misuse among heterosexually active homeless men. Subst Abus. 2013;34:143–9.

    Google Scholar 

  44. 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.

    CAS  Google Scholar 

  45. 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.

    PubMed Central  Google Scholar 

  46. Scott J. Homelessness and mental illness. Br J Psychiatry. 1993;162:314–24.

    CAS  Google Scholar 

  47. 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.

  48. 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.

    Google Scholar 

  49. 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.

    Google Scholar 

  50. 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.

    CAS  Google Scholar 

  51. 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.

    Google Scholar 

  52. Tsai J, Rosenheck RA. Risk factors for homelessness among US veterans. Epidemiol Rev. 2015;37:177–95.

    PubMed Central  Google Scholar 

  53. 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.

    Google Scholar 

  54. 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.

    Google Scholar 

  55. 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.

    Google Scholar 

  56. 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.

    Google Scholar 

  57. 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.

    Google Scholar 

Download references

Acknowledgments

We are delighted to acknowledge all the authors from the included studies.

Author information

Authors and Affiliations

  1. Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

    Getinet Ayano & Melat Solomon

  2. School of public health, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102, Australia

    Getinet Ayano

  3. Department of Psychiatry, Aksum University, Aksum, Ethiopia

    Light Tsegay

  4. Department of Psychiatry, Dilla University, Dilla, Ethiopia

    Kalkidan Yohannes

  5. Department of Psychiatry, Paulo’s millennium medical college, Addis Ababa, Ethiopia

    Mebratu Abraha

Authors
  1. Getinet Ayano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melat Solomon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Light Tsegay
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kalkidan Yohannes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mebratu Abraha
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The author (GA) conceptualized the study, conducted analyses, write-up and approval of the final manuscript. MA was performed the search, data extraction, quality assessment, write the discussion, draft and approved the final manuscript. LT and KY were participated in discussion and consensus and approved the final manuscript.

Corresponding author

Correspondence to Getinet Ayano.

Ethics declarations

Ethics Approval and Consent to Participate

N/A

Consent for Publication

N/A

Competing Interests

The authors declare that there are no competing interests.

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

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-020-09746-1

Keywords

Search

Navigation