Post-traumatic stress disorder amongst homeless, substance-using adults

  • Ms Sarah Larney, National Drug and Alcohol Research Centre, University of New South Wales, Australia
  • Ms Elizabeth Conroy, National Drug and Alcohol Research Centre, University of New South Wales, Australia
  • Dr Katherine Mills, National Drug and Alcohol Research Centre, University of New South Wales, Australia
  • Dr Lucy Burns, National Drug and Alcohol Research Centre, University of New South Wales, Australia
  • Dr Maree Teesson, National Drug and Alcohol Research Centre, University of New South Wales, Australia

    • Objective
    To determine the prevalence and correlates of post-traumatic stress disorder (PTSD) in a cohort of homeless adults using alcohol and illicit drugs.

    Methods
    Cross-sectional data were collected from clients of an intoxicated person’s unit in inner-Sydney. PTSD was assessed using the Trauma Screening Questionnaire. Logistic regression was used to identify predictors of PTSD.

    Results
    Of 106 participants, the majority (80%) were male and the mean age was 42. Eighteen participants identified as Aboriginal or Torres Strait Islanders. The most commonly used drugs were nicotine (95%), alcohol (84%), cannabis (55%) and methamphetamine (34%). Most participants used multiple licit and illicit drugs.

    Almost all participants had experienced at least one traumatic event, most commonly, being physically attacked (68%), witnessing someone being injured or killed (67%) and being in a life-threatening accident (66%). Over half (57%) of the sample screened positive for PTSD. Bivariate analysis revealed that a diagnosis of PTSD was associated with being homeless for longer than 12 months, heroin use in the last month, having injected drugs in the last month, severe depression, having been tortured, having been sexually abused or raped, and having experienced a greater number of traumatic events. In the final multivariate model (R2=0.34, p<.001), PTSD was independently associated with being homeless for longer than 5 years, severe depression and exposure to a greater number of traumatic events.

    Conclusion
    Trauma exposure and PTSD were highly prevalent among this sample. Drug use factors were not significant predictors of PTSD in the multivariate model, possibly due to the high level of poly-drug use in the sample. Chronic homelessness was associated with an increased risk for PTSD, suggesting a need for the assessment and management of posttraumatic stress symptoms among homeless persons. Future research should address causality in the relationship between homelessness, trauma exposure and PTSD.