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Homeless Women and Victimization: Abuse and Mental Health History among Homeless Rape Survivors.

Using the database of a hospital-based sexual assault care centre, this study examined data about previous and current victimization from homeless women clients and compared them to data from housed women clients. More homeless women than housed women reported childhood physical abuse, childhood sexual abuse, adult physical assault, previous sexual assault in adulthood, and a history of mental health problems. Among homeless women, 78.5 percent reported at least one previous incident of victimization; 23.7 percent said they had experienced all four types of violence. Of the recent sexual assaults for which the women were treated at the centre, those against the homeless women were more violent, and were more often perpetrated outdoors, by a stranger. Ramifications for treatment and prevention of abuse and homelessness are discussed.

En partant de la base de donnees d'un centre hospitalier pour le traitement d'agression sexuelle, cette etude a compare les donnees touchant la victimisation d'un groupe de femmes sans abri a celles concernant un groupe de femmes logees. Un plus grand nombre de femmes sans abri que de femmes logees ont indique qu'elles avaient vecu l'abus sexuel et physique en tant qu'enfants, et l'agression sexuelle et physique en tant quadultes, ainsi que des antecedents mentaux. Parmi les femmes sans abri, 78,5 pourcent ont indique qu'elles avaient vecu au moins un episode anterieur de violence; 23,7 pourcent d'entre elles ont dit qu'elles avaient vecu les quatre genres de violence. En ce qui concerne les agressions sexuelles recentes pour lesquelles les femmes ont ete traitees au centre, celles contre les femmes sans abri etaient plus violentes et un plus grand nombre d'entre elles ont ete commis par un etranger, L'article discute des solutions passibles, dont le traitement et la prevention de l'abus et du manque de logement.

Research studies have documented high rates of various forms of childhood and adult victimization as well as mental health problems among homeless women. While many of these studies document prevalence rates of abuse, few provide details of abuse characteristics and specific mental health problems. In order to address these limitations within the literature, this study examined recent and previous victimization experiences as well as mental health problems among homeless women and a comparison group of housed women attending a sexual assault treatment centre.

Numerous studies have documented the high rates of victimization among homeless women. In a study of homeless women in Toronto, Breton and Bunston (1992) found a 75 percent rate of lifetime physical and sexual abuse, most of which took place before the women became homeless. Another Toronto-based study of both homeless women and men (Ambrosio, Baker, Crowe, & Hardill, 1992) found that of 106 female participants, 46.2 percent, had been physically assaulted in the previous year and 43.3 percent had experienced sexual harassment and/or assault. An astonishing 21.2 percent of the women interviewed said that they had been raped at least once in the preceding year. Both studies found that the experience of multiple incidents and forms of abuse is the rule, rather than the exception, for homeless women (Ambrosio et al. 1992; Breton & Bunston, 1992). In their examination of sexual assaults, Breton and Bunston (1992) found that the majority of homeless women were assaulted by a known assailant, in a familiar place tha t was not public.

American researchers also document very high rates of abuse and assault among homeless women. Simons and Whitbeck (1991) found that 43 percent of women in their sample had been raped by a father or father-figure in childhood. Anderson, Boe, and Smith (1988) report that two-thirds of their sample of homeless women experienced physical abuse in childhood, adulthood, or both. Almost half had been sexually assaulted at least once in their lifetime.

Some subgroups of homeless women are at even greater risk for victimization. In a comparison study of homeless women of colour and homeless white women, North and Smith (1994) found that white women were significantly more likely to have been abused in childhood. Among the white women, 37.9 percent reported physical abuse and 41.4 percent reported sexual abuse compared to 16.4 percent and 20.9 percent of the women of colour. About 40 percent of the women cited relationship breakup or family conflict as the reason they had first become homeless, hinting at the importance of family violence in the etiology of women's homelessness.

A study of young homeless women in a program for adolescents found that 83 percent had been sexually abused as children (Schram & Giovengo, 1991). Goodman, Dutton and Harris (1995) found that episodically homeless women being treated in hospital psychiatric settings are so likely to experience abuse -- 97 percent reported some victimization over their lifetimes -- that physical and sexual violence amount to normative experiences for them.

Some American studies have found that victimization rates are higher among homeless women than other high-risk populations of women. For example, homeless women have reported significantly higher rates of abuse than housed low-income women (Ingram, Corning, & Schmidt, 1996) and urban African-American women (D'Ercole & Streuning, 1990), two groups whose risk of victimization is greater than that of the general population. Only Goodman (1991) found no difference in the prevalence of abuse among homeless mothers and housed poor mothers. The rate of lifetime victimization for the whole sample, however, was a staggering 89 percent.

Research has found significant relationships between homeless women's experience of victimization and aspects of their mental health. Among the women interviewed by Ambrosio et al. (1992), the high rate of recent sexual assault was accompanied by a very high rate of suicidal ideation and attempts: almost two-thirds of the women reported that they had contemplated suicide in the past year, and almost one-third said they had attempted suicide in that same period. Padgett and Streuning (1992) found depressive symptoms, alcohol problems, and drug dependence to be strongly associated with physical and sexual assault. D'Ercole and Streuning (1992) identified a strong, positive relationship between current depression and past physical or sexual assault, and a positive relationship between victimization and psychotic symptoms. Ingram et al. (1996) identified amount and level of victimization as significant predictors of psychological distress of both homeless and housed women in their sample. Similar links between vi ctimization and mental health have been found in housed populations, including female psychiatric inpatients (Beck & van der Kolk, 1987) and outpatients (Carmen, Rieker, & Mills, 1984; Herman, 1986; Surrey, Swett, Michaels, & Levin, 1990), and in community samples of women (Duncan, Saunders, Kilpatrick, Hanson, & Resnick, 1996; Moeller, Bachmann & Moeller, 1993). Homeless women, then, may not differ from housed women in terms of the correlation between abuse and mental health problems or treatment; the difference may lie in the rates at which homeless women experience both problems.

Some theorists (e.g., Browne, 1993; Goodman, Saxe, & Harvey, 1991) suggest that this relationship between violence and mental health reflects the impact of psychological trauma. Not only are most homeless women survivors of traumatic victimization, but homelessness itself, with its attendant dangers and stigma, is also a traumatic experience (Goodman et al., 1991). There is a risk that the chronic trauma of homelessness will exacerbate or entrench women's existing trauma-related difficulties. This can result in what Herman (1992) has described as complex post-traumatic stress, in which the physical, mental and social dynamics of hyperarousal, intrusion, hypervigilance, dissociation, and depression inform a survivor's functioning in most areas of her life.

While the research studies cited shed light on the overall magnitude of victimization among homeless women, they do not examine the specific characteristics of childhood and adult violence as well as the associated mental health problems experienced by homeless women. The current study was designed to examine previous and current victimization experiences and history of mental health problems of homeless women and to compare these experiences to a group of housed women. Women in the study experienced a recent sexual assault and were attending a hospital-based sexual assault care centre for assessment and treatment. The study focussed on characteristics of the sexual assault for which the women were treated as well as the history of childhood and previous adulthood abuse, mental health and treatment. Aspects of the victim-assailant relationship and violence-related variables of the current sexual assault were examined. It was predicted that the history of sexual and physical abuse among homeless sexual assault survivors, as well as the characteristics of the present sexual assault, would differ from the comparison sample of housed women in terms of both the higher prevalence of abuse histories and the nature of the sexual assault. It was further predicted that homeless women would have a higher rate of mental health problems and treatment than housed women, but that the relationship between victimization and mental health would be significant for both groups.

Method

Participants

Data for this study were obtained from non-identifying information coded from clinical records of 136 homeless women and 180 comparison women seen at the Sexual Assault Care Centre (SACC) at Women's College Campus of Sunnybrook and Women's College Health Sciences Centre in Toronto. The Centre is designed to offer specialized, emergency medical care, including the collection of forensic evidence (Sexual Assault Evidence Kit), and counselling to women and men within 72 hours of a rape or sexual assault. Follow-up services including therapy are also available. For the purposes of this study, homeless women were defined as women who stated that they lived on the street or in a hostel or shelter at the time they presented to the Centre.

Women who stated that they lived with non-relatives were chosen as the comparison group for a number of reasons. First, they did not differ significantly from the homeless women in age. As well, it was theorized that both homeless women and women living with non-relatives were similar in that they lacked the potentially stabilizing or protective functions of living in a family home.

All study data were drawn from the SACC database which contains coded, anonymous information as recorded by intake and treatment personnel when clients present at the hospital. SACC staff are specially trained to work with sexual assault clients. Information is recorded by clinical staff on a standardized interview protocol designed and tested by researchers and clinicians at the Centre. In addition, information is coded from hospital health records. For example, clinical staff record specifics of the assault such as perpetrator characteristics, assault location and assault type. Abuse history is noted by type and occurrence when described by the client. Data from approximately 1500 women seen at the Centre between 1992 and 1997 are included in the database. For this study, the records of 136 homeless women and 180 comparison women living with non-relatives were identified through chronological admissions and analysed. The database includes specific client, assault, assailant, and treatment variables as well as general demographic, historical and presentation information. Use of the database has been approved by the Women's College Campus Ethics Board.

Variables and Analyses

Variables related to previous victimization, mental health, and the current assault were examined. Previous victimization variables included child physical assault, child sexual assault, adult physical assault and adult sexual assault. Women's abuse histories are usually recorded by intake personnel, although staff may not always inquire about this (e.g., if client is highly distressed). Women who had previously used the Centre's services were known to have histories of adult sexual assault. In addition, information about women's histories was sometimes available from hospital records used for the database.

Examination of mental health status included recorded information as to whether women had any history of mental health problems and treatment. Current sexual assault variables included victim-assailant relationship status, location of assault, number of assaults, weapons used, and amount of physical violence. Group comparisons were carried out with Chi-square analyses for categorical variables.

Results

Demographics

The women in the sample were generally young. Among homeless women the mean age was 25.24 years (SD=9.53, range=15 to 62); the mean age among housed women was 25.77 (SD=10.72, range=15 to 85). The two groups did not differ significantly in age. Both groups were culturally diverse. Of the homeless women, 56.6 percent were white and English-speaking; 17.6 percent were of colour; 5.9 percent were non-English-speaking white women, and 5.1 percent were First Nations women. Housed women did not differ significantly in ethno-cultural group membership from the homeless women.

The groups did not differ in relationship status; the vast majority (83.8 percent of the homeless and 88.3 percent of the housed) were unmarried and not cohabiting with a partner. Data on sexual orientation were not available. Significant differences were found in the groups' rates of employment, 02(3, N = 316) = 23.90, p < .05. Most homeless women (72.1 percent) stated that they were not currently employed, while only 11.8 percent said that they were. In contrast, 47.8 percent of the housed women were unemployed and 32.2 percent said that they were currently working outside of home. A substantial portion of both homeless women (13.2 percent) and housed women (22.2 percent) reported that they were students.

Previous Victimization

An analysis of women reporting on their experiences of previous victimization indicates that homeless women's reporting of physical and sexual abuse in childhood and adulthood was significantly higher than that of housed women (see Table 1). Prevalence rates reported in each of these categories represent minimum estimates due to the high rates of missing data. The problem of missing data is particularly evident in abuse-related variables. This may be due to a clinician's reluctance to probe abuse history in a crisis setting or a client's reluctance to disclose this information. Differential rates of missing data were found for homeless and housed women. The reason for this is unclear but may be due to more previously documented data for homeless women. A history of childhood physical assault was reported by 39.3 percent of the homeless women, compared to 16.2 percent of the housed women, 02(2, N = 314) = 24.99, p < .05. Childhood sexual assault was reported by 43 percent of the homeless women and 24.6 percent of the housed women, 02(2, N = 314) = 37.28, p < .05. Adult physical assault was reported by 49.6 percent of the homeless women and 19 percent of the housed women, 02(2, N = 314) = 22.88, p < .05. Finally, 61.5 percent of the homeless women said they had experienced previous adult sexual assault, compared to 35.8 percent of the housed women, 02(2, N = 314) = 12.70, p < .05.

Given the large numbers of women who provided no information in some abuse categories, merged categories were created (see Table 1), yielding information on women who reported in at least one category. Across all categories of childhood and adulthood abuse, significantly more of the homeless women (78.5 percent) in the sample reported at least one previous experience of violence, compared to 51.4 percent of housed women who said they had been previously assaulted at some time in their lives, 02(1, N=3 14) = 24.30, p < .05. When both physical and sexual abuse in adulthood were combined, a prevalence rate of 69.6 percent for homeless women and 40.2 percent for housed women was found, 02(1, N = 314) = 26.71, p < .05. Similarly, when childhood physical and sexual abuse were combined, 50.4 percent of the homeless women and 29.6 percent of the housed women reported at least one form of childhood abuse, 02(1, N = 314) = 14.00, p < .05. In fact, 23.7 percent of the homeless women and 6.1 percent of the housed women s aid they had experienced all four types of victimization, 02(1, N = 314] = 20.07, p < .05, while only 3 percent of the homeless women and 9.4 percent of the housed women answered "no" in all four categories.

Finally, homeless women were more likely to have experienced multiple forms of victimization. While the rate of reporting a single type of abuse was similar for the two groups of women, homeless women were more likely to experience multiple types of violence. At least 59.2 percent of the homeless women had survived two or more forms of abuse, compared to 26.7 percent of housed women. A Chi-square analysis showed that, of women reporting at least one type of abuse, homeless women were significantly more likely than housed women to have experienced multiple forms of abuse, 02(1, N = 198) = 11.70, p < .05.

Mental Health History

Reporting rates for mental health were somewhat higher than those for abuse; information was available for 72.6 percent of the homeless women and 76.5 percent of the housed women. Of the homeless women, 46.3 percent were known to have a history of mental health problems or treatment, compared to 18.3 percent of the housed women, 02(2, N = 314) = 38.53, p < .05. Only 25.7 percent of the homeless women said they had no history of mental health concerns, while 57.7 percent of the housed women stated that they did not have a history of mental health problems or treatment. In an examination of number of types of abuse experienced and mental health concerns it was found that having experienced more types of abuse was significantly associated with more mental health problems for both homeless women, 02(8, N = 135) = 17.91, p <.05, and housed women, 02(8, N = 179) = 32.94, p <.05.

Of the 63 homeless women who were known to have a history of mental health problems or treatment, additional descriptive details were accessed for 50 of them (these details were not available for housed women). Of these, 20 women reported depression (40 percent), 14 reported substance use problems (28 percent), and 20 said they had attempted suicide (40 percent). In addition, some women had received psychiatric diagnoses including schizophrenia (20 percent), bi-polar disorder (12 percent), and personality disorders (16 percent). With regards to mental health treatment, 15 of the women (30 percent) were taking at least one psychiatric medication, and only two women (4 percent) had participated in counselling or psychotherapy.

Current Sexual Assault

Differences were also found between homeless and housed women in the characteristics of the current sexual assault (see Table 2). Examination of the victim-assailant relationship revealed that homeless women (40.4 percent) were assaulted by a stranger significantly more often than housed women (25.7 percent), 02(1, N = 315) = 7.71, p < .05. More housed women (52.2 percent) than homeless women (39.0 percent) were assaulted by dates, friends or acquaintances, 02(1, N = 316) = 5.47, p < .05. There were no significant differences between the two groups in rates of assault by a relative, a client, or a current or former partner.

As seen in Table 2, the sexual assaults on homeless women were more violent and were more likely than those on housed women to include more than one sexual act, 02(1, N = 316) = 5.11, p < .05. While physical violence was used as a form of coercion in significantly more of the assaults on homeless women, 02(1, N = 307) = 6.32, p < .05, physical trauma as a result of the sexual assault was noted as often by homeless women as housed women, 02(3, N 316) = 4.10, p > .05. The two groups also did not differ on the likelihood that the assailant used a weapon. Housed and homeless women were equally likely to have been drugged by their assailant; however, housed women were significantly more often assaulted while asleep or not conscious, 02(1, N = 307) = 5.01, p < .05.

Finally, there were significant differences between homeless and housed women in the location of the assault. While both groups were frequently assaulted in their assailants' homes (26.7 percent of homeless women and 30.7 percent of housed women), the homeless women (31.3 percent) were assaulted outdoors significantly more often than the housed women (9.5 percent), 02(1, N = 310) = 23.64, p < .05. Approximately one-quarter (26.3 percent) of the housed women were assaulted in their own homes compared to 9.9 percent of homeless women who reported being sexually assaulted in the location considered to be their current residence (e.g., hostel), 02 (1, N 310) 12.93, p <.05.

Discussion

Homeless women, victimization and mental health

This study revealed high rates of victimization among the homeless women using the Sexual Assault Care Centre. Homeless women were significantly more likely than a comparison group of housed women matched on age to state that they had experienced previous sexual and physical abuse both in their childhood and in adulthood. While caution is required in drawing any conclusions due to missing data among these variables, for the vast majority of the homeless women using the Centre, the rape or sexual assault they had survived in the past 72 hours was not their first experience of victimization. More than half of the homeless women had experienced violence repeatedly in their lives. For approximately one-quarter of the homeless women -- compared to a small minority of the housed women -- the assault they were now trying to survive was one more incident in a history of physical and sexual violence. Also, the homeless women reported significantly more mental health concerns than the housed women; for both groups, men tal health concerns were associated with more types of victimization experienced.

The results of this study also revealed that the sexual assaults committed against homeless women were characterized by more violence and a greater number of sexual acts than those against housed women. In contrast to the findings of Breton and Bunston (1992), homeless women in this study were likely to have been assaulted by a stranger and to have been assaulted outdoors. While Breton and Bunston (1992) conclude that sexual assaults on homeless women are not necessarily related to life on the streets, data from this study suggest that homeless women's life circumstances do place them at risk for sexual assaults that differ significantly from those experienced by housed women.

On the other hand, some assumptions about the dangers of homelessness were not borne out. For example, one may expect to find that more homeless women are assaulted while sleeping, since sleeping in a public place would appear to be more risky than sleeping at home. The opposite, in fact, was true in this study: housed women were more likely to be assaulted while sleeping or unconscious from alcohol consumption. In contrast to stereotypes about violent and unstable relationships among homeless women, we found that homeless women in this study were less at risk of sexual assault from their dates, friends and acquaintances than were housed women.

These findings raise significant questions about the understanding and prevention of sexual assault among homeless women, and have important implications for services offered to homeless women who are survivors of abuse and assault.

First, the homeless women were significantly more likely than the housed women to have been assaulted outside. More information is needed about the context of these assaults in order to devise prevention strategies. Do they take place, for example, in the hours between hostels' morning closures and the opening of drop-in centres? Or are they more likely to occur when a woman is unsheltered and not using hostels or drop-in centres? Are they perhaps related to street activities such as drug use or the sex trade? With more information, some potential prevention strategies could be identified and developed.

An unexpected finding was that the homeless women were significantly less likely than the housed women to have been sexually assaulted by a date, friend or acquaintance. This is particularly interesting given the homeless women's high rates of reported previous victimization. This finding appears to reinforce Breton and Bunston's (1992) assertion that homeless women who have been victimized by family members and partners are less likely -- not more likely -- to be revictimized by intimates. Breton and Bunston (1992) point out that many women become homeless as a result of their determination to survive and escape abuse. Some researchers advocate a shift from looking at homelessness as pathological to seeing the ways in which it may reflect or develop inner strengths and positive adaptation (Montgomery, 1994; Sumerlin, 1996; Sumerlin & Privette, 1994). More information is needed about the relationship between pre-homeless abuse experiences and homelessness.

The homeless women in this study reported more assaults by an unknown person than the housed women. This might be related to their high daily exposure to strangers, and to what Bunston and Breton (1992) have identified as the loss of the home's functions of protection and privacy. On the other hand, it is possible that reporting effects have influenced these data: some homeless women, similar to other sexual assault survivors, might have been unwilling to reveal the nature of their relationship with the assailant to centre staff or the police. If this is the case, the factors affecting their willingness to disclose need to be better understood. Agencies providing services to homeless women coping with violence might need to modify factors -- such as a hospital environment or the presence of police -- that could cause their homeless clients to feel unsafe disclosing significant details about their experiences of sexual assault. Again, more information is needed about the context of stranger assaults on homeles s women before appropriate prevention strategies can be devised.

The finding that the assaults on homeless women were more physically and sexually violent than those on housed women is of grave concern, especially considering that homeless women's physical and emotional well-being is already threatened by a range of other factors. This finding underlines the need for services to help homeless women cope with the aftermath of assault and prevent further victimization.

Finally, the homeless women in this study reported significantly more previous experiences of violence than the housed women. While noting the high rate of missing information on abuse history variables, it appears that more than three-quarters of the homeless women had experienced previous violence, more than half had survived more than one type of abuse, and about one-quarter had experienced multiple incidents of both sexual and physical abuse. This finding may suggest the importance of previous violence in the etiology of women's homelessness. While the root causes of homelessness are certainly economic, other factors can increase women's vulnerability in the context of poverty. Prevention of family violence, and adequate material aid to women and girls escaping violent homes, must be part of any effort to put an end to women's homelessness.

In addition to suggesting a possible relationship between abuse and women's homelessness, these findings also raise concerns about the indirect role of violence in creating and maintaining women's homelessness. Research has found significant relationships between homeless women's experience of victimization and aspects of their mental health, including substance use, diagnoses of depression and psychosis, and hospitalization (D'Ercole & Streuning, 1990; Ingram et al, 1996; Padgett & Streuning, 1992; Ralston, 1997). Among the women interviewed by Ambrosio et al. (1992) the high rate of recent sexual assault was accompanied by a very high rate of suicidal ideation and attempts: almost two-thirds reported that they had contemplated suicide in the past year, and almost one-third said they had attempted suicide in that same period.

It is in this context that the sexual assault of homeless women occurs. In addition to their vulnerability due to previous victimization and their current circumstances, their risk of psychological trauma is further heightened by the increased physical and sexual violence that characterizes these assaults. The resulting emotional, cognitive, behavioural and social difficulties, perilous even for a housed woman's functioning, can be disastrous for a homeless woman. Meanwhile, anecdotal accounts from staff at the sexual assault care centre suggest that homeless women rarely access the follow-up trauma recovery services offered by the centre. This points, again, to the need for accessible services to help homeless women who are coping with sexual and physical violence.

Limits of the data

A number of factors limit the applicability and generalizability of this data. First, because this research is a retrospective analysis of information from an existing database, terms such as "homeless," "child/adult sexual assault" and "child/adult physical assault" have not been operationally defined. This study relied on clients' disclosure of their living situations and histories of violence. It is possible that this method has led to under-reporting, rather than over-reporting, of homelessness and abuse in the total sample. This cannot be confirmed. As well, it is noted that more background information was missing for housed women than for homeless women. While the reasons for this are unclear, it may be that homeless women have more previously documented histories. Homeless women who were not living in shelters or on the street (for example, those doubled up with friends or living in squats), or homeless women who didn't want to be identified as homeless, would not have been included in this research. A s well, researchers studying women's histories of victimization (Randall & Haskell, 1995) have found that women asked only about "rape" or "sexual assault" are less likely to report their experiences of sexual violence than those asked questions that include operational definitions of these terms. Responses from all women, both homeless and housed, therefore should be seen as reflecting only the surface of the experience of abuse in this sample.

The low reporting rates in all four categories of abuse have impeded conclusive statistical tests of the significance of the differences between homeless and housed women's abuse histories. Nonetheless, all possible interpretations of the data strongly suggest that the homeless women are significantly more likely than the housed women to have experienced previous abuse.

Conclusion

Service providers working with women who are homeless and/or women who have been assaulted should be aware that when a homeless woman is victimized, it is almost certainly not the first time she has had to survive violence. In fact, there is a strong possibility that a homeless woman's current experience of victimization occurs in the context of a lifetime of physical and sexual abuse which could affect her reactions to the current sexual assault, and strongly influence the work of recovery. As well, the characteristics of sexual assaults on homeless women may differ from those on housed women, involving sexual assaults that are more violent, and more often perpetrated by strangers in public places. These factors must be considered in any program for the treatment or prevention of sexual assault against homeless women.

The findings of this study, with respect to homeless women's history of victimization and the characteristics of sexual assaults they experience while homeless, point to many questions that could guide future research. First, are homeless women coping with sexual assault able to find services to help them? If so, which services do they turn to, and how well do these meet homeless women's needs? If not, how else do women cope with the violence they experience while homeless?

Secondly, what impact do sexual and physical assaults have on the physical, mental, and social health of homeless women? What are the long-term effects on women's efforts to set goals, find employment, and return to housing. How can agencies that offer material, employment, housing and other services to women who are homeless respond to the short-term and long-term effects of trauma?

Thirdly, what relationship exists between violence against girls and women, psychological trauma, psychiatrization, and women's homelessness? As noted, research has found a correlation between victimization and psychiatric diagnoses among homeless women. Some theorists (Herman, 1992; Rieker & Carmen, 1986; Rosewater, 1985, 1988) have pointed out that trauma is often misidentified as psychosis, depression, or personality disorder. Are homeless women's high levels of involvement with the psychiatric system (Marhall & Reed, 1992) reflective of the "disconfirmation and transformation" (Reeker & Carmen, 1986) of abuse they have experienced? If so, how have psychiatric treatments -- including institutionalization and medication -- and the failure to deal with the trauma affected women's risk of homelessness?

Fourthly, what personal and social resources do homeless women employ to survive the chronic stress of homelessness, the legacy of past victimization, and the physical and sexual violence they experience while homeless? How might these resources be drawn upon to aid homeless women's struggles to establish stable and safe living situations?

Finally, how can agencies intervene in the cycles of violence and homelessness? What types of services would be most helpful for women who are homeless or at risk, as they deal with the effects of victimization in their lives? What types of programs could be effective in preventing homelessness among women coping with family violence, and ending violence against homeless women? What policies and resources are needed to create and maintain these services?

Acknowledgements

Emily Paradis is grateful to the Fonds pour la formation des chercheur(e)s et l'aide a la recherche (FCAR) for graduate funding without which this study would not have been possible. Correspondence concerning this article should be addressed to Lana Stermac at the Counselling Psychology Program, Ontario Institute for Studies in Education at the University of Toronto, 252 Bloor St. W., Toronto, Ontario, M5S 1V6, Canada. Electronic mail may be sent via Internet to lstermac@oise.utoronto.ca.

Lana Stermac is a Professor in the Department of Adult Education, Community Development and Counselling Psychology at OISE/UT. Emily Paradis, M.Ed., is with the Sexual Assault Care Centre, Women's College Campus, Sunnybrook and Women's College Health Sciences Centre, Toronto.

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Table 1

Rates of Previous Abuse and Assault for Homeless and Housed Women

Single categories

Abuse / assault % homeless women % housed women
 (N = 136) (N = 180)

Childhood physical

 yes 39.3 (*) 16.2 (*)
 no 5.9 16.8
 no info 54.8 67.0

Childhood sexual

 yes 43.0 (*) 24.6 (*)
 no 11.1 19.0
 no info 45.9 56.4

Adult physical

 yes 49.6 (*) 19.0 (*)
 no 5.2 18.4
 no info 45.2 62.6

Adult sexual

 yes 61.5 (*) 35.8 (*)
 no 8.1 21.8
 no info 30.4 42.5

Merged categories

Abuse / assault % homeless women % housed women
 (N = 136) (N = 180)

Some previous abuse/assault 78.5 (*) 51.4 (*)
Some adulthood assault 69.6 (*) 40.2 (*)
Some childhood abuse 50.4 (*) 29.6 (*)
All forms of abuse/assault 23.7 (*) 6.1 (*)
No previous abuse/assault 3.0 9.4

Number of forms of previous abuse/
 assault reported

Abuse / assault % homeless women % housed women
 (N = 136) (N = 180)

 0 (a) 21.5 48.6
 1 19.3 24.6 (*)
 2 27.4 (*) 15.6 (*)
 3 8.1 (*) 5.0 (*)
 4 23.7 (*) 6.1 (*)

(a)Includes "No" and "No info"

(*)p <.05
Table 2

Characteristics of Current Sexual Assault

Assailant identity

Characteristic % homeless women % housed women
 N = 136 N = 180

 stranger 40.4 (*) 25.7 (*)
 riend/acquaintance 39.0 (*) 52.2 (*)
 client 5.1 5.2
 (ex) spouse/boyfriend 8.9 12.3
 relative 3.7 3.4

Violence/coercion

Characteristic % homeless women % housed women
 N = 136 N = 180

 more than one act 65.4 (*) 52.8 (*)
 physical violence 37.8 (*) 24.4 (*)
 victim drugged 8.7 6.7
 victim sleeping 5.5 (*) 13.3 (*)
 weapon(s) used 17.9 12.8
 physical trauma 65.4 74.4

Location

Characteristic % homeless women % housed women
 N = 136 N = 180

 victim's home 9.9 (*) 26.3 (*)
 assailant's home 26.7 30.7
 outside 31.3 (*) 9.5 (*)
 vehicle 9.2 15.1

(*)p <.05
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Author:Stermac, Lana; Paradis, Emily K.
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