PTSD Risk Among Young Adults Experiencing Homelessness with Lifetime Indirect and Direct Gun Violence Exposure

Background and Purpose: Young adults experiencing homelessness (YAEH) are exposed to high levels of victimization, yet less is known about how gun violence, distinct from other forms of violence, informs risk for posttraumatic stress disorder (PTSD), a condition with pervasive mental and functional health consequences. Although YAEH face disproportionate exposure to firearm-related harm, quantitative evidence linking gun violence to PTSD remains limited. Identifying which forms of gun violence confer the greatest trauma risk, and for whom, is critical for developing trauma-informed, developmentally and identity-responsive interventions. This study examined associations between indirect and direct gun violence exposures (witnessing gun injury/death, having a gun pulled on them, being shot at, and gunshot injury) and PTSD symptoms among YAEH, adjusting for sociodemographic characteristics, homelessness experiences, and carceral and foster care histories.

Methods: Cross-sectional survey data were collected from 686 YAEH ages 18-25 recruited from drop-in centers in Los Angeles and St. Louis (2023-2025). PTSD symptoms were assessed using the 4-item Primary Care PTSD Screen (PC-PTSD), dichotomized at ≥3 for probable PTSD. Key independent variables were lifetime gun violence exposure types. Covariates included race/ethnicity, gender identity (cisgender male, cisgender female, trans/gender-nonconforming), LGBQ identity, time homeless, living unsheltered in past-year, lifetime arrest, and foster care history. Separate multivariable logistic regression models were estimated for each exposure, reporting adjusted odds ratios (aORs) with 95% confidence intervals or p-values.

Results: Witnessing gun injury/death (aOR 2.21, 95% CI 1.54-3.18), having a gun pulled (aOR 2.51, 95% CI 1.72-3.65), and being shot at (aOR 1.73, 95% CI 1.13-2.63) were each associated with higher odds of PTSD. Gunshot injury showed a positive but marginal association (aOR 1.80, 95% CI 0.99-3.41). Across models, trans/gender-nonconforming YAEH had 4.5 times higher odds of PTSD than cisgender males (aOR 4.52, p<.001), and cisgender females also had elevated odds (aOR 1.82, p≤.003). Longer duration of homelessness and recent unsheltered status were consistently associated with higher PTSD risk for most exposures (time homeless aOR 1.16, p=.03; unsheltered aOR 1.56, p=.02), while associations for having a gun pulled were marginal.

Conclusions and Implications: Findings highlight both indirect and direct gun violence exposure as a potent, distinct driver of PTSD symptoms among YAEH. Providers of youth services are often trauma-informed, but most of this focus assumes trauma has come in the form of sexual and physical abuse. These findings suggest expanding this sensitivity to gun violence–related trauma would enhance service delivery. Cisgender male results raise a possible limitation; based on prior literature, we question whether the PTSD screener captures stressors among cisgender males given their high levels of gun violence exposure. Because of high exposure rates among YAEH with longer duration and unsheltered status, youth homeless service systems should integrate trauma-informed practices that include gun violence sensitivity, particularly for youth with longer homelessness histories and who are unsheltered. Referrals to highly competent community violence specialists are important, and we recommend they have awareness of PTSD symptomology among youth and by gender.