Substance Abuse and Mental Health Correlates of Victimization Classes among Homeless Youth

Background

Literature demonstrates that street victimization is a common occurrence among homeless youth.¹ Street victimization is correlated with poorer mental health, including substance abuse,^2,3 depressive symptoms,³ and posttraumatic stress disorder (PTSD).⁴ Despite much research on street youth victimization, few studies have examined victimization classes and how those classes differ by type and frequency of victimization. In two separate studies, authors Bender, Thompson, Ferguson, and Langenderfer relied on latent class analysis to determine subgroups of homeless youth based on the youths’ self-reported victimization experiences. The authors then ran analyses to determine which of several variables predict subgroup membership. Study One focused on substance abuse, whereas Study Two focused on mental health.

The Sample

Purposive sampling between March 2010 and July 2011 resulted in a sample of 601 street youth, each served by a homeless youth agency in Los Angeles (n=200), Austin (n=200), or Denver (n=201). The three eligibility criteria were that the youth had to 1) be 18 to 24 years old, 2) have spent at least two weeks away from home prior to the interview, and 3) provide written informed consent. Researchers conducted quantitative retrospective interviews with the youth to assess demographics, victimization experiences, substance use symptoms, and mental health symptoms. Researchers assessed victimization experiences using a revised version of the Traumatic Life Events Questionnaire,⁵ retaining items only if they were relevant to homeless youth. Substance use and mental health variables were assessed by the Mini International Neuropsychiatry Interview (MINI).⁶ Specifically, Study One examined substance abuse and substance dependence correlates of victimization class while Study Two examined depression and PTSD correlates.

Demographics for the total sample are as follows:

• Age: M=20.5 years (SD=1.6)
• Gender: 64% male, 36% female
• Race/Ethnicity: 40% White, 25% Black, 18% Latino, 17% Other
• Primary living arrangement: 50% homeless, 50% temporarily housed
• Met diagnostic criteria for:
• Alcohol Addiction: 49.8%
• Drug Addiction: 59.7%
• Substance Abuse: 36.6.%
• Substance Dependence: 48.5%
• Depression: 31%
• PTSD: 23%
• Number of moves: M=3.5 (SD=3.7)
• Months homeless: M=32.4 (SD=31) = 2.7 years

The Results

Identifying Victimization Classes

In Study One, researchers identified victimization classes using exploratory latent class analysis, grouping youth based on type and frequency of victimization. Researchers ran multiple models, from one to six classes, and used best-fit indices and their abilities to describe distinct patterns in classes to decide on a three-class model: low-victimization, high victimization, and witness classes.

Among youth in the low-victimization class (n=215, 36%) more than 85% never experienced robbery, experienced physical or sexual assault by a stranger, experienced threat of bodily harm, witnessed an assault, or personally overdosed on drugs. Typically, youth in this class experienced lower rates of all types of victimization than both the high-victimization and witness classes.

The high-victimization class (n=136, 23%) reported high rates of both indirect (e.g., witnessing a severe assault) and direct (e.g., physical assault by a stranger) victimization. This class also reported experiencing victimization types rarely reported by either the low-victimization or witness classes, such as physical or sexual assault by an intimate partner and personally overdosing on drugs.

The witness class (n=250, 42%) reported high rates of indirect victimization, such as witnessing severe assault, witnessing a drug overdose, or experiencing the sudden death of a close friend or loved one. Typically, these indirect forms of victimization were experienced only once.

Study One: Substance Abuse

Results of a first multinomial regression model indicate that, compared to low-victims, witnesses are approximately twice as likely to meet criteria for both substance abuse and dependence. Moreover, both substance abuse and substance dependence increased the odds of being classified as a high-victim versus a low-victim. Results of a second multinomial regression model indicate that although alcohol and drug addiction both increase the risk of being classified as a witness or high-victim as opposed to a low-victim, the odds ratios were higher for alcohol than for drugs.

Study Two: Mental Health

Again using multinomial regression, results indicate that youth in the high-victimization and witness classes were nearly twice as likely to experience depression symptoms and nearly three times as likely to experience PTSD compared to youth in the low-victimization class. Researchers found no significant differences in mental health risks between high-victims and witnesses.

The Implications

Street youth classified as witnesses or high-victims demonstrated higher rates of substance abuse, substance dependence, depression, and PTSD than low-victims. Given the distinct experiences of youth in the three classes, it is important that providers screening for victimization among homeless youth assess not only types of victimization, but potential consequences as well, such as substance abuse and mental health problems. Moreover, prevention efforts targeting homeless youth should include victimization prevention education.

For More Information

For more details on how latent classes were determined; how time homeless, primary living situation, and transience impact classification; and expanded implications, refer to the full articles in Child Abuse & Neglect and Journal of Adolescence. Click the links below to learn more about the authors’ work.

Dr. Kimberly Bender

Lisa Langenderfer-Magruder

Citations

Bender, K., Ferguson, K., Thompson, S., & Langenderfer, L. (in press). Mental health correlates of victimization classes among homeless youth. Child Abuse & Neglect.

Bender, K., Thompson, S.J., Ferguson, K., & Langenderfer, L. (2014). Substance use predictors of victimization profiles among homeless youth: A latent class analysis. Journal of Adolescence, 37(2), 155-164. doi: 10.1016/j.adolescence.2013.11.007

References

1 Stewart, A.J., Steiman, M., Cauce, A.M., Cochran, B.N., Whitbeck, L.B., & Hoyt, D.R. (2004). Victimization and posttraumatic stress disorder among homeless adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(3), 325-331.

2 Hoyt, D.R., Ryan, K.D., & Cauce, A.M. (1999). Personal victimization in a high-risk environment: Homeless and runaway adolescents. Journal of Research in Crime and Delinquency, 36(4), 371-392

3 Whitbeck, L.B., Hoyt, D.R., & Bao, W. (2000). Depressive symptoms and co-occurring depressive symptoms, substance abuse, and conduct problems among runaway and homeless adolescents. Child Development, 71(3), 721-732.

4 Whitbeck, L.B., Hoyt, D.R., Johnson, K.D., & Chen, X. (2007). Victimization and posttraumatic stress disorder among runaway and homeless adolescents. Violence and Victims, 22(6), 721-734.

5 Kubany, E. S., Leisen, M. B., Kaplan, A. S., Watson, S. B., Haynes, S. N., Owens, J. A., Burns, K. (2000). Development and preliminary validation of a brief broad-spectrum measure of trauma exposure: The Traumatic Life Events Questionnaire. Psychological Assessment, 12(2), 210-224. doi: 10.1037/1040-3590.12.2.210

6 Sheehan, D., Lecrubier, Y., Sheehan, K., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22-33.

Substance Use and Victimization: Street-involved Youths’ Perspectives and Service Implications

Research shows that homeless youth engage in substance use and abuse at high rates, with results from one national study (N=11,000) indicating lifetime use rates among homeless youth to be 99% for marijuana, 78% for cigarettes, and 76% for alcohol.¹ Rates of recent use are similarly high; one study found 84% of homeless youths had used one or more substances in the past three months.² This substance use is associated with street victimization; those who meet criteria for alcohol abuse are three times more likely to have experienced a traumatic event and five times more likely to meet PTSD criteria.⁴ Though using substances is related to experiencing trauma and PTSD,^4,5 explanations for this relationship vary. Some scholarship indicates substance use is a risk factor or precursor to trauma.^6-8  Still other scholarship places substance use among homeless youth as a type of self-medication strategy used to relieve trauma or PTSD symptoms.⁹ In the present study, the authors rely on qualitative inquiry to determine 1) how substance use places homeless youth at risk for trauma and 2) how substance use acts as a coping mechanism.

The Sample

A purposive sample of 50 youth participated in individual interviews, responding to open-ended questions regarding coping methods, substance use, and victimization.

• Age: M=20 (SD=1.1)
• Gender: 54% male, 46% female
• Race/ethnicity: 40% Black, 26% Latino, 20% White, 14% other
• Living situation: 66% street or temporary shelter; 34% with friends, family, or in foster or criminal justice systems
• 82% experienced a traumatic event, 22% met PTSD criteria, 68% met drug abuse or dependence criteria, 42% met alcohol abuse or dependence criteria

The Results

The authors used template analysis¹⁰ based on existing literature. The authors discuss themes in the data within two categories: substance use leads to negative consequences and substance use as coping for victimization or distress. These themes are briefly summarized below.

Substance Use Leads to Negative Consequences

• Physical health problems from substance use (e.g., sexually transmitted illnesses, withdrawal symptoms, substance overdose, addiction)
• Emotional consequence of substance use (e.g., anger, irritability, depressive symptoms, guilt, pain, sadness)
• Loss of relationships and support systems (e.g., broken trust, feelings of abandonment and isolation)
• Decreased motivation to leave the streets (e.g., laziness, not showing up for obligations, disruption of service-seeking behaviors, sacrificing money for substances)
• Lack of awareness (e.g., reducing inhibitions and awareness of potential victimization)
• Participation in illegal or violent activities to support need for substances (e.g., robbing, mugging, prostituting)

Substance Use as Coping for Victimization or Distress

• Substance use to deal with uncomfortable emotions/moods (e.g., to improve mood, deal with loss, reduce traumatic flashbacks)
• Substance use to relax (e.g., deal with current life circumstances, to avoid anger and violence in social interactions)
• Substance use to escape and avoid thoughts (e.g., forget trauma and avoid thoughts of homelessness and related living conditions)
• Substance use to socialize and find support (e.g., having fun, help open up to homeless peers for support)
• Substance use as a temporary fix (i.e., fixes current emotional pain, but often leads to long-term consequences)

The Implications

Overall, homeless youth described substance use as a temporary solution, while still recognizing ways in which it places them at risk for victimization. Despite limitations (e.g., single city sample, potential for social desirability bias), the authors offer several implications for research and practice:

• Many programs offer substance use prevention curricula for homeless youth. This study suggests trauma-related material should be integrated and the interconnectedness of substance use and victimization explicitly discussed with youth.
• Intervention to improve contextual factors in the lives of homeless youth may be necessary to reduce substance use and victimization. Social service providers can help by connecting youth to stable housing, education, and employment opportunities; aid youth in disengaging from street culture; and encourage prosocial connections.

For More Information

To learn more about Dr. Bender’s work with street-involved youth, visit her faculty page or DU portfolio.

Citation

Bender, K., Thompson, S.J., Ferguson, K., Komlo, C., Taylor, C., & Yoder, J. (2012). Substance use and victimization: Street-involved youths’ perspectives and service implications. Children and Youth Services Review, 34(12), 2392-2399. doi: 10.1016/j.childyouth.2012.09.008

References

¹ Thompson, S.J., Maguin, E., & Pollio, D.E. (2003). National and regional differences among runaway youth using federally funded crisis shelters. Journal of Social Service Research, 30(1), 1-17. doi: 10.1300/J079v30n01_01

² Bousman, C.A., Blumberg, E.J., Shillington, A.M., Hovell, M.F., Ji, M., Lehman, S., & Clapp, J. (2005). Predictors of substance abuse among homeless youth in San Diego. Addictive Behavior, 30, 1100-1110. doi:10.1016/j.addbeh.2004.10.006

³ Stewart, A.J., Steiman, M., Cauce, A.M., Cochran, B.N., Whitbeck, L.B., & Hoyt, D.R. (2004). Victimization and posttraumatic stress disorder among homeless adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 43(3), 325-331. doi: 10.1097/00004583-200403000-00015

⁴ Bender, K., Ferguson, K., Thompson, S., Komlo, C., & Pollio, D. (2010). Factors associated with trauma and posttraumatic stress disorder among homeless youth in three U.S. cities: The importance of transience. Journal of Traumatic Stress, 23(1), 161-168. doi: 10.1002/jts.20501

⁵ Ginzler, J.O., Garrett, S.B., Baer, J.S., & Peterson, P.L. (2007). Measurement of negative consequences of substance use in street youth: An expanded use of the Rutgers Alcohol Problem Index. Addictive Behaviors, 32(7), 1519-1525. doi: 10.1016/j.addbeh.2006.11.004

⁶ Wenzel, S.L., Leake, B.D., & Gelberg, L. (2001). Risk factors for major violence among homeless women. Journal of Interpersonal Violence, 16(8), 739-752. doi: 10.1177/088626001016008001

⁷ Baron, S.W. (1999). Street youths and substance use: The role of background, street lifestyle, and economic factors. Youth & Society, 31(1), 3-26. doi: 10.1177/0044118X99031001001

⁸ Thompson, S., Barczyk, A.N., Gomez, R., Dryer, L., & Popham, A. (2010). Homeless, street-involved emerging adults: Attitudes toward substance use. Journal of Adolescent Research, 25(2), 231-257. doi: 10.1177/0743558409350502

⁹ Nymanthi, A., Hudson, A., Greengold, B., Slagle, A., Marfisee, M., Khalilifard, F., & Leake, B. (2010). Correlates of substance use severity among homeless youth. Journal of Child and Adolescent Psychiatric Nursing, 23(4), 214-222. doi: 10.1111/j.1744-6171.2010.00247.x

¹⁰ King, N. (1998). Template analysis. In G. Symon, & C. Cassell (Eds.). Qualitative methods and analysis in organizational research: A practical guide (pp.118-134). Thousand Oaks, CA: Sage Publications.