Factors Associated with Trauma and PTSD among Street Youth in Three U.S. Cities: The Importance of Youth Transience

Purpose: Living on the streets in unprotected and dangerous neighborhoods, homeless youth experience disproportionate rates of trauma. They often engage in deviant survival strategies, such as panhandling, selling sexual favors, and dealing drugs, which increases their risk for criminal assault and other forms of victimization. Due to low rates of service utilization, homeless youth are likely to suffer from recurring traumatic experiences, resulting in elevated rates of Posttraumatic Stress Disorder (PTSD). Previous research underscores the importance of substance abuse and depression in predicting trauma and PTSD among homeless youth; however, few studies have examined the impact of transience on the mental health of homeless youth despite the fact that transience is an intricate part of homeless youth culture. The purpose of this study is to specifically examine transience, and other factors, to test their associations with trauma and PTSD among homeless youth across multiple U.S. cities.

Methods: In this cross-sectional study, 146 homeless youth from Los Angeles (n=50), Denver (n=50) and St. Louis (n=46) were recruited using comparable research methods and measurement instruments from shelters, drop-in centers and street locations. Participants were 18-24 years old and had spent at least 2 weeks away from home in the month prior to study involvement. Semi-structured retrospective interviews were conducted to assess youth transience level (number of inter-city moves). The Mini International Neuropsychiatry Interview was used to determine level of depression, mania, trauma experience, PTSD, and addiction to alcohol and drugs. Self-report questionnaires queried other risk factors, including school status, criminal history, and support systems. Separate logistic regression models examined factors associated with experiencing a traumatic event (yes/no) and meeting PTSD criteria (yes/no).

Results: Approximately 56.8% of surveyed youth had experienced a traumatic event, while 24.0% met criteria for PTSD. Youth who had an alcohol use disorder, were more transient, reported symptoms of mania, and had graduated from high school were significantly more likely to have experienced a traumatic event, x2=34.38(df=5), p = .001. Similar factors predicted meeting PTSD criteria, including manic symptoms, alcohol use disorders, and transience, x2=37.96(df=6), p = .001. In addition PTSD was associated with more frequent use of self-protection techniques (carrying weapons, avoiding certain people). Importantly, transient youth (4+ moves) were nearly 3 times more likely to have experienced a traumatic event and to meet criteria for PTSD.

Implications: Findings confirm alcohol use and mood disorders as highly predictive of trauma/PTSD among homeless youth. Concurrent treatment for PTSD symptoms that integrates co-occurring substance abuse and mental health conditions should be prioritized. This study is among the first to highlight transience as a significant factor associated with trauma and PTSD. Highly mobile homeless youth appear to live particularly dangerous lifestyles, exposing them to traumatic events. Furthermore, their transience may prevent consistent treatment, resulting in fewer coping skills, incomplete recovery, and PTSD symptoms. Creating stability is therefore critical to reducing trauma risk among homeless youth. Alternatively, use of virtual interventions (e.g., social networking software) for highly mobile homeless youth may provide this population with continuity of care amid their transient episodes.