As people with lived experiences of homelessness, trauma, and mental health issues, we were excited at the opportunity to critically review the research article ‘A Co-produced International Qualitative Systematic Review on Lived Experiences of Trauma During Homelessness in Adulthood and Impacts on Mental Health’ (Adams et al, 2025).
We are keenly aware of the effects that trauma has had on us before, during, and after experiences of homelessness. This enduring impact of traumatic experiences, and the link between experiences of homelessness and trauma, is well established. Studies indicate that 80-100% of people who experience homelessness also have experience of traumatic events (Piercy, 2023; O’Donnell et al, 2014). Adams et al’s (2025) systematic review about how trauma is a result of adult experiences of homelessness is speaking to an issue that is dear to our hearts.
However, we were disappointed by the scope and conclusion of this review. We agree with the authors’ conclusion that ‘understanding traumatic experiences during adulthood homelessness [is] important for informing intervention development and policies to mitigate and eradicate homelessness’ (Adams et al, 2025, p. 1). We are unsure, however, if this is new knowledge.
The link between homelessness and trauma is well known; some studies estimate that 100% of people who experience homelessness also have experience of traumatic events. This co-produced review aimed to explore experiences of both homelessness and trauma.
Methods
The researchers involved in this systematic review demonstrate a rigorous use of multiple established protocols, including for their co-production with people with lived experience of homelessness. The co-production aspect was shaped by the Authors and Consumers Together Impacting on eVidencE (ACTIVE) framework (Pollock et al, 2019). ACTIVE directs transparent co-production processes that clearly outline who was involved, how they were recruited, and the degree to which they influenced the research.
The international qualitative systematic review incorporated academic and grey literature sourced from ASSIA, CINAHL, Cochrane, EMBASE, MEDLINE, Proquest theses and dissertations, PsycINFO, Scopus, and Web of Science, as well as Google and relevant charity/health/social care websites. The search keywords included terms related to qualitative research, homelessness, trauma, mental health, and substance use.
The processes of this review were further guided by the Critical Appraisal Skills Programme Qualitative Studies Checklist, an established rating scale that was adapted by the researchers, and a ‘“best-fit” framework synthesis’ (Adams et al, 2025, p. 513).
As well as the comprehensive use of multiple frameworks, the literature search was notably thorough. The researchers included all relevant international literature published up until February 2024, seeking translations and direct access to papers where needed.
For this review, the researchers chose to use a broad understanding of mental health: they included discussion of resilience and wellbeing, substance use, and mental health disorders. They also chose to use SAMHSA’s ‘holistic representation’ of trauma to include ‘the range of events and experiences of trauma that would be reflected in qualitative literature’ (Adams et al, 2025, p. 513). However, they refined the population of people experiencing homelessness, excluding those who were homeless due to community displacement.
Results
In total, 8,915 records were screened for inclusion by the team with 180 fully assessed for eligibility and 27 included in the review. These studies representing the experiences of 909 people were included and direct quotes from people with experiences of homelessness, trauma, and mental health were used for the analysis.
The researchers identified ten themes from the literature using their SAMSHA-based conceptual model of trauma related to homelessness.
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Experience of homelessness
The researchers identified that people experiencing homelessness recurrently used negative emotional descriptors of their experiences. This included experiences of shame, rejection, isolation, shock, disbelief, helplessness, and failure. Homelessness was described as a highly traumatic experience.
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Chaos surrounding homelessness
Homelessness was recurrently experienced alongside other traumatic and complex events. This included inappropriate, inadequate, and unsafe accommodation; criminal justice involvements; caregiving responsibilities; and health difficulties.
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Dealing with the mental health impacts of trauma
All included studies described trauma as impacting the mental health of people with experiences of homelessness. The authors describe these impacts as ‘very prominent in the evidence’ (Adams et al, 2025, p. 519), but note that impacts varied.
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A constant state of fear
The authors describe fears related to personal safety as a ‘common impact of trauma while homeless’ (Adams et al, 2025, p. 519). These fears arose from personal experiences of violence as well as from witnessing the experiences of others.
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Anxiety and depression
People experiencing homelessness described being overwhelmed by their experiences, leading to panic attacks and suicidality.
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Substance use as a management strategy
Use of drugs and alcohol were described as a coping mechanism while experiencing homelessness.
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Strategies to feel safe
The authors described strategies that were put in place to increase feelings of safety. These included the use of shelters and withdrawal from other people experiencing homelessness.
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Responses to repeated exposure to trauma
People experiencing homelessness also described direct and indirect traumas in addition to being homeless. These experiences were identified as creating an acceptance of the inevitability of trauma or as forming a motivation to change.
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Acceptance and resignation as a response
The recurrent experiences of trauma contributed to traumatic experiences being seen as the norm. This included the description of traumatic experiences without the expected negative emotions and/or with the assumption of traumatic experiences as inevitable.
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Hope for a better tomorrow as a response
A minority of people experiencing homelessness expressed hope and resilience in response to their experiences of homelessness. This included the expression of a desire to make a difference in the lives of others.
This qualitative review found that people experiencing homelessness were so accustomed to trauma that it was seen as a normal part of being.
Conclusions
The authors concluded that experiences of homelessness involve experiences of trauma. They highlight the further effects of this on mental health, substance use, and a desensitisation to traumatic experiences.
The authors recommend early intervention to mitigate the impacts of trauma and ‘improve the mental health and wellbeing of people who are experiencing homelessness and support their transition out of homelessness’ (Adams et al, 2025, p. 523).
The authors also suggest that more research is needed to better understand strategies to prevent the trauma of homelessness.
This review highlights the impact of trauma on mental health and substance use among those who experience homelessness.
Strengths and limitations
As we have already noted, we are not convinced that the findings of this systematic review are noteworthy or sufficient. While this systematic review is clearly comprehensive within its scope, we feel that this scope is unhelpfully limited.
The authors argue that interventions to build more positive responses to homelessness would reduce the impacts of trauma and increase the likelihood that people experiencing homelessness will engage with services that can help them exit homelessness. However, this does not account for the reality that homelessness services have limited resources and that these impact on the supports that they are able to provide, particularly in the context of insufficient access to affordable housing (Bullen & Baldry, 2019; Clarke et al, 2020; Spinney et al, 2020).
We recognise that the authors’ analysis might well be influenced by the lived experiences of the research team. As the authors state, including people with lived experience of the subject matter in research teams can improve the quality, impact and relevance of the findings. The experiences of this team might be different to our own, and this might lead them to different priorities and understandings.
However, we were also unclear about the degree of influence exerted by the lived experience research team members. While almost all aspects of the ACTIVE framework indicated that the lived experience researchers exercised influence or control, the authors do not make it explicit which member/s of the research team made this assessment.
Also, the authors do not describe how power and conflicts were managed between lived experience team members and the rest of the research team. This is despite the authors stepping through their process for managing conflicts between the institutional researchers including when, and how, decisions are escalated to the senior researcher.
While we commend the authors for acknowledging the importance of lived experience, and including co-production processes in this project, we found ourselves with more questions than answers about the effects on this review. For example, how were the lived experiences related to the particulars of this review? Did the lived experience researchers have any opportunities to decide on the scope of this review or how they were to be involved in its processes? Considering this review relied on established protocols, which the lived experience contributors were trained in, how did their lived experience expertise interact with the academic understandings of knowledge?
Overall, the methods used in this study demonstrate a conscientious and thorough research design, but we worry that the nuances and grey areas of lived experience and co-produced research might have been lost where there wasn’t explicit, and academically created guidelines.
The methods used in this study demonstrate a conscientious and thorough research design, but we worry that the nuances and grey areas of lived experience and co-produced research might have been lost.
Implications for practice
The clearest implications of this review for practice are that addressing homelessness inevitably involves addressing trauma.
Christine has long advocated for trauma-informed practices to be embedded in all homeless services to reduce trauma triggers and de-escalate mental health crises. Beyond this, trauma-informed practices provide transparent services that support independent and informed decision-making for people experiencing homelessness (Wiewel & Hernandez, 2022). Christine has personal experience, and we both have professional experience, which has shown us how services can either reduce or increase the impacts of trauma.
However, the key reason that homelessness continues is because of inadequacies in housing policy and supply (see, for example, Clarke et al, 2020; Colburn & Aldern, 2022; Spinney et al, 2020). While it might be important to address the impacts of trauma that results from homelessness, we cannot see how any interventions to address trauma could be effective while people are otherwise kept in experiences of homelessness.
Trauma-informed services, and better individual trauma coping strategies, will not end homelessness on their own, but they can contribute to better outcomes.
Trauma-informed services will not alone end homelessness, but they can contribute to better outcomes.
Statement of interests
Christine Thirkell and Skye Constantine are founding members of the Lived Experience Led Homelessness Collective, an independent peer network of people with lived/living experience of homelessness in Australia. They are both actively involved in various collaborations with lived/living experience of homelessness including research, advocacy, and capacity building in both volunteer and paid capacities. All views expressed are their own and are independent of any affiliations.
Edited by
Laura Hemming.
Links
Primary paper
Emma Adams, Kerry Brennan-Tovey, Joanne McGrath, Steven Thirkle, Neha Jain, Maria Aquino, Victoria Bartle, Joanne Kennedy, Margaret Ogden, Jeff Parker, Sophie Koehne, Eileen Kaner, Sheena Ramsay (2025) A co-produced international qualitative systematic review on lived experiences of trauma during homelessness in adulthood and impacts on mental health. Trauma, Violence, & Abuse 2025 26(3) 510-527.
Other references
Piercy, PB. Homelessness and trauma: a vicious cycle. The Mental Elf, 31 Mar 2023.
