Interventions to treat post-traumatic stress disorder (PTSD) in vulnerably housed populations and trauma-informed care: a scoping review

• Published in: BMJ open 2022-03, Vol.12 (3), p.e051079
• Main Authors: Bennett, Alexandria, Crosse, Kien, Ku, Michael, Edgar, Nicole E, Hodgson, Amanda, Hatcher, Simon
• Format: Article
• Language: English
• Subjects: Adult; adult psychiatry; Clinical medicine; Cognitive Behavioral Therapy; Employee turnover; Health services; Homeless people; Housing; Humans; Intervention; Length of stay; Mental Health; Population; Post traumatic stress disorder; psychiatry; Psychotherapy; quality in health care; Search strategies; Self-medication; Sex crimes; Shelters; Stress Disorders, Post-Traumatic - psychology; Stress Disorders, Post-Traumatic - therapy; Substance abuse; Substance-Related Disorders; Trauma; Treatment methods
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-051079

ObjectivesThe goals of this study are to identify and analyse interventions that aim to treat post-traumatic stress disorder (PTSD) and complex PTSD in people who are vulnerably housed and to describe how these treatments have been delivered using trauma-informed care.DesignScoping review.Search strategyWe searched electronic databases including MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, Web of Science and PTSDpubs for published literature up to November 2021 for any studies that examined the treatment of PTSD in adults who were vulnerably housed. Websites of relevant organisations and other grey literature sources were searched to supplement the electronic database search. The characteristics and effect of the interventions were analysed. We also explored how the interventions were delivered and the elements of trauma-informed care that were described.Results28 studies were included. We identified four types of interventions: (1) trauma focused psychotherapies; (2) non-trauma psychotherapies; (3) housing interventions and (4) pharmacotherapies. The trauma-informed interventions were small case series and the non-trauma focused therapies included four randomised controlled trials, were generally ineffective. Of the 10 studies which described trauma-informed care the most commonly named elements were physical and emotional safety, the experience of feeling heard and understood, and flexibility of choice. The literature also commented on the difficulty of providing care to this population including lack of private space to deliver therapy; the co-occurrence of substance use; and barriers to follow-up including limited length of stay in different shelters and high staff turnover.ConclusionsThis scoping review identified a lack of high-quality trials to address PTSD in people who are vulnerably housed. There is a need to conduct well designed trials that take into account the unique setting of this population and which describe those elements of trauma-informed care that are most important and necessary.