Trauma Profiles As a Predictor of Adverse Outcomes in Homeless Young Adults

BACKGROUND. Exposure to Adverse Childhood Experiences (ACE) such as neglect, abuse, and environmental stressors, like domestic violence are risk factors for mental distress and risk behaviors in young adulthood.  Homeless young adults are already at extremely high risk for these problems yet little is known about how trauma is related to these outcomes and whether different amounts or types of trauma may increase risk. This study aimed to: (1) identify trauma profiles in homeless young adults and (2) examine how these profiles were related to mental distress, substance use, and trade sex. METHODS. Homeless youth, ages 18-24, were surveyed at multiple locations across Houston over 4 weeks in 2014 (n=378) using a self- administered survey.  Trauma was measured using the ACE scale, mental distress using the Kessler 6, and past year substance use with items from Monitoring the Future. Two items assessed trade sex.  Latent Class Analysis was used to group individuals into trauma classes based on their responses to the 10 items in the ACE.  A four-class solution was the best fitting model based on the Vuong-Lo-Mendell-Rubin likelihood ratio test.  Separate logistic regressions tested the relation between the trauma profiles and mental distress, substance use, and trade sex using each trauma class as the reference group, controlling for gender and age. RESULTS. Trauma in the sample was high with a mean ACE score of 4.3 (SD=3.1). We identified 4 distinct trauma profiles: (C1) extremely high trauma, characterized by high rates of all 10 ACEs (n=44), (C2) high trauma/maltreatment, characterized by generally high levels of trauma but with traumatic events clustered around emotional/ physical abuse and neglect (n = 63), (C3) moderate trauma, characterized by moderate rates across the ACE (n=166), and (C4) very low trauma (n=105). Individuals in each of the three higher trauma groups had significantly higher odds of mental distress (C1 OR=4.7 (2.1-10.2), C2 OR=4.1 (2.0-8.3), C3 OR=2.6 (1.5-4.5)), substance use (C1 OR=4.3 (1.6-11.8), C2 OR=4.2 (1.6-10.6), C3 OR=3.4 (1.5-7.4)), and trade sex (C1 OR=6.0 (2.3-16.1), C2 OR=4.4 (1.8-10.5), C3 OR=2.3 (1.1-5.0)) compared to the low trauma group. The high and moderate classes did not significantly differ from each other in predicting mental distress or substance use, but those in the extremely high and high maltreatment trauma groups had higher odds than the moderate trauma group of trade sex. CONCLUSION. Homeless youth have high exposure to multiple traumatic events. Distinct trauma profiles can assist in determining those at higher risk for mental distress, substance use, and trade sex. Findings suggest that high and moderate levels of trauma are equally associated with mental distress and substance use, indicating a potential threshold effect where the amount and trauma type do not significantly increase these particular outcomes. However, for trade sex, a gradient effect was seen where increases in the level of trauma experienced was associated with greater risk of trade sex.  These data support the importance of considering amount and type of trauma exposure when developing interventions to address mental distress and risk behaviors for homeless youth.