Prevalence and Outcomes of Childhood Poly-Victimization Among Homeless Youth

Background: Research finds that homeless youth often report leaving home to escape various forms of childhood abuse. Studies of youth in the general population suggest that those who experience multiple types of victimization (poly-victims) are particularly likely to experience adverse mental health and behavioral outcomes. While it is well recognized that homeless youth experience elevated rates of abuse, few studies have examined the consequences of homeless youths’ exposure to multiple types of abuse during childhood. This study of homeless youth aimed to: 1) examine the proportion of youth experiencing poly-victimization, 2) describe the types of victimization that commonly co-occur, and 3) determine the mental health and behavioral outcomes associated with homeless youths’ experiences of poly-victimization.

Methods: Data were collected from quantitative interviews conducted in a multisite, cross-sectional study of youth (N=601), ages 18-25, seeking homeless services in Denver (n=201), Austin (n=200) and Los Angeles (n=200). The Childhood Trauma Questionnaire was used to develop a measure of poly-victimization, indicating the number of distinct types of victimization youth experienced during childhood. Descriptive analyses indicated the proportion of youth experiencing 0, 1, 2, or 3 types of victimization (physical, sexual, emotional abuse); bivariate analyses examined the types of victimization that commonly co-occur. Finally logistic regression models examined whether poly-victimization predicted three mental health outcomes: posttraumatic stress disorder (PTSD), depression, and substance use disorder (Mini International Neuropsychiatry Interview), controlling for demographics and homelessness-related risk factors such as length of time homeless, transience and street victimization (Trauma Life Events Questionnaire).

Results: Approximately 7% of the respondents indicated no exposure to victimization. Among the small group of youth (14%) who reported exposure to a single type of victimization, the majority experienced emotional abuse (74.1%) and the remainder physical abuse (25.9%). Notably, no participants reported exposure to sexual abuse exclusively. A larger subgroup (49.7%) reported exposure to two types of victimization; this group primarily experienced overlapping emotional abuse (99%) and physical abuse (94%), with a small minority reporting co-occurring sexual abuse (7%). Thirty percent of youth experienced all 3 types of victimization. Accounting for other homeless-related risk factors, poly-victimization (i.e., greater number of victimization types experienced) predicted meeting DSM-IV criteria for PTSD (OR=1.94, p<.05) and depression (OR=1.86, p<.05) but not substance use disorder (OR=1.23, p=.110). 

 Conclusions: Findings indicate homeless youth experience extremely elevated rates of poly-victimization as approximately 79% reported more than one type of victimization. This poly-victimization places them at risk for serious mental health consequences. For each additional type of childhood victimization experienced, youth were nearly twice as likely to meet criteria for PTSD or depression, even after accounting for street victimization. In contrast, substance use disorders were better predicted by street victimization than childhood poly-victimization. Homeless youth services aiming to identify youth with mental health needs should screen for previous victimization experiences; when poly-victimization is reported, more thorough assessment should occur. Furthermore, considering high rates of poly-victimization and significant associations with mental health problems, a trauma-informed approach to mental health treatment for homeless youth is warranted.