The relationship between PTSD factors and depression in a chronically homeless sample

ABSTRACT

The relationship between post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) is the subject of ongoing inquiry. Homeless adults with psychiatric illnesses are at risk for comorbid PTSD and MDD. However, the factor structures of commonly used screening tools for PTSD (PCL-5) and MDD (PHQ-9), and their interrelationships, have not been widely investigated in this population. The present article tests the factor structure of the PCL-5 and PHQ-9 in a sample of chronically homeless adults who reported lifetime trauma exposure and were enrolled into intensive community mental health services (N = 197). Confirmatory factor analysis was used to test six models of PTSD and four models of depression, although more complex models produced indefinite covariance matrices. The four-factor Dysphoria Model of PTSD and a two-factor model of MDD were considered the best models in this sample. Regression analyses tested the variance between PTSD and MDD symptom clusters. The PTSD dysphoria factor explained the most variance in depressive symptoms. Reexperiencing, avoidance, and arousal symptoms capture phenomena unique to the experience of PTSD among this psychiatric sample. These findings have implications for conceptualizing the underlying structures of PTSD and MDD among a moderately depressed sample of homeless adults with psychiatric illnesses.

KEYWORDS:

• Chronic homelessness
• serious mental illness
• depression
• post traumatic stress disorder
• CFA

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Nathaniel A. Dell, AM, MSW, LCSW, is Program Manager for Research and Evaluation at Places for People, Inc. and a doctoral student at Saint Louis University in the School of Social Work. His social work practice experience includes providing clinical services for adults transitioning from homelessness who have mental health and/or substance use concerns. His research interests include evidence synthesis methods, recovery, and the implementation of evidence-based interventions in community mental health settings.

Jin Huang, Ph.D., is an associate professor at Saint Louis University and a research associate professor with the Brown School at Washington University in St. Louis. His research interests include research methods and social policy that supports family and child well-being, with a particular focus on financial capability and asset-based programs.

Gary Morse, Ph.D., Vice President of Research and Development at Places for People, has served in the behavioral health field since 1987, providing direct services, administering programs, and delivering consultation and training. His research includes burnout prevention interventions for mental health staff and program implementation for under-served populations with mental health and/or substance use, including persons with co-occurring homelessness, HIV/AIDS, or criminal justice involvement.

Pallavi Nishith, Ph.D., is a Staff Psychologist at Places for People, Inc. In this role she provides clinical services and conducts research with a focus on clinical outcome research in the area of trauma and PTSD. She is particularly interested in the psychopathology of PTSD and its comorbidity with depression and substances.

Additional information

Funding

This work was supported by the Substance Abuse and Mental Health Services Administration [grant number TI025617].