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Cited by 65Homelessness and Social IssuesPosttraumatic Stress Disorder ResearchMigration, Health and Trauma

“If somebody could just understand what I am going through, it would make all the difference”: Conceptualizations of trauma in homeless populations experiencing severe mental illness

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Gilmoor, Andrew, Vallath, Smriti, Regeer, Barbara, Bunders, Joske·2020·Transcultural Psychiatry
DOI 10.1177/1363461520909613PMC PMC7263042
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Abstract

Exposure to violence, vulnerability due to lack of shelter, alienation due to stigma, the experiences of severe mental illness (SMI) and subsequent institutionalization, make homeless persons with SMI uniquely susceptible to trauma exposure and subsequent mental health consequences. This study aims to contribute to the development of culturally sensitive interventions for identifying and treating trauma in a population of homeless persons with SMI in Tamil Nadu, India by understanding the manifestations of trauma and its associated consequences in this population. Free-listing exercises followed by in-depth interviews were conducted with a convenience sample of 26 user-survivors who have experienced homelessness or were at risk of homelessness, and suffered from SMI. Topics explored included events considered to be traumatic, pathways to trauma, associated emotional, physical and social complaints, and coping strategies. Results indicate discrepancies in classification of traumatic events between user-survivors and the Diagnostic and Statistical Manual of Mental Disorders. Traumatic experiences, particularly relating to social relationships and poverty, mentioned by user-survivors did not match traditional conceptualizations of trauma. Positive coping strategies for trauma included being mentally strong, knowledge and awareness, whereas the main negative coping strategy is avoidance. User-survivors attributed their experiences of homelessness and SMI to past traumas. Differing views of trauma between user-survivors and mental health professionals can lead to misdiagnosis and under-recognition of trauma in this population of homeless persons with SMI.

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  • La exposición de las PcDM en situación de indigencia a la privación de bienes o criminalización puede redundar en un mayor deterioro de su salud mental.

    “Todo ello, a su vez, puede redundar en un mayor deterioro de su salud mental 80 .”

    From El derecho a la vivienda adecuada de las personas con discapacidad mental en Chile (2023) · cites this paper as Gilmoor et al. (2020), pp.455-467.

    Results > Types of traumatic events (page not provided) identifies loss of property and lack of basic necessities as traumatic experiences. The Conclusion (page not provided) says participants’ traumatic experiences negatively affected their well-being and likely contributed to mental illness, supporting the possibility of further mental-health harm. The paper does not address criminalization as a cause of that harm. (LLM, conf=0.83)

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Research works printed but not linked: 48

  1. Aakre J. M. Brown C. H. Benson K. M. Drapalski A. L. Gearon J. S. (2014) Trauma exposure and PTSD in women with schizophrenia and coexisting substance use disorders: Comparisons to women with severe depression and substance use disorders. Psychiatry Research 220(3): 840– 845. 10.1016/j.psychres.2014.10.004. 25453637 PMC4312200 · DOI
  2. Allendorf K. (2012) Women's agency and the quality of family relationships in India. Population Research and Policy Review 31(2): 187– 206. 10.1007/s11113-012-9228-7. 27147776 PMC4852544 · DOI
  3. Álvarez M.-J. Roura P. Foguet Q. Osés A. Solà J. Arrufat F.-X. (2012) Posttraumatic stress disorder comorbidity and clinical implications in patients with severe mental illness. The Journal of Nervous and Mental Disease 200(6): 549– 552. 10.1097/NMD.0b013e318257cdf2. 22833878 · DOI
  4. American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association. 10.1176/appi.books.9780890425596.dsm05. · DOI
  5. Baddam John P. Russell S. Russell P. S. S. (2007) The prevalence of posttraumatic stress disorder among children and adolescents affected by tsunami disaster in Tamil Nadu. Disaster Management & Response 5(1): 3– 7. 10.1016/j.dmr.2006.11.001. 17306747 · DOI
  6. Betancourt T. S. Speelman L. Onyango G. Bolton P. (2009) A qualitative study of mental health problems among children displaced by war in northern Uganda. Transcultural Psychiatry 46(2): 238– 256. 10.1177/1363461509105815. 19541749 PMC2775515 · DOI
  7. Betancourt T. Scorza P. Meyers-Ohki S. Mushashi C. Kayiteshonga Y. Binagwaho A. Beardslee W. R. (2012) Validating the center for epidemiological studies depression scale for children in Rwanda. Journal of the American Academy of Child and Adolescent Psychiatry 51(12): 1284– 1292. 10.1016/j.jaac.2012.09.003. 23200285 PMC5730330 · DOI
  8. Bhaskaran S. T. S. Gaikwad A. D. Chandrakanth C. Seshadri S. P. (2016) Post-traumatic stress disorder in pre-schoolers: A report of two cases. Asian Journal of Psychiatry 20(2016): 52– 54. 10.1016/j.ajp.2016.01.010. 27025472 · DOI
  9. Bhat R. M. Rangaiah B. (2015) Exposure to armed conflict and prevalence of posttraumatic stress symptoms among young adults in Kashmir, India. Journal of Aggression, Maltreatment & Trauma 24(7): 740– 752. 10.1080/10926771.2015.1062449. · DOI
  10. Bhushan B. Kumar J. S. (2012) A study of posttraumatic stress and growth in tsunami relief volunteers. Journal of Loss and Trauma 17(2): 113– 124. 10.1080/15325024.2011.635580. · DOI
  11. Breslau N. Davis G. C. Andreski P. Peterson E. (1991) Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry 48(3): 216 10.1001/archpsyc.1991.01810270028003. 1996917 · DOI
  12. Caton C. L. M. Shrout P. E. Dominguez B. Eagle P. F. Opler L. A. Cournos F. (1995) Risk factors for homelessness among women with schizophrenia. American Journal of Public Health 85(8): 1153– 1156. 10.2105/AJPH.85.8_Pt_1.1153. 7625518 PMC1615821 · DOI
  13. Chadda R. Deb K. (2013) Indian family systems, collectivistic society and psychotherapy. Indian Journal of Psychiatry 55(6): 299 10.4103/0019-5545.105555. PMC3705700 23858272 · DOI
  14. Chadha M. Malhotra S. Srivastava P. (2013) Issue in the psychological assessment of trauma victims. Delhi Psychiatry Journal 16(1): 196– 203. Retrieved from http://medind.nic.in/daa/t13/i1/daat13i1p196.pdf.
  15. Chandra P. S. Deepthivarma S. Carey M. P. Carey K. B. Shalinianant M. P. (2003) A cry from the darkness: Women with severe mental illness in India reveal their experiences with sexual coercion. Psychiatry: Interpersonal and Biological Processes 66(4): 323– 334. 10.1521/psyc.66.4.323.25446. PMC2430935 14964694 · DOI
  16. Fodor K. E. Unterhitzenberger J. Chou C.-Y. Kartal D. Leistner S. Milosavljevic M. Alisic E. (2014) Is traumatic stress research global? A bibliometric analysis. European Journal of Psychotraumatology 5(1): 23269 10.3402/ejpt.v5.23269. PMC3930940 24563730 · DOI
  17. Funk M. Drew N. Knapp M. (2012) Mental health, poverty and development. Journal of Public Mental Health 11(4): 166– 185. 10.1108/17465721211289356. · DOI
  18. Goodman L. Saxe L. Harvey M. (1991) Homelessness as psychological trauma broadening perspectives. American Psychologist 46(11): 1219– 1225. 10.1037/0003-066X.46.11.1219. 1772159 · DOI
  19. Hinton D. E. Lewis-Fernández R. (2011) The cross-cultural validity of posttraumatic stress disorder: Implications for DSM-5. Depression and Anxiety 28(9): 783– 801. 10.1002/da.20753. 21910185 · DOI
  20. Hooper L. M. Stockton P. Krupnick J. L. Green B. L. (2011) Development, use, and psychometric properties of the trauma history questionnaire. Journal of Loss and Trauma 16(3): 258– 283. 10.1080/15325024.2011.572035. · DOI
  21. Hopper E. Bassuk E. Olivet J. (2009) Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal 2(617): 131– 151. 10.2174/1874924001003020080. · DOI · Paper page
  22. Jones L. K. Cureton J. L. (2014) Trauma redefined in the DSM-5: Rationale and implications for counseling practice. Professional Counsellor: Research & Practice 4(3): 257.
  23. Kar N. Krishnaraaj R. Rameshraj K. (2013) Long-term mental health outcomes following the 2004 Asian tsunami disaster: A comparative study on direct and indirect exposure. Disaster Health 1(March): 35– 45. PMC5314937 28228999
  24. Kar N. Mohapatra P. K. Nayak K. C. Pattanaik P. Swain S. P. Kar H. C. (2007) Post-traumatic stress disorder in children and adolescents one year after a super-cyclone in Orissa, India: Exploring cross-cultural validity and vulnerability factors. BMC Psychiatry 7(1): 8 10.1186/1471-244X-7-8. 17300713 PMC1808457 · DOI · Paper page
  25. Kendler K. S. (2008) Explanatory models for psychiatric illness. The American Journal of Psychiatry 165(6): 695– 702. 10.1176/appi.ajp.2008.07071061. 18483135 PMC2744075 · DOI
  26. Kessler R. C. Sonnega A. Bromet E. Hughes M. Nelson C. B. (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52(12): 1048– 1060. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7492257. 7492257
  27. Kipke M. D. Simon T. R. Montgomery S. B. Unger J. B. Iversen E. F. (1997) Homeless youth and their exposure to and involvement in violence while living on the streets. Journal of Adolescent Health 20(5): 360– 367. 10.1016/S1054-139X(97)00037-2. 9168383 · DOI
  28. Koegel P. Melamid E. Burnam A. (1995) Childhood risk factors for homelessness among homeless adults. American Journal of Public Health 85(12): 1642– 1649. 10.2105/AJPH.85.12.1642. 7503338 PMC1615728 · DOI
  29. Kumar, P. (2014). Homelessness and mental health: Challenging issue in an Indian context. ISSN ISSN (CD-ROM American International Journal of Research in Humanities, Arts and Social Sciences AIJRHASS, 7(2), 2328–3734. Retrieved from http://www.iasir.net.
  30. Kumuda D. (2014) Homeless population in India: A study. Global Journal for Research Analysis 3(8): 54– 55.
  31. Levitt A. J. Culhane D. P. DeGenova J. O'Quinn P. Bainbridge J. (2009) Health and social characteristics of homeless adults in Manhattan who were chronically or not chronically unsheltered. Psychiatric Services 60(7): 978– 981. 10.1176/ps.2009.60.7.978. 19564231 · DOI
  32. Lu W. Yanos P. T. Silverstein S. M. Mueser K. T. Rosenberg S. D. Gottlieb J. D. Giacobbe G. (2014) Correlates of symptom severity 26(2): 266– 273. 10.1002/jts.21791.Public. PMC3888861 23508645 · DOI
  33. Minsky, S. K., Lu, W., Silverstein, S. M., Gara, M., Gottlieb, J. D., & Mueser, K. T. (2015). Service use and self-reported symptoms among persons with positive PTSD screens and serious mental illness. Psychiatric Services. 10.1176/appi.ps.201400192. 25873024 · DOI
  34. Molchanova, E., Agazade, N., & Dobryakov, I. (2016). Culturally shaped manifestations of PTSD in Kyrgyzstan. In Comprehensive guide to post-traumatic stress disorders (pp. 1605–1615). Cham: Springer International Publishing. 10.1007/978-3-319-08359-9_62. · DOI
  35. Mueser K. T. Rosenberg S. D. Goodman L. A. Trumbetta S. L. (2002) Trauma, PTSD, and the course of severe mental illness: An interactive model. Schizophrenia Research 53(1–2): 123– 143. 10.1016/S0920-9964(01)00173-6. 11728845 · DOI
  36. Narasimhan L. Gopikumar V. Jayakumar V. Bunders J. Regeer B. (2019) Responsive mental health systems to address the poverty, homelessness and mental illness nexus: The Banyan experience from India. International Journal of Mental Health Systems 13 1): Article 54. 10.1186/s13033-019-0313-8. PMC6689864 31413729 · DOI
  37. Onyut L. P. Neuner F. Ertl V. Schauer E. Odenwald M. Elbert T. Michaelodenwalduni-konstanzde M. O. (2009) Trauma, poverty and mental health among Somali and Rwandese refugees living in an African refugee settlement – an epidemiological study. Conflict and Health 3 Article 6. 10.1186/1752-1505-3-6. PMC2695430 19470171 · DOI
  38. Ovuga, E., & Abbo, C. (2016). “Orongo” and “Cen” spirit possessions: Post-traumatic stress disorder in a cultural context – local problem, Universal disorder with local solutions in northern Uganda, 1637–1648. 10.1007/978-3-319-08359-9_89. · DOI
  39. Patel V. (2000) Culture and the mental health consequences of trauma. The Indian Journal of Social Work 61(4): 626– 630.
  40. Patel V. (2014) Rethinking mental health care: Bridging the credibility gap. Intervention 12(1): 15– 20. 10.1097/WTF.0000000000000065. · DOI
  41. Patel V. Kleinman A. (2003) Poverty and common mental disorders in developing countries. Bulletin of the World Health Organization 81(8): 609– 615. 14576893 PMC2572527
  42. Pillai, L., Mehta, S. G., & Chaudhari, B. L. (2016). Comprehensive guide to post-traumatic stress disorders, 1617–1635. 10.1007/978-3-319-08359-9. · DOI
  43. Raju M. K. (2005) Ego strengthening and eye movement desensitization reprocessing in post traumatic stress disorder. Medical Journal Armed Forces India 61(3): 289– 290. 10.1016/S0377-1237(05)80179-0. PMC4925579 27407783 · DOI
  44. Seethalakshmi R. Dhavale H. S. Gawande S. Dewan M. (2006) Psychiatric morbidity following motor vehicle crashes: A pilot study from India. Journal of Psychiatric Practice 12(6): 415– 418. 17122705
  45. Shalev A. Y. Freedman S. Peri T. Brandes D. Sahar T. Orr S. P. Pitman R. K. (1998) Prospective study of posttraumatic stress disorder and depression following trauma. The American Journal of Psychiatry 155(5): 630– 637. 10.1176/ajp.155.5.630. 9585714 · DOI
  46. Smith C. P. (1992) Motivation and personality, Cambridge: Cambridge University Press 10.1017/CBO9780511527937. · DOI
  47. Tichy L. L. Becker J. V. Sisco M. M. (2009) The downside of patriarchal benevolence: Ambivalence in addressing domestic violence and socio-economic considerations for women of Tamil Nadu, India. Journal of Family Violence 24(8): 547– 558. 10.1007/s10896-009-9253-4. · DOI
  48. Tyler K. A. Hoyt D. R. Whitbeck L. B. (2000) The effects of early sexual abuse on later sexual victimization among female homeless and runaway adolescents. Journal of Interpersonal Violence 15(3): 235– 250. 10.1177/088626000015003001. · DOI

Cited by

Sorted by citations

Authors
Gilmoor, A., Vallath, S., Regeer, B., & Bunders, J.
Affiliations
Vrije Universiteit Amsterdam (NL)
Corresponding author
Gilmoor, Andrew
ORCID
Venue
Transcultural Psychiatry
Publisher
SAGE Publications
Published
2020-03-08
Volume
57
Issue
3
Pages
455-467
ISSN
  • 1363-4615 (ISSN-L)
  • 1461-7471
DOI
10.1177/1363461520909613
PMC
PMC7263042
OpenAlex
W3010619374
Cited by
65
References
6
Citations by year
2026: 4 · 2025: 3 · 2024: 9 · 2023: 3 · 2022: 6 · 2021: 37 · 2020: 3
FWCI
12.79
Type
journal article
Language
en
Open access
Licence
Locations
  • Transcultural Psychiatry (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • VU Research Portal (publishedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords
homelessness, severe mental illness, trauma exposure, coping strategies, avoidance, misdiagnosis, stigma, poverty, interpersonal relationships, culturally sensitive interventions, Tamil Nadu
MeSH terms
Adaptation, Psychological, Adult, Aged, Mental Disorders, Concept Formation, Female, Ill-Housed Persons, Humans, India, Interpersonal Relations, Interviews as Topic, Male, Middle Aged, Poverty, Wounds and Injuries, Persons with Psychiatric Disorders, Mentally Ill Persons

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