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Adams EA, Aquino MRJ, Bartle V, Brennan-Tovey K, Kennedy J, Koehne S, McGrath J, Ogden M, Parker J, Thirkle S, Kaner E, Ramsay SE. International evidence on lived experiences of trauma during homelessness and effects on mental health including substance use: a co-produced qualitative systematic review. Lancet 2023; 402 Suppl 1:S18. [PMID: 37997057 DOI: 10.1016/s0140-6736(23)02075-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/17/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Trauma is an experience (physical or emotional) that is life-threatening, harmful, or out of the ordinary and has lasting effects on mental health and wellbeing. Much of the information about trauma within homeless populations focuses on events in childhood. Using coproduction principles, we aimed to synthesise qualitative evidence exploring the impact of trauma during adulthood homelessness on mental health, including substance use. METHODS In this qualitative systematic review, we searched ASSIA, CINAHL, Cochrane, EMBASE, MEDLINE, Proquest theses and dissertations, PsychInfo, Scopus, and Web of Science for studies published from inception until Sept 6, 2022, alongside grey literature from relevant websites. Search terms were developed based on the PICO framework. No language, date, or geographical limits were applied. Any qualitative research reporting experiences of trauma and its impact on mental health during homelessness in adults was eligible. We extracted relevant data (eg, methodology, sample characteristics, homelessness, and findings). People with lived experience of homelessness were provided with bespoke training by the lead researcher. They contributed to refining the review aims, screening, coding, and theme development. Quality was assessed using the CASP Qualitative Studies Checklist. FINDINGS We included 26 qualitative papers, including 876 adults experiencing homelessness between ages 18 and 70 years (448 [51%] women and 428 [49%] men). All papers focused on urban settings. Eight papers were from the USA, five from Canada, four from the UK and Australia, three from Brazil, and one from Ethiopia and Iran. A framework synthesis of these 26 papers identified three preliminary themes. People experiencing homelessness make sense of trauma in three ways: internalised understanding, relationality to others, and with a survival lens. Coping strategies for managing feelings of fear, anxiety, and depression included substance use, self-rationalisation, and strategies to feel safe. Finally, when people experienced repeated trauma, they became either dissociated, and accepted their situation, or resilient, wishing to change their circumstances. INTERPRETATION Further evidence is needed in rural or coastal regions, where people experiencing homelessness may face greater isolation. Trauma rarely takes place in isolation, and often previous experiences of trauma shape how people experiencing homelessness make sense of trauma and cope with it. Support to address coping with the effects of trauma should focus on ensuring people do not become desensitised and prevent deterioration of mental health and substance use. The strength of this review is its coproduction with people with lived experience. Single person data extraction with secondary checks was a limitation. FUNDING National Institute for Health and Care Research (NIHR) School for Primary Care Research as part of the Three NIHR Research Schools Mental Health Programme.
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Affiliation(s)
- Emma A Adams
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Kerry Brennan-Tovey
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Joanne McGrath
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, UK
| | | | | | - Steven Thirkle
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Brennan-Tovey K, Aquino MRJ, Flanagan S, Kaner E, Wearn A, Bigirumurame T, Fong M, Todd A, Aveyard P, Jolly K, Damery S, Attwood A, Robson D, West J, Bridges S, Armitage CJ, Russell S, Strong S, Ramsay SE. Implementation of the NHS-funded tobacco dependence services in England: a qualitative study to understand the contexts of implementation. Lancet 2022; 400 Suppl 1:S24. [PMID: 36929967 DOI: 10.1016/s0140-6736(22)02234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The National Health Service (NHS) Long Term Plan is a national policy that offers a package of treatment and support, called the NHS-funded tobacco dependence service, to help people stop smoking. It will be offered to people who smoke and are admitted to hospital by 2023-24. We present preliminary findings from our study, aiming to describe the contexts that the NHS-funded tobacco dependence services is being implemented in, including current service provisions. METHODS We did a qualitative study in five regions across England to understand the current provision and context implementing the NHS-funded tobacco dependence services, including current barriers to a quality service, and challenges of implementing the new service. We used key informant technique and document analysis. We interviewed those involved in the planning, commissioning, or delivery of NHS-funded tobacco dependence services. Documents analysed included implementation plans. Interviews and documents were analysed thematically. Ethical approval was obtained from Newcastle University. FINDINGS At time of writing (May 25, 2022), 11 interviews had been done, conducted by KBT and SF, and 12 documents analysed (Integrated Care System implementation plans, hospital trust polices, and protocols). Preliminary findings show that pre-existing services were patchy across regions, trusts, and patient pathways, whereas referrals to Local Authority Stop Smoking Services and community pharmacies differed between regions. Current practices to identify smokers within NHS settings were inadequate, with many smokers being discharged with no nicotine replacement therapy. Barriers to implementing the NHS Long Term Plan included funding issues, engagement of trusts, and a hesitancy to change. Participants identified anticipated changes being a reduction in health inequalities, reducing stigma, and a change in staff perception of smoking. INTERPRETATION Our findings show how funding, trust interest and systems, current services, infrastructure, and attitudes and culture of staff pose challenges and barriers to the successful implementation of the NHS Long Term Plan, locally and nationally. These findings will provide a detailed insight into the plans implementation challenges to policy and practice partners, as well as hopefully guide them on how to overcome these challenges. FUNDING NIHR's National Priority Areas Research Programme 2020-23 via the Prevention Including Behavioural Risk Factors Applied Research Collaboration (ARC) Consortium.
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Affiliation(s)
- Kerry Brennan-Tovey
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Flanagan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Angela Wearn
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Theophile Bigirumurame
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Mackenzie Fong
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Adam Todd
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Angela Attwood
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Debbie Robson
- National Addiction Centre, Kings College London, London, UK
| | - Jane West
- Bradford institute for Health Research, Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sally Bridges
- Bradford institute for Health Research, Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Samantha Russell
- National Institute for Health and Care Research Applied Research Collaboration North East and North Cumbria Tobacco Evaluation Public Advisory Group, Newcastle, UK
| | - Steve Strong
- National Institute for Health and Care Research Applied Research Collaboration North East and North Cumbria Tobacco Evaluation Public Advisory Group, Newcastle, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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