The Role of Childhood Violence in Adult Victimization Among Women Experiencing Homelessness in Spain.

Persons experiencing homelessness represent one of the principal manifestations of the phenomenon of social exclusion, with homeless women constituting a group in a particularly vulnerable situation. The article analyzed the experience of violence in childhood and adolescence, and its implications in terms of violence experienced as an adult, in a sample of women experiencing homelessness in Madrid (Spain) (n = 138). All participants were of legal age and had spent the night before the interview in a shelter or other facility for the homeless, on the street, in public spaces or in places not suitable for sleeping. Information was gathered through a structured interview. The results show that the interviewees had experienced a high percentage of physical, psychological, and/or sexual violence, both in their childhood and adolescence and throughout their lives, with a strong correlation between the experience of violence in childhood and the experience of violence in adulthood, particularly sexual assaults, intimate partner violence, and sex work. The experience of childhood sexual abuse among women experiencing homelessness appears to have had particularly negative consequences in adulthood. Public policies, prevention programs, and care mechanisms with a gendered perspective must be implemented, aimed at reducing the number and intensity of situations of violence experienced by women and girls at risk of social exclusion or in a homeless situation.

The Effects of Traumatic Events on Mental Health Among Women Experiencing Homelessness: A Longitudinal Study.

In this longitudinal study, we aim to evaluate the prevalence and impact of interpersonal and non-interpersonal traumatic events among women experiencing homelessness in Madrid (Spain) (N = 136). The information was collected through a structured interview and standardized instruments at baseline and at a 12-month follow-up. The most prevalent events were physical assaults, intimate partner violence, and severe illnesses or accidents. Path analysis revealed that personal and non-interpersonal traumatic events had direct effects on mental health, but also had differential indirect effects. Greater efforts are needed to address the effects of various types of potentially traumatic events and to design effective trauma-informed interventions for women experiencing homelessness.

Differences in Drug Use among Persons Experiencing Homelessness According to Gender and Nationality.

The main aims of this article are to update the data related to drug and alcohol use in persons experiencing homelessness (PEH) who use shelters, and to see if there are significant differences in their drug use depending on their gender and nationality. The article presents an analysis of the interconnections between the results of drug dependence detection tools (Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST-10), Severity of Dependence Scale (SDS)) according to gender and nationality with the intention of identifying specific needs that lead to new lines of research into better approaches to homelessness. A cross-sectional, observational and analytical method was used to analyse the experiences of persons experiencing homelessness who use various shelters in the cities of Madrid, Girona, and Guadalajara (Spain). The results show that there are no gender differences in the risks of using drugs and drug addiction, but there are differences in terms of nationality for drug addiction, with Spanish nationals showing a greater tendency to develop drug addiction. These findings have significant implications, as they highlight socio-cultural and socio-educational influence as risk factors in drug addiction behaviours.

Determining factors in the overall happiness and outlook for the future of women living homeless: Evidence from Madrid, Spain.

People living homeless are quite heterogeneous groups, including different subgroups with specific characteristics that vary substantially. Within this group, women living homeless are an understudied subgroup with specific necessities which in most cases have not been addressed in general studies related to the group. The present study examines determining factors that influence the levels of overall happiness and outlook for the future of women living homeless. To fulfill this objective, a survey was conducted on a group of women living homeless in the city of Madrid (Spain). The results of a structural equation modeling analysis found that having a larger and stable social support network, loneliness, and good health conditions without any problems associated with drug abuse are the main factors influencing their levels of overall happiness and their outlook for the future. The proposed model has also shown that stressful life events play an important role in the analysis, unlike economic aspects, which have a limited impact on their situation. This article provides new information and innovation in research about homelessness, in particular women living homeless, thus being important for extending and replicating its findings to an international context.

Health situation and perceived health status among women experiencing homelessness: A longitudinal study in Spain.

The paper analyses the health situation and the perceived health status of a sample of women experiencing homelessness (n = 138) in Madrid, Spain. All participants were adults, and the night before the baseline interview, they had slept on the street, at a shelter or any facility provided to care for people living homeless. The information was collected using structured interviews, repeated twice a year for a 3-year follow-up period. The findings of this study show that women experiencing homelessness presented poor health, particularly in comparison with the general Spanish population. Over half of the women questioned claimed to have a diagnosed serious or chronic illness, with a correlation between these conditions and the age, time spent homeless or high levels of drug use. There was a positive correlation found between women's perceived health status and being younger and having access to independent accommodation, while having suffered a number of stressful life events and having spent long periods of time living homeless presented a negative correlation with a good perceived health status.

Sedación intravenosa en domicilio tras fracaso a la sedación subcutánea / Intravenous sedation at home after failure of subcutaneous sedation

La vía subcutánea representa la vía de elección en el manejo de los síntomas del paciente oncológico paliativo. De especial importancia en domicilio, resulta fundamental para plantear sedación en situación de agonía. Por otro lado, es habitual que el paciente oncológico dispongo de catéteres centrales de acceso periférico debido a los múltiples ciclos de medicación citostática que reciben a lo largo de su vida.Por ello, y ante la situación de fracaso a la sedación por vía subcutánea en situación de últimos días, podría plantearse como alternativa la sedación endovenosa a través de estos dispositivos, en domicilio. Esta hipótesis de trabajo se pone de manifiesta en base a nuestra experiencia de sedación intravenosa a través de reservorio venoso central (RVC) en paciente con diagnóstico de adenocarcinoma de páncreas estadio Iv en situación de agonía. La paciente falleció con buen control de síntomas y sedación completa en domicilio. (AU)

The subcutaneously pharmacological administration represents the best choice in the management of symptoms in palliative cancer patients. Specially at home, it is essential to propose sedation in a situation of agony. Also, it's common that cancer patients to have peripheral access central catheters due to the multiple cycles of cytostatic medication they receive throughout their lives.For this reason and given the situation of failure of subcutaneous sedation in agony, intravenous sedation through these devices at home could be considered as an alternative. This working hypothesis is made clear based on our experience with intravenous sedation through a central venous reservoir (CVR) in a patient diagnosed with stage IV pancreatic adenocarcinoma at the end of her life. The patient died with good control of symptoms and complete sedation at home. (AU)

Access to employment and the labor market among women living homeless in Madrid, Spain.

BACKGROUND: People living homeless represent one of the most extreme embodiments of the phenomena of poverty and social exclusion, and women are a particularly vulnerable group among people living homeless. METHODS: Various factors in a sample of women living homeless in Madrid, Spain (n = 136) have been analyzed for relationships to connections to the employment and labor market. Information was collected using a structured interview. RESULTS: Results show the considerable difficulties women living homeless have in accessing the employment and labor market, despite largely having worked throughout their lives, mainly in unstable jobs, in the informal sector or in related marginal activities. In general, women living homeless tended to attribute their difficulties in accessing the labor market to personal characteristics, dispositional factors, or situational factors beyond their control. A large number of interviewees wanted to work, although few of them did so. Interviewees who reported that they were seeking employment were primarily younger women, in better health, who had been unemployed for a short time, had spent less time homeless, and were of foreign origin.

Evolution of the accommodation situation among women living homeless in Madrid, Spain: A longitudinal study.

Women constitute a particularly vulnerable subgroup of people living homeless, with their own set of circumstances and life histories that are different from men in the same situation. In this paper, we present the results of a longitudinal study on the situation, needs, characteristics, and process of change among women in a homeless situation in Madrid (Spain). This study involved 136 homeless women who were spending the night at shelters, drop-in centers, on the street, or in public spaces. Data was collected through structured interviews conducted every 6 months for a total of 3 years. Throughout that period of time approximately half of the interviewed leaves the most extreme situation of homelessness. One in four interviewees gained access to independent accommodation, although in most cases this did not mean that they were no longer in a position of residential exclusion. The logistic regression analyses performed suggested that the variables with the closest correlation to improved accommodation were: receiving stable government economic benefits, obtaining income from work, not having Spanish nationality, not having a disability and having suffered fewer stressful life events at baseline, as well as a better perceived state of health. However, with regard to access to independent accommodation, the most closely-related variables were receiving stable government economic benefits and obtaining an income from work. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Initial Effectiveness Evaluation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for Homeless Women.

The purpose of this study is to evaluate the effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders adapted for homeless women (UPHW). Eighty-one homeless women participated in this single-blinded quasi-experimental clinical trial, involving up to 12 sessions of group treatment, and 3-and 6-month follow-ups. The participants received either immediate treatment with the UPHW (n = 46) or delayed treatment, following a 12-week wait-list control period (WLC; n = 35). Primary outcomes included depression and anxiety. Secondary measures comprised positive and negative affect, psychological well-being, health perception, and social support. The UPHW resulted in significant improvement on measures of anxiety, depression and negative affect. Improvements in anxiety and depression were maintained over a 3-month follow-up period, but not at 6-month. The reliability of the clinical changes showed significant differences between UPHW and WLC for depression. Moreover, the inter-session assessment in the UPHW group showed a linear trend reduction for depression and anxiety scores along the 12 sessions. The clinical implications on the UPHW in social settings are also discussed.

The Prevalence and Nature of Violence Against Women Experiencing Homelessness: A Quantitative Study.

Individuals experiencing homelessness-an extreme form of social exclusion-have considerably higher risk of being victims of violence than the general population. We analyze the episodes of violence suffered by 504 individuals experiencing homelessness in Spain, as well as the differences between men and women. The results indicate high levels of violence and suggest that gender (specifically, being a woman) is the primary factor driving exposure to violence among this group. Highlighting the reality of women experiencing homelessness can help social, mental health, and addiction services adjust responses to better address the needs of this group and offer comprehensive care.

Disability, health, and quality of life among homeless women: A follow-up study.

The objectives of this study were: (a) to assess the prevalence of disability among homeless women; (b) to compare homeless women with and without a disability in key variables (e.g., sociodemographic, homelessness history, physical and mental health, etc.); (c) to examine paths between disability, perceived discrimination, mental health, and quality of life. The methodology was a longitudinal study of homeless women in Madrid, who were followed for a 12-month period. There were 136 interviewees at baseline and 85 interviewees at follow-up. Prevalence of self-reported disability was 36.6% at baseline and 58.8% at follow-up. Approximately, in three out of four cases, disability existed prior to becoming homeless. Participants with a disability had been homeless for a longer time at baseline compared to participants without a disability. Moreover, they presented worse mental health, worse overall health status, and lower health-related quality of life at follow-up. Mediation analyses showed that disability at baseline had direct effects on health-related quality of life, but also indirect effects mediated by perceived discrimination and mental health. This study shows the prominent prevalence rates of disability among homeless women in comparison with the general population, and the links to discrimination and negative health outcomes. These findings have significant implications for planning community services for homeless women. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intimate partner sexual violence and violent victimisation among women living homeless in Madrid (Spain).

The purpose of this paper is to discover the extent to which women living homeless in Madrid (Spain) have been victims of intimate partner sexual violence (IPSV), analysing the connection between stressful life events (SLE) relating to violent victimisation and having suffered sexual assault by a partner. This study took place using a sample of women living homeless in Madrid (n = 136). The results obtained show that a high percentage of the women living homeless who were questioned had been victims of IPSV. The women interviewed, who had been victims of IPSV, had suffered, to a greater extent, SLEs relating to situations of violent victimisation, both during childhood and adolescence as well as in adulthood. The episodes of violent victimisation that seem to be the most common forerunners to IPSV are incidents of sexual abuse in childhood and adolescence.

Application of the unified protocol for transdiagnostic treatment of emotional disorders among homeless women: A feasibility study.

Despite the high prevalence of emotional disorders and comorbidity among homeless women, there is a shortage of studies focused on interventions targeted at this population. This study aims to examine the feasibility of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders among homeless women, in relation to its quantitative effects on attendance, satisfaction, usefulness, emotional state, and group cohesion. The trial was registered at clinicalstrials.gov as NCT04392856. We use a one-group pretest-posttest design. The program consisted of 12 group sessions of approximately 90 min each. Treatment was provided to 54 homeless women, who were recruited from four different shelters in Madrid (Spain). The average attendance rate was 69.44%. Participants reported high levels of satisfaction (M = 8.97, SD = 1.45; out of 10), perceived usefulness (M = 9.10, SD = 1.42; out of 10), mood state (M = 6.11, SD = 1.02; out of 7), and group cohesion (M = 6.34, SD = 0.86; out of 7). There was a significant increase in the total score across these four variables following treatment. These findings suggest that the Unified Protocol is a feasible intervention for homeless women and may be beneficial; however, further studies that include a control group and a larger sample are on progress to test its effectiveness. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Role of Stressful Life Events among Women Experiencing Homelessness: An Intragroup Analysis.

The aim of this study is to examine stressful life events (SLEs) among homeless women and how SLEs were related to patterns and trajectories of homelessness. Specifically, the study aimed to replicate and build upon by Muñoz et al. (2005) by using cluster and discriminant analysis in a sample of 116 homeless women. The sample was classified based on SLEs, and the relationship between the resulting subgroups and sociodemographic characteristics, homeless trajectories, physical and mental health, and social support was examined. The results suggest that the three-cluster solution was theoretically and structurally meaningful: (a) the "Shorter homelessness trajectories and best health and mental health" subgroup was characterized by low levels of SLEs, a shorter homeless trajectory, lower prevalence of physical and mental health problems, and lower rates of alcohol and substances consumption; (b) the "Early onset of homelessness and poorer health and poorer mental health" subgroup was characterized by a higher prevalence of childhood and adolescence SLEs, an early onset of homelessness and greater chronification, mental health problems, and alcohol consumption; and (c) the "Chronic homelessness and poorest health and mental health" subgroup was mainly characterized by a higher prevalence of typically adulthood SLEs, as well as some SLEs that may be unique to women, a greater number of periods of homelessness, physical health problems, disabilities, and substance misuse. Increased knowledge about the different subgroups and trajectories of homeless women, as well as their specific characteristics and needs, will help us design social services and policies sensitive to all these differences.

Differences in stressful life events between men and women experiencing homelessness.

People experiencing homelessness are particularly vulnerable to experiencing stressful life events (SLEs) at some point in their lives; these SLEs are crucial for understanding the etiology and maintenance of homelessness. This study analyses the differences between men and women experiencing homelessness in the suffering of SLEs throughout their lives (childhood, adolescence, and adulthood). The sample consisted of a group of 293 people experiencing homelessness in Madrid (Spain): 156 men and 137 women. The results suggest that the number and type of SLEs experienced by men and women are different. In general, women experiencing homelessness suffer more SLEs than men in all periods of their lives. The differences in the level of sexual violence in childhood, sexual abuse in adulthood, and abuse by a spouse or partner are particularly striking. However, men experiencing homelessness score significantly higher than women for alcohol abuse, police complaints, arrest, and imprisonment throughout their lives. These findings have significant implications for the design of interventions and social policies that should be tailored to the specific needs of men and women who are homeless.

Immigrant women living homeless in Madrid (Spain).

Homeless people are one of the most obvious embodiments of the phenomenon of social exclusion, and homeless immigrants and homeless women are considered 2 particularly vulnerable groups. The objective of this article is to analyze the differences between women living homeless born in Spain (nonimmigrants) and those born abroad (immigrants). The study was carried out based on the data obtained from a sample of women living homeless in Madrid (Spain; N = 136). The information was collected using a structured interview. The results show major similarities between immigrant and nonimmigrant homeless women in terms of their basic sociodemographic characteristics (age, marital status, number of children), their state of health, satisfaction with their family and/or partner relationships, and feelings of loneliness or abandonment. Fewer immigrant women had their documentation in order, they received fewer financial benefits and their contact with their family of origin was more limited. However, the immigrant women became homeless at an older age and were subject to less chronic homelessness, their levels of consumption of alcohol and other psychoactive substances were lower, they had experienced fewer stressful life events, more of them had completed higher education, and more of them used mobile telephones and the Internet. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Risk of mental ill-health among homeless women in Madrid (Spain).

Several studies have revealed that homeless people suffering from mental health problems are more vulnerable than homeless without those mental health problems. Nevertheless, there is a lack of evidence describing the real circumstances of homeless women. This paper explores the differences between homeless women at high risk of mental ill-health compared with those who do not present this risk. The sample consisted of a group of 120 homeless women in Madrid (Spain). For this study, we collected data on background information (trajectory of homelessness and stressful life events experienced) and current aspects (living conditions, physical health, and social support). The risk of mental ill-health has been measured by the short version of the General Health Questionnaire (GHQ-28). The results showed that homeless women with higher risk of mental ill-health had become homeless at a younger age, had experienced more stressful life events in their lives, had a poorer physical health, felt less happy, had less social support, and a greater feeling of loneliness when compared with homeless women who did not present risk of mental ill-health. Improving knowledge about the risk of mental ill-health among homeless women is essential for the design of specific psychological interventions within this population.

Meta-stereotypes among women living homeless: Content, uniformity, and differences based on gender in Madrid, Spain.

This paper examines the content and degree of uniformity of meta-stereotypes among women living homeless in Madrid, Spain, and the differences with their male counterparts. The study was conducted utilizing a structured interview with a representative sample of men living homeless (n = 158) and a convenience sample of a similar size (n = 138) of women living homeless. The results show that the meta-stereotypes of women living homeless in Madrid are characterized by mainly negative (e.g., consumers of alcohol, drug users, lazy, criminals) or indulgent (e.g., physically and psychologically worn out, rejected by society, sick) contents, with very limited positive (e.g., courteous, respectful, polite) contents, and a high degree of uniformity. There are no major differences in the content of meta-stereotypes of the female interviewees in terms of their age, academic background, motherhood, or nationality. Compared to men in the same situation, a larger percentage of women living homeless agree with negative and indulgent meta-stereotypes, and a smaller percentage agree with positive meta-stereotypes.

Substance use, stressful life events and mental health: A longitudinal study among homeless women in Madrid (Spain).

The objectives of this study were: (1) to assess the prevalence of substance use among homeless women; (2) to examine the correlates for drug abuse; (3) to analyze paths between early stressful life events, drug abuse and mental health. The methodology was a longitudinal study of women homeless in Madrid (Spain), who were followed for a 24 months period. There were 138 participants interviewed at baseline and 73 participants interviewed at follow-up. We ran bivariate and multivariate analysis to examine the correlates for drug abuse. We also performed path analysis to test the interconnections between stressful life events, drug abuse and mental health. Results at baseline showed that 83.3% of participants had consumed at least one substance in the previous month. Tobacco was the most common substance consumed (70.1%), followed by sedatives (48.6%), alcohol (36.2%), methadone (13.7%), cocaine (7.2%), cannabis (6.5%) and heroin (5.1%). In addition, women who met criteria for drug abuse (19.6% of the sample) were more likely to be younger, have suffered adverse experiences during childhood, have engaged in prostitution, and have ever attempted suicide, in comparison with women who did not meet criteria for drug abuse. Path analysis supported that early stressful life events increased the vulnerability for subsequent negative outcomes among homeless women. These findings have significant implications for understanding how to implement programs for homeless women in Spain.

The Particularly Vulnerable Situation of Women Living Homeless in Madrid (Spain).

People in homeless situation are one of the major embodiments of the phenomenon of social exclusion, and women living homeless are considered a particularly vulnerable group. This paper examines different variables that may affect the situation of vulnerability experienced by women living homeless in Madrid (Spain). The study was carried out using data obtained from a representative sample of homeless men in Madrid (n = 158) and a sample of homeless women in Madrid of a similar size (n = 138). The information was gathered using a structured interview in shelters or other facilities for people in a homeless situation, on the street and in other places not initially designed for sleeping. The results show that woman living homeless are highly vulnerable compared to the domiciled population and, in some respects, to homeless men as well, especially in the number of times homeless (χ2 = 10.314; p < .01), in the time working with a contract and/or self-employed (t = 5.754; p < .001), and in the use of sedatives (χ2= 14.741; p < .001). It is however noted that homeless women show in some aspects greater strengths than homeless men. Such strengths could serve as a supporting point for their social inclusion processes. The analysis of issues that differentiate women in a homeless situation from their male counterparts could be useful for developing public policies and care resources adapted to the specific characteristics and needs of women living homeless.