Posttraumatic Stress Disorder Among Homeless Young Adults: A Structural Equation Model
Experiencing victimization and traumatic events play a major role in the daily lives of homeless young adults. Although rates of posttraumatic stress disorder (PTSD) are elevated among this population, little explanatory research has investigated the types of trauma that lead to symptom development. Even less is known about individual characteristics that buffer or protect them from symptom progression. The current study utilized structural equation modeling to identify pathways to PTSD among a large and diverse sample of homeless young adults. Specific research questions included: (1) Does childhood maltreatment predict street victimization which then places young people at risk for PTSD? and (2) What characteristics (self-esteem, social connectedness, and resiliency) buffer against developing PTSD symptoms among homeless young adults?
Data were analyzed from a multi-site, cross-sectional study of 601 homeless emerging adults, ages 18-25 years, who were seeking homeless services in Denver (n=201), Austin (n=200) and Los Angeles (n=200). Face-to-face quantitative interviews assessed demographics, whether participants met criteria for posttraumatic stress disorder (using the Mini International Neuropsychiatry Interview), child maltreatment (using the Childhood Trauma Questionnaire), and direct (e.g. physical assault) and indirect victimization (e.g. witnessed violence) while on the streets (using the Traumatic Events Questionnaire). Standardized measures of self-esteem, resilience, and social connectedness were also included. Structural equation modeling, using M-Plus.7, tested direct and indirect effects of these factors on PTSD, while controlling for site of interview (city) and age. Maximum likelihood estimation was used to model observed and latent (child maltreatment and indirect/direct street victimization) predictors of PTSD.
The model represented a good fit to the data (chi-square=252.6, (df=113), p=.00; CFI=.87, RMSEA=.05). Results of the structural model revealed a significant direct effect of childhood maltreatment on street victimization (path coefficients= .61, p<.00) and a direct effect of street victimization on PTSD (.45, p<.00). As levels of self-esteem (-.04, p<.01), social connectedness (-.02, p<.01), and resiliency (-.07, p<.01) increased, rates of PTSD decreased, although the effects of these protective variables were relatively small. Data collection sites varied in rates of PTSD and were thus controlled for in all analyses (-31, p<.00).
Results of the structural model are promising for the field of homeless services as they provide insight into the antecedents of posttraumatic stress disorder among these emerging young adults. For this population, it appears that experiencing childhood trauma results in greater likelihood of experiencing victimization on the streets. Such information could aid practitioners to better recognize the important issues concerning trauma symptoms and focus on effective interventions for treating these highly vulnerable young people and for preventing further victimization on the streets. Findings also suggest that feeling resilient, being more socially connected and have higher self-esteem may act as protective factors buffering youth from developing posttraumatic stress disorder. Although this study included homeless young people from disparate regions of the country, further research is needed to replicate this structural model to verify its utility in predicting pathways leading to posttraumatic stress disorder among highly traumatized and vulnerable homeless young people.