ARTICLES
Victimization and Posttraumatic Stress Disorder Among Homeless Adolescents

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ABSTRACT

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.

Section snippets

PTSD Symptom Classification

In recent years, researchers have questioned the validity of the existing PTSD symptom classification. Since PTSD was introduced in the DSM-III (American Psychiatric Association, 1980), the classification of symptoms has remained largely intact. Symptoms are classified into three clusters: (1) reexperiencing, (2) increased arousal, and (3) avoidance and numbing. While classification decisions were based on expert consensus, empirical research has not supported PTSD symptom dimensionality and,

METHOD

Participants were homeless youths from the greater Seattle metropolitan area. Approval for the Seattle Homeless Adolescent Research and Education project (SHARE) was granted by the Internal Review Board at the University of Washington, and data collection took place over a 3-year period beginning in 1995. Adolescents aged 13 to 21 years who were not physically in custody of the state and whose residence was unstable were eligible for participation. Unstable residence was defined as living away

Victimization

Within the full sample (N = 374), most homeless youths were exposed to at least one form of physical or sexual victimization since leaving home (82.7%). Many were physically but not sexually victimized (44.2%), some were both physically and sexually victimized (31.0%), and a few were sexually but not physically victimized (6.4%). Victimization results are presented in Table 1, which shows the proportion of youths who were victimized one or more times since leaving home. χ2 tests revealed gender

Victimization

The results of the present study are consistent with other studies that found high rates of victimization among homeless adolescents (Kipke et al., 1997; MacLean et al., 1999). Moreover, the hypotheses that victimization rates differ according to gender were supported. Homeless males reported higher rates of physical victimization and females reported higher rates of sexual victimization. This finding is similar to other studies of housed (Hashima and Finkelhor, 1999) and homeless youths (Kipke

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    This work was supported by grants from NIAAA (AA10253) and NIMH (MH57110).

    Article Plus (online-only) materials for this article appear on the Journal's website:www.jaacap.com

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    Copyright © 2004 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.