Victimization and posttraumatic stress disorder among homeless adolescents.

OBJECTIVE To examine street victimization and posttraumatic stress symptoms among urban homeless adolescents and to test whether emotional numbing and avoidance represent distinct posttraumatic stress disorder (PTSD) symptom clusters. METHOD Structured, private interviews were conducted with homeless adolescents (N = 374) in the Seattle metropolitan area (95% response rate) from 1995 to 1998. RESULTS Eighty-three percent of street youths were physically and/or sexually victimized after leaving home. Approximately 18% of these youths met research criteria for PTSD. Results from a confirmatory factor analysis suggest that disaggregating symptoms of avoidance from symptoms of emotional numbing provides a better fit of the data than the current DSM-IV model in which these symptoms are combined in one factor. CONCLUSIONS Sexual and physical victimization are serious threats for homeless adolescents, and those who are victimized are at risk for PTSD. Results challenge the belief that symptoms of avoidance and numbing represent one unified cluster in this population.

[1]  D. Kilpatrick,et al.  Posttraumatic stress disorder in adolescents after Hurricane Andrew. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[2]  B. McCarthy,et al.  Surviving on the Street , 1992 .

[3]  M. Stein,et al.  Dimensionality of posttraumatic stress symptoms: a confirmatory factor analysis of DSM-IV symptom clusters and other symptom models. , 2000, Behaviour research and therapy.

[4]  E. Foa,et al.  Exploring the Roles of Emotional Numbing, Depression, and Dissociation in PTSD , 2000, Journal of traumatic stress.

[5]  E. Blanchard,et al.  A confirmatory factor analysis of posttraumatic stress symptoms. , 1998, Behaviour research and therapy.

[6]  James D. Wright,et al.  Tracking non-traditional populations in longitudinal studies☆ , 1995 .

[7]  K. Fitzpatrick,et al.  The prevalence and consequences of exposure to violence among African-American youth. , 1993, Journal of the American Academy of Child and Adolescent Psychiatry.

[8]  E. Foa,et al.  Psychosocial treatments for posttraumatic stress disorder: a critical review. , 1997, Annual review of psychology.

[9]  N. Breslau,et al.  Traumatic events and posttraumatic stress disorder in an urban population of young adults. , 1991, Archives of general psychiatry.

[10]  K. Jackson,et al.  Prevalence of PTSD in a community sample of older adolescents. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[11]  R. Kessler,et al.  Posttraumatic stress disorder in the National Comorbidity Survey. , 1995, Archives of general psychiatry.

[12]  L. Whitbeck,et al.  Abusive family backgrounds and later victimization among runaway and homeless adolescents , 1997 .

[13]  P. Bentler Comparative Fit Indices in Structural Models , 1990 .

[14]  C. Lonigan,et al.  Children's reactions to a natural disaster: symptom severity and degree of exposure , 1991 .

[15]  C. Lonigan,et al.  Children exposed to disaster: I. Epidemiology of post-traumatic symptoms and symptom profiles. , 1994, Journal of the American Academy of Child and Adolescent Psychiatry.

[16]  S. Taylor,et al.  The structure of posttraumatic stress symptoms. , 1998, Journal of abnormal psychology.

[17]  D. Finkelhor,et al.  Violent Victimization of Youth Versus Adults in the National Crime Victimization Survey , 1999 .

[18]  B. Rothbaum,et al.  Uncontrollability and unpredictability in post-traumatic stress disorder: an animal model. , 1992, Psychological bulletin.

[19]  I. Liberzon,et al.  The structure of posttraumatic stress disorder symptoms in combat veterans: a confirmatory factor analysis of the impact of event scale. , 2001, Journal of anxiety disorders.

[20]  S Eth,et al.  Life threat and posttraumatic stress in school-age children. , 1987, Archives of general psychiatry.

[21]  S. Perrin,et al.  Practitioner Review: The Assessment and Treatment of Post-traumatic Stress Disorder in Children and Adolescents , 2000 .

[22]  S. Wolfe,et al.  Homeless and matched housed adolescents: a comparative study of psychopathology. , 1998, Journal of clinical child psychology.

[23]  M. Prinstein,et al.  Symptoms of posttraumatic stress in children after Hurricane Andrew: a prospective study. , 1996, Journal of consulting and clinical psychology.

[24]  E. Ellis Treating the Trauma of Rape: Cognitive Behavioral Therapy for PTSD , 1999 .

[25]  Brett T. Litz,et al.  Emotional numbing in combat-related post-traumatic stress disorder: A critical review and reformulation , 1992 .

[26]  A. M. Cauce,et al.  Predicting DSM-III-R disorders from the Youth Self-Report: analysis of data from a field study. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[27]  N. Terrell Street Life , 1997 .

[28]  Peter M. Bentler,et al.  EQS : structural equations program manual , 1989 .

[29]  E. Foa,et al.  Arousal, numbing, and intrusion: symptom structure of PTSD following assault. , 1995, The American journal of psychiatry.

[30]  J. Unger,et al.  Homeless youth and their exposure to and involvement in violence while living on the streets. , 1997, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[31]  J. Davidson,et al.  Post-traumatic stress disorder in the community: an epidemiological study , 1991, Psychological Medicine.

[32]  A. Burgess,et al.  Histories of sexual abuse in adolescent male runaways. , 1987, Adolescence.

[33]  J. Ginzler,et al.  The Characteristics and Mental Health of Homeless Adolescents , 2000 .

[34]  A. M. Cauce,et al.  Homeless adolescents' paths to separation from family: Comparison of family characteristics, psychological adjustment, and victimization , 1999 .

[35]  H. Reinherz,et al.  Traumas and posttraumatic stress disorder in a community population of older adolescents. , 1995, Journal of the American Academy of Child and Adolescent Psychiatry.

[36]  Lynda A. King,et al.  Confirmatory Factor Analysis of the Clinician-Administered PTSD Scale: Evidence for the Dimensionality of Posttraumatic Stress Disorder. , 1998 .