背景:创伤是一种危及生命的经历(身体或情感),有害,或与众不同,并对心理健康和福祉产生持久影响。关于无家可归人群创伤的大部分信息都集中在童年时期的事件上。使用联合生产原理,我们的目的是综合定性证据,探索成年期间无家可归的创伤对心理健康的影响,包括物质使用。
方法:在这篇定性系统综述中,我们搜索了ASSIA,CINAHL,科克伦,EMBASE,MEDLINE,论文和论文,PsychInfo,Scopus,和WebofScience从开始到2022年9月6日发表的研究,以及相关网站的灰色文献。搜索词是基于PICO框架开发的。没有语言,date,或应用了地理限制。任何报告成人无家可归期间创伤经历及其对心理健康影响的定性研究都是合格的。我们提取了相关数据(例如,方法论,样本特征,无家可归,和发现)。首席研究员为有无家可归经历的人提供了定制培训。他们为完善审查目标做出了贡献,筛选,编码,和主题发展。使用CASP定性研究清单评估质量。
结果:我们纳入了26篇定性论文,包括876名年龄在18至70岁之间的无家可归的成年人(448名[51%]女性和428名[49%]男性)。所有论文都集中在城市环境上。八篇论文来自美国,五个来自加拿大,四个来自英国和澳大利亚,三个来自巴西,还有一个来自埃塞俄比亚和伊朗。这26篇论文的框架综合确定了三个初步主题。经历无家可归的人通过三种方式理解创伤:内在化的理解,与他人的关系,和生存镜头。管理恐惧感的应对策略,焦虑,抑郁症包括物质使用,自我合理化,以及安全感的策略。最后,当人们经历反复的创伤时,他们要么分离了,接受了他们的处境,或者有弹性,希望改变他们的情况。
结论:在农村或沿海地区需要进一步的证据,无家可归的人可能会面临更大的孤立。创伤很少孤立地发生,通常,以前的创伤经历会塑造经历无家可归的人如何理解创伤并应对创伤。应对创伤影响的支持应侧重于确保人们不会变得脱敏,并防止心理健康和药物使用恶化。这篇评论的优势在于它与有生活经验的人共同制作。使用二次检查进行单人数据提取是一个限制。
背景:国家健康与保健研究所(NIHR)初级保健研究学校作为三个NIHR研究学校心理健康计划的一部分。
BACKGROUND: Trauma is an experience (physical or emotional) that is life-threatening, harmful, or out of the ordinary and has lasting effects on mental health and wellbeing. Much of the information about trauma within homeless populations focuses on events in childhood. Using coproduction principles, we aimed to synthesise qualitative evidence exploring the impact of trauma during adulthood homelessness on mental health, including substance use.
METHODS: In this qualitative systematic
review, we searched ASSIA, CINAHL, Cochrane, EMBASE, MEDLINE, Proquest theses and dissertations, PsychInfo, Scopus, and Web of Science for studies published from inception until Sept 6, 2022, alongside grey literature from relevant websites. Search terms were developed based on the PICO framework. No language, date, or geographical limits were applied. Any qualitative research reporting experiences of trauma and its impact on mental health during homelessness in adults was eligible. We extracted relevant data (eg, methodology, sample characteristics, homelessness, and findings). People with lived experience of homelessness were provided with bespoke training by the lead researcher. They contributed to refining the
review aims, screening, coding, and theme development. Quality was assessed using the CASP Qualitative Studies Checklist.
RESULTS: We included 26 qualitative papers, including 876 adults experiencing homelessness between ages 18 and 70 years (448 [51%] women and 428 [49%] men). All papers focused on urban settings. Eight papers were from the USA, five from Canada, four from the UK and Australia, three from Brazil, and one from Ethiopia and Iran. A framework synthesis of these 26 papers identified three preliminary themes. People experiencing homelessness make sense of trauma in three ways: internalised understanding, relationality to others, and with a survival lens. Coping strategies for managing feelings of fear, anxiety, and depression included substance use, self-rationalisation, and strategies to feel safe. Finally, when people experienced repeated trauma, they became either dissociated, and accepted their situation, or resilient, wishing to change their circumstances.
CONCLUSIONS: Further evidence is needed in rural or coastal regions, where people experiencing homelessness may face greater isolation. Trauma rarely takes place in isolation, and often previous experiences of trauma shape how people experiencing homelessness make sense of trauma and cope with it. Support to address coping with the effects of trauma should focus on ensuring people do not become desensitised and prevent deterioration of mental health and substance use. The strength of this
review is its coproduction with people with lived experience. Single person data extraction with secondary checks was a limitation.
BACKGROUND: National Institute for Health and Care Research (NIHR) School for Primary Care Research as part of the Three NIHR Research Schools Mental Health Programme.