Victimization and posttraumatic stress disorder in homeless women with mental illness are associated with depression, suicide, and quality of life

Abstract

Aurelie Tinland,1,2 Laurent Boyer,1,3 Sandrine Loubière,1,3 Tim Greacen,4 Vincent Girard,1,2 Mohamed Boucekine,1,3 Guillaume Fond,1,5 Pascal Auquier1,3 1EA 3279: CEReSS – Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France; 2Department of Psychiatry, Sainte-Marguerite University Hospital, Marseille, France; 3Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France; 4Research Unit, Public Health Institution Maison Blanche, Paris, France; 5Jeanne d’Arc – private Hospital, Paris-East University, FondaMental Fundation, Paris, France Objective: This study aimed to determine the following: 1) the proportion of women in the homeless population with schizophrenia (SZ) or bipolar disorder (BD), in addition to the trajectory of their homelessness (ie, homelessness history, number of nights spent without home during the 180 past nights) and the characteristics of their illnesses compared to men (ie, illness severity, suicide risk, physical health status, and quality of life [QoL]); 2) whether these women were victimized more frequently than similarly situated men; 3) the impact of victimization on these women in terms of illness severity, suicide risk, physical health status, and QoL; and lastly 4) the differences and overlap of homeless women with SZ and BD. Methods: This study employed data at baseline from a multicenter randomized controlled trial conducted in the following four large French cities: Lille, Marseille, Paris, and Toulouse. Mobile mental health outreach teams recruited SZ/BD homeless patients in the street, emergency shelters, hospitals, and jails from August 2011 to April 2014. Evaluations were performed during face-to-face interviews by psychiatrists and research assistants in the offices of mobile mental health outreach teams that were located in the downtown area of each city. The quantitative data were analyzed using descriptive analyses, chi-square and Student’s t-tests, generalized estimating equation regression models, and path analysis. Results: A total of 703 patients were included in this study. The proportion of women in the SZ/BD homeless population was 123/703 (17.5%). In this population, women were more likely than men to declare that they were subjected to physical or sexual assault during the past 6 months, that they had been diagnosed with posttraumatic stress disorder (PTSD), and that they had experienced more severe depressive symptoms. Moreover, these women presented a higher suicide risk, worse physical health status, and lower QoL than similarly situated men. Homeless women with BD were more vulnerable than women with SZ. A path analysis revealed that PTSD and violent victimization might explain the higher levels of depression and suicide risk and the lower levels of physical health status and QoL in homeless women. Conclusion: SZ/BD homeless women experience more PTSD and victimization than men, which are both associated with poor clinical outcomes. These results confirm the vulnerability of homeless women in this high need population and should be considered by public health policy. Keywords: homelessness, victimization, quality of life, schizophrenia, bipolar disorder, women

Keywords

• Homelessness
• victimization
• quality of life
• schizophrenia
• bipolar disorder
• women.