Camp Bethany, Elahi Anam, Waqas Ahmed, Weatherhead Stephen
Primary Care and Mental Health, University of Liverpool, Liverpool, UK.
Primary Care and Mental Health, University of Liverpool, Liverpool, UK
BMJ Open. 2025 Sep 4;15(9):e087270. doi: 10.1136/bmjopen-2024-087270.
Homelessness is a global public health concern which extends to the health and well-being of people working in homelessness, and this mixed-methods systematic review aims to explore their experiences of trauma.
The review protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance and a mixed-methods convergent segregated approach, a systematic search for qualitative and quantitative research across seven databases.
CINAHL, MEDLINE, PsychINFO, Psychology Database, Public Health Database, Web of Science and PubMed, searched from inception until May 2023.
A total of 22 articles met the eligibility criteria and were retained for inclusion (12 quantitative, 13 qualitative and 3 mixed methods). The methodological quality was assessed using the Mixed Methods Appraisal Tool, and confidence in the findings was assessed via GRADE-CERQual.
Peer-reviewed empirical research and relevant grey literature, available in English, were considered for inclusion. Data were synthesised per the Joanna Briggs Institute guidance on mixed-methods systematic review synthesis, drawing upon the Substance Abuse and Mental Health Services Administration (SAMHSA) definition of trauma.
The methodological quality of studies varied due to unclear reporting on sample representativeness and confounder control, particularly in quantitative studies. Despite this, a high prevalence of trauma experiences was evidenced, with a significant number of participants across this sector encountering traumatic 'events', 'experiences' and 'effects', as conceptualised by SAMHSA, stressing the urgent need for systemic-level change.
This review provides an important evidence base for future research, policy and practice, and discusses the need for psychologically informed practice, to prevent and alleviate trauma experiences across homelessness, along with nuanced, inclusive and consistent measurements of trauma.
无家可归是一个全球公共卫生问题，它延伸到了从事无家可归者相关工作的人员的健康和福祉，而这项混合方法的系统评价旨在探索他们的创伤经历。
该评价方案遵循系统评价与Meta分析的首选报告项目指南以及混合方法收敛性分离方法，对七个数据库进行了定性和定量研究的系统检索。
CINAHL、MEDLINE、PsychINFO、心理学数据库、公共卫生数据库、科学引文索引和PubMed，检索时间从数据库建立至2023年5月。
共有22篇文章符合纳入标准并被保留（12篇定量研究、13篇定性研究和3篇混合方法研究）。使用混合方法评价工具评估方法学质量，并通过GRADE-CERQual评估对研究结果的信心。
纳入经过同行评审的实证研究和相关灰色文献，文献语言为英文。根据乔安娜·布里格斯研究所关于混合方法系统评价综合的指南进行数据综合，借鉴物质滥用和精神健康服务管理局（SAMHSA）对创伤的定义。
由于样本代表性和混杂因素控制的报告不明确，研究的方法学质量各不相同，尤其是在定量研究中。尽管如此，仍有证据表明创伤经历的发生率很高，该领域的大量参与者遭遇了SAMHSA所定义的创伤性“事件”“经历”和“影响”，强调了进行系统性变革的迫切需要。
本评价为未来的研究、政策和实践提供了重要的证据基础，并讨论了采用心理知情实践的必要性，以预防和减轻无家可归者群体中的创伤经历，以及对创伤进行细致入微、包容且一致的测量。
