Cumulative Trauma Exposure and Chronic Homelessness Among Veterans: The Roles of Responses to Intrusions and Emotion Regulation

Abstract

Veterans with mental health problems and a history of interpersonal and military trauma exposure are at increased risk for chronic homelessness. Although studies have examined posttraumatic stress disorder (PTSD) as a predictor of homelessness, there is limited understanding of specific mechanisms related to cumulative trauma exposure. We sought to elucidate how cumulative interpersonal and military trauma exposure may be linked to homelessness chronicity by examining the role of factors that influence trauma recovery and functional impairment. Specifically, we examined the indirect association of cumulative trauma exposure with homelessness chronicity through distress and responses to trauma-related intrusions and emotion regulation problems in a sample of 239 veterans in community-based homeless programs. Participants completed measures of trauma exposure, responses to intrusions, intrusion distress, difficulties with emotion regulation, and duration and episodes of homelessness. Structural equation modeling was used to test a serial indirect effect model in which cumulative trauma exposure was indirectly associated with homelessness chronicity through distress from and responses to intrusions as well as emotion regulation problems. The results supported the hypothesized sequential indirect effect for episodes of homelessness, indirect effect odds ratio (IE ORs) = 1.12-1.13, but not for current episode duration, IE OR = 1.05. Overall, the present findings elucidate specific trauma-related factors that may be particularly relevant to episodic patterns of homelessness and interfere with efforts to remain housed. These findings represent an important step toward shaping policy and program development to better meet mental health care needs and improve housing outcomes among homeless veterans.

Air Pollution-Related Health Impacts on Individuals Experiencing Homelessness: Environmental Justice and Health Vulnerability in Salt Lake County, Utah

“…For instance, perhaps there are external explanatory factors about the overall homeless population that contribute to higher incidence of cardiopulmonary ill health, making differences in individuals’ duration of homelessness less than a causal factor. Statistically, there are no reported health differences associated with duration of homelessness, either sheltered or unsheltered individuals, which adds to the literature on this topic [ 19 , 52 , 53 , 54 , 55 , 56 , 57 ]. It also may be the case that even short-term experiences of homelessness contribute substantially to cardiopulmonary concerns, again negating duration as a causal, explanatory factor of differences in reported negative health outcomes.…”

Air Pollution-Related Health Impacts on Individuals Experiencing Homelessness: Environmental Justice and Health Vulnerability in Salt Lake County, Utah

“…For instance, perhaps there are external explanatory factors about the overall homeless population that contribute to higher incidence of cardiopulmonary ill health, making differences in individuals' duration of homelessness less than a causal factor. Statistically, there are no reported health differences associated with duration of homelessness, either sheltered or unsheltered individuals, which adds to the literature on this topic [19,[51][52][53][54][55][56]. It also may be the case that even short-term experiences of homelessness contribute substantially to cardiopulmonary concerns, again negating duration as a causal, explanatory factor of differences in reported negative health outcomes.…”

Traumatic Stress and Homelessness: A Review of the Literature for Practitioners

“…Other studies have also concluded that ACEs are powerful risk factors and can predict or shed light on pathways into adult homelessness (Caton et al, 2005;Goodman et al, 1991;Hamilton et al, 2011;Hayes et al, 2013;Herman et al, 1997;Roos et al, 2013). Recent research with veterans indicated that cumulative trauma exposure plays a role in future homelessness and that vulnerabilities for homelessness in female veterans were histories of isolation and lack of social support (Hamilton et al, 2011;Macia et al, 2020). Thus, early childhood trauma has an important association with both the incidence and severity of homelessness.…”

“…Persons experiencing homelessness (PEH) may experience traumatic stress from multiple sources, including structural violence throughout the life course, adverse childhood experiences (ACEs), events leading up to an episode of homelessness, and/or experiences that occur while a person remains unsheltered (Bassuk et al, 2001;Goodman et al, 1991;Los Angeles Homeless Services Authority, 2019;Roos et al, 2013;Young et al, 2017). Repeated or multiple traumatic experiences can overwhelm a person's available internal and/or external resources to such a degree that their physiological reactions interfere with effective coping and they have reduced capacity for emotional regulation (Macia et al, 2020;McVicar, 2003). Additionally, there is evidence to show a correlation between racism, oppression, marginalization, and a history of trauma with lifetime homelessness (Fusaro et al, 2018;Galtung & Fischer, 2013;Jones, 2016;Los Angeles Homeless Services Authority, 2019;Olivet et al, 2019;Roth & Bean, 1986).…”