When trauma violates trust: PTSD symptoms among chronically homeless adults in Australia

ABSTRACT

Trauma involving violation of trust, or betrayal trauma, plays a significant role in the lifetime trajectories of homeless adults. This study investigates this type of trauma and posttraumatic stress disorder (PTSD) symptom severity in the chronically homeless population. The sample consisted of 77 adults with a history of trauma and chronic homelessness in Melbourne, Australia. Using the Composite International Diagnostic Interview Traumatic Events Questionnaire, participants nominated their worst traumatic event and self-reported if their trust was violated as a result of that trauma. PTSD symptom severity was assessed by the 6-item PTSD Checklist. Forty percent of the sample reported violation of trust occurred in their worst trauma. Within this group, 80.6% screened positive for PTSD, compared to 50.0% of those whose worst trauma had not involved a trust violation (p = .006). The violation of trust group presented with significantly more severe PTSD symptoms, in comparison to the group without violation of trust during their worst trauma, controlling for gender, age of worst trauma, cumulative trauma, and psychological distress (p = .020). The findings highlight the importance of providing trauma-informed care and trauma-specific treatment for chronically homeless adults.

Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12616000162415.

KEYWORDS:

• Homelessness
• trauma
• PTSD
• trust
• betrayal

Acknowledgments

The authors thank the individuals who participated in this research, the services that supported recruitment, and the research assistants who administered the surveys. Dr Rebecca Sng and Dr Tiffany Jones are thanked for advising on aspects of the analysis (Australian New Zealand Clinical Trials Registry http://www.anzctr.org.au/ ACTRN12616000162415; 10/02/2016).

Data availability statement

A confidentialized unit record file specific to the research contained in the paper will be made available on request from the corresponding author (MT) on the conclusion of the overall study to university-based researchers who consent to strict criteria concerning its use. The data are not publicly available due to the data containing information that could compromise the privacy of research participants.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Journey to Social Inclusion PhD Scholarship, awarded to KT. The authors thank Sacred Heart Mission, the Victorian Government, and individual philanthropists for their generous support of the Journey to Social Inclusion – Phase 2 intervention and research study. The two universities engaged in the study, The University of Western Australia and Swinburne University of Technology, also provided significant in-kind support.

Notes on contributors

Kathryn M. Taylor

Kathryn M. Taylor, DCP MSc, is a registered clinical psychologist and PhD candidate at Swinburne University of Technology. Her research focuses on mental health care for adults experiencing homelessness. Dr Taylor is the founder and inaugural Convener of the Australian Psychological Society Interest Group on Psychology and Homelessness.

Monica Thielking

Monica Thielking, DPsych (Counselling Psychology), has led several research and evaluation projects for the education, community and justice sectors, specifically dealing with strengthening service integration and improving outcomes for people with a history of social exclusion, disadvantage, homelessness, and trauma. Associate Professor Thielking is Chair of the Department of Psychological Sciences, Swinburne University of Technology.

Jessica L. Mackelprang

Jessica L. Mackelprang, PhD (Clinical Psychology), is a clinical psychologist and Senior Lecturer in the Department of Psychological Sciences at Swinburne University of Technology. Her research interests include trauma and intentional (e.g. suicide) and unintentional injury, with a focus on marginalized populations, particularly people who are currently experiencing homelessness or who have a history of homelessness.

Denny Meyer

Denny Meyer, DBL (Statistics), specialises in the area of mental health and the use of statistical and machine learning tools for the analysis of data collected through clinical trials and large online interventions. Screening for suicide risk in various at-risk populations is a current focus of her work. Professor Meyer has led several evaluation projects and is a member of teams working on National Health and Medical Research Council grants.

Stephen Quinn

Stephen Quinn, PhD MMath, is a senior biostatistician. He is mainly involved in the design, conduct, and analysis of randomized clinical trials. He has collaborated in a wide variety of projects over many fields, has co-authored in over 100 publications and been successful in many National Health and Medical Research Council grant applications.

Paul Flatau

Paul Flatau, PhD MEc, is Professor and Chair in Social Investment and Impact and Director of the Centre for Social Impact at the University of Western Australia. His main fields of research are homelessness and housing, the impacts of unemployment, and poverty.