Research Article, Int J Ment Health Psychiatry Vol: 11 Issue: 2

Factors Associated with Violence Against Homeless People: Cross Sectional Study in Sorocaba/2023

Reinaldo Jose Gianini^*, Abel Efraim Martuscelli-Neto, Kathleen Vilarim Villena

Department of Medical and Health Sciences, Pontifical Catholic University of Sao Paulo, Partridges, Sao Paulo, Brazil

*Corresponding Author: Reinaldo Jose Gianin
Department of Medical and Health Sciences, Pontifical Catholic University of Sao Paulo, Partridges, Sao Paulo, Brazil
E-mail:reinaldognn@gmail.com

Received date: 11 June, 2024, Manuscript No. IJMHP-24-138773; Editor assigned date: 14 June, 2024, PreQC No. IJMHP-24-138773 (PQ); Reviewed date: 01 July, 2024, QC No. IJMHP-24-138773; Revised date: 10 Jun, 2025, Manuscript No. IJMHP-24-138773 (R); Published date: 17 Jun, 2025, DOI: 10.4172/2471-4372.1000289.

Citation: Gianini RJ, Martuscelli-Neto AE, Villena KV (2025) Factors Associated with Violence Against Homeless People: Cross-Sectional Study in Sorocaba/ 2023. Int J Ment Health Psychiatry 11:2.

Abstract

Keywords: Homelessness; Violence; Addiction; Prevention; Mental health; Cross-sectional

Introduction

The problem of homelessness has been the subject of discussion in various spheres of public policy given its complexity and the need for intervention from different sectors, such as health, social assistance, housing, and education. The homeless population (PSR) constantly faces the lack of guarantees and access to social rights established by the 1988 Federal Constitution, leaving them on the margins of a society that excludes and stigmatizes. According to the PSR's National Social Inclusion Policy, it is possible to identify that this group, despite being heterogeneous, shares some characteristics in common. It is defined as a diverse population that, however, has in common the experience of poverty, the breakdown of family ties, the experience of social disconnection due to the lack of paid employment and the protections associated with this bond, the absence of regular housing and the street as a space for social interaction, housing and sustenance [1].

There is a lack of updated information about the PSR profile. The research carried out by the Institute of Applied Economic Research, a public foundation linked to the Brazilian Ministry of Economy, with estimates designed based on information from the Single Registry for Social Programs of the Federal Government (CadÚnico) and the Unified Social Assistance System, allows us to assume that in 2020 there were 221,869 PSR in Brazil, predominantly in the Southeast region, but with very significant growth in the North of the country [2].

In relation to the factors that lead individuals to make the street their place of reference, also called the streetization process, according to Ferreira and Machado [3], the reasons can be grouped into four large groups: Experiences of violence, use and abuse of drugs, unemployment and health problems, which can be identified separately or in combination, are not always very easy to identify and separate.

It is explained that experiences of violence, including domestic violence directed mainly at women, the elderly, children and the disabled, contribute to family breakdowns, leading some to leave their homes for long periods or permanently. Unemployment is also an important factor, where the lack of stable employment or work opportunities leads some people to live on the streets, especially when they cannot return home due to distances or fear of facing failure in front of their family. Furthermore, people suffering from socially stigmatized illnesses, such as HIV/Aids, leprosy, mental disorders, or physical and mental disabilities, often face family difficulties due to a lack of resources to cope with these conditions or medical costs. This may lead some to take refuge on the streets instead of returning home.

In this context of social exclusion, the health of PSR is significantly inferior to that of the general population. Their mortality rates are higher, and morbidity trends indicate a higher incidence of infections, prevalence of cardiovascular and respiratory diseases, premature aging, and a notable increase in frailty scores compared to the stable population [4,5]. Furthermore, the prevalence of diseases such as Tuberculosis, HIV/Aids, dermatitis, psychiatric comorbidities and drug abuse is high [6,7]. Alcoholism and other drugs are generally related both to keeping people on the streets and exposing them to violence.

One of the causes that may explain the lack of health services offered to PSR and consequently increased morbidity is that the ability to perceive health needs is often absent in this vulnerable group [8]. Negative experiences can affect beliefs and expectations regarding health and, therefore, the patient's ability to perceive health needs; in some cases, the PSR was in a state of denial that they had any health needs [9].

Objective

Analyze the factors associated with the types and perpetrators of violence against PSR, with special attention to drug use, social and demographic variables, variables related to homelessness, and variables related to health.

Materials and Methods

This research refers to the part of the PSR present in the Municipality of Sorocaba, which had an estimated population of 735,523 inhabitants in the 2022 CENSUS. Located just 90 km from the Capital of São Paulo, it is the hub of a region with 15 municipalities, and approximately 2 million inhabitants. The interviews were carried out from August 2022 to July 2023, in places known to be frequented by PSR, such as the vicinity of the Sorocaba Cathedral, the surroundings of the Bus Station, the clientele of the “Bom Prato” Program, those who frequent the Center of Reference to Social Assistance and its support facilities and, mainly, individuals temporarily housed in philanthropic institutions. This is a crosssectional study, with a convenience sample, with sampling effort calculated on 84 individuals to satisfy the assumptions alpha=0.05, beta=0.20, and estimated prevalence of events=50% given that there are no parameters in the literature and this proportion is the most conservative. The variables and their categories are described in the tables in the results section. Data collection took place through interviews using a standardized, pre-formatted questionnaire approved by the Ethics Committee. The data were first transferred to an EXCEL spreadsheet and then coded for statistical analysis in STATA. Data analysis included the description of the absolute and relative frequency (in %), the Chi-square test or Fisher's Exact Test for the analysis of associations, and the calculation of the Relative Risk Ratio (RRR) to explore the relationship between occurrence, types and perpetrators of violence. A p<0.05 was considered significant. This project was submitted and approved by the research ethics committee of the faculty of medical sciences of Sorocaba–Pontifical Catholic University of São Paulo, under registration CAAE 56407222.9.0000.5373. The interviewees were aware of the Free and Informed Consent Form, and expressly agreed to participate in the research.

Results

The data presented here refers to the 81 research participants. In addition to this number, 4 interviews were discarded due to one of the interviewees having answered the interview twice, with different interviewers; and 3 interviewees were using substances.

In Table 1, it is observed that predominate in the general characteristics of the sample individuals: male, over 40 years old, nonwhite, without steady partners, with income between 400 and 600 Reais, with secondary education or higher, not born in Sorocaba, and that refer to some religion or occupation. The most frequently used drug is tobacco, followed by alcohol, cocaine, crack, cannabis, in this order; the use of solvents is less frequent. The prevalence of smoking varies from 100% in married to 57% in income of 700-2500 reais; the prevalence of alcohol use varies from 88.9% in married to 54.2% in medium or higher education; the prevalence of cannabis use varies from 77.8% in married to 37.5% in females; the prevalence of cocaine use varies from 88.9% in married to 48.9% in “non-white”; the prevalence of crack use varies from 77.8% in married and 35.5% in individuals with no income; and the prevalence of solvent use varies from 22.2% in married and 4.3% in “non-whites”.

It appears that only 9 individuals reported not using any drugs, and on average the use is 3 drugs, with 5 individuals using all the drugs mentioned. Regarding the differences for each drug, it is observed: for tobacco, a higher prevalence for white people and married; for cocaine, higher prevalence for married; for crack, higher prevalence among individuals with income between 400-600 reais, secondary education or higher, and no religion. The other drugs do not show significant differences between social and demographic categories. Still, there are significant differences between drugs in total: The prevalence of smoking is higher, use of solvents is lower. And when different drugs are compared according to the categories of each social or demographic variable, there are no significant differences.

Table 1: Distribution of the sample according to social and demographic variables and their association with drug use. Sorocaba–2023.

In Table 2, there is a predominance of individuals with less than 6 months living on the streets, who sleep in shelters, who have documents, who have regular hygiene and food, who maintain contact with their family, who have never been arrested, who maintain social but do not participate in NGOs, and who are interested in resocialization through work or study.

Significant differences are observed for: time spent on the street for less than 6 months and a higher proportion of crack use; irregular eating habits and a higher proportion of crack use; a higher proportion of individuals with a history of arrest among cocaine, cannabis and crack users; less contact with family in cocaine users; higher proportion of individuals without social interaction among solvent users. Considering the same variable, there are no significant differences in the use profile of different drugs between their categories, for example, the use profile of different drugs is similar when we compare those who sleep in a shelter or on the street–tobacco predominates and solvents are less frequent.

Table 2: Distribution of the sample according to variables related to homelessness and its association with drug use. Sorocaba-2023.

In Table 3, there is a predominance of the sample of individuals who do not have unprotected sex, who have had psychiatric hospitalizations, are not vaccinated, have had morbidity in the last 15 days, have not undergone recent medical treatment, report a mental health problem, do not carry out prevention practices, do not have chronic morbidity, have already been hospitalized and judge their quality of life to be less than 5 on a scale of 0 to 10. There is a significant association between unprotected sex and the use of alcohol, cannabis, cocaine and crack: those who report unprotected sex are more likely to use these substances. People who report psychiatric hospitalization have a significant association with the use of all drugs mentioned in the table; they are more likely to use tobacco, alcohol, cannabis, cocaine, crack and solvents. There is no significant association between vaccination and drug use. Those reporting morbidity in the past 15 days are more likely to use all drugs mentioned except solvents. There is no significant association between recent medical treatment and drug use. People who report mental health problems are more likely to use all of the drugs mentioned except solvents. Those who do not report prevention practices have a significant association with the use of crack and solvents. There is no significant association between chronic morbidity and drug use. People who report hospitalization in a general hospital have a significant association with the use of tobacco and crack. There is a significant association between quality of life and drug use: those with a quality of life below the median are more likely to use tobacco, alcohol, cannabis and cocaine.

Table 3: Sample distribution according to health-related variables and their association with drug use.

In Table 4, physical violence practiced by the police predominates. The use of drugs such as alcohol, cocaine and crack tends to be more associated with violence perpetrated by the police. Physical violence is associated with greater use of tobacco, cannabis, cocaine and crack.

Table 4: Analysis of violence suffered by PSR (type and authorship) and drug use.

In Table 5, the Relative Risk Ratio (RRR) is significantly lower for economic violence in tobacco users. The RRR is significantly lower for economic violence in alcohol users. The RRR is significantly lower for violence by third parties for alcohol users. The RRR is significantly higher for violence by other PSR individuals and third parties for cannabis users. The RRR is significantly higher for physical violence in cannabis users.

Table 5: Multivariate analysis of factors associated with violence suffered by PSR (type and author).

In Table 6, the RRR is significantly higher for police violence in cocaine users and crack users, significantly higher for violence by other PSR individuals for cocaine users, and significantly higher for physical violence in cocaine and crack users.

Table 6: Multivariate analysis of factors associated with violence suffered by PSR (type and author).

Discussion

PSR is defined as the group of individuals who do not have or are at imminent risk of losing a fixed, regular residence or suitable place to stay overnight. It is a global problem, and in the USA alone it is estimated to affect 582,620 people.

The results of the present study show high rates of drug use in PSR, with crack users presenting a more critical profile: irregular eating habits, history of arrest, history of psychiatric hospitalization, reports of various mental health problems, and non-adherence to prevention measures. The prevalence of reported morbidity and psychiatric hospitalizations are relevant in the sample, as well as hospitalizations for acute and chronic illnesses. Victimization due to physical violence, which is predominantly carried out by the police and mainly involves cocaine and crack users, is another aspect that deserves attention. This situation is similar to that described in the literature.

Illicit drug use has been an added complexity with the younger homeless population, making access to healthcare more difficult and creating problems for staff when treating them. This proved to be the main reason for the loss of housing and/or family conflicts of the participants in this research, a result that is repeated in the literature.

Respondents, when asked about the beginning of use, stated that it occurred at school, because they saw classmates using it and were curious; others claim that life on the street ends up attracting this habit, in order to forget reality. These effects are expected due to the vulnerable conditions in which they are found.

Conclusion

In our study, only 11.1% PSR claimed not to use drugs. The most used drug is tobacco (69.1%), followed by alcohol (60.5%) and cocaine (58.0%), however other Brazilian studies describe crack as the main substance consumed in PSR. Several studies from different countries report that PSR is at greater risk of substance use, both occasional use and dependence, with a tendency to worsen. The combined use of 3 or 4 drugs is common in PSR. The most common drug in PSR cited in international literature is alcohol, with rates of 68–72%. Other drugs commonly used by PSR are crack, cocaine, heroin and cannabis. In our data, crack users had the worst profile, which is also consistent with the literature.

Regarding morbidity and psychiatric hospitalizations, unsheltered PSR is often associated with high rates of mental illness, including depression. As an aggravating factor, they have less demand for health services.

As for violence, more than 66% declared having suffered some type of violence since being homeless and 53.7% mentioned other homeless people as the aggressor. This is due to the high number of drug addicts on the streets. Pre-judice was much commented on during our interviews, mainly by police officers, the Municipal Civil Guard, and people passing by on the street. Of the types of violence suffered, swearing and beatings were the most cited (73.6%). Of the 62.5% who have already been hospitalized, 17.6% were due to violence. The literature highlights PSR as victims of mainly physical violence, perpetrated by the police, and targeting cocaine and crack users. In the research by Friedman, et al., 42.2% of injecting drug users reported physical violence by the police, 62.3% suffered verbal abuse, 9.1% reported sexual violence and 38.5% reported the confiscation of new, unused syringes. According to Kerman et al., shelters are a central component of PSR service systems, however, the results of their systematic review demonstrate that these service environments can be considered dangerous by PSR due to the greater risk of violent and non-violent victimization in these spaces.

The last questions of the interviews carried out in this research were about the future perspectives of PSR. When asked how they see themselves in the next 5 years, more than half of the answers were hopeful and positive, mentioning family, work and permanent housing. But there were those, even if in smaller numbers, who could not imagine a future, and some even saw themselves dead within a period of 5 years; in terms of proportion, 67.4% are thinking about going back to school, 63.3% are considering changing professions, and 78% are not satisfied with their current situation.

Limitation

Some limitations of this research should be noted. As many interviews were carried out in a shelter, some answers were limited to the profile of people who use this type of service, for example, the number of meals eaten per day. Furthermore, a difficulty encountered when interviewing PSR is controlling the interviews so as not to interview the same person more than once, as not everyone has documents, and the interviewee's identification may be lost. In this same context, sensitivity on the part of the interviewers is necessary in order to classify whether that interview was noteworthy or not, considering that the majority of interviewees are substance users and may be under the influence of these substances. Furthermore, consider the scarcity of qualitative approaches on the topic in our country, as already presented in literature reviews, and the need to reverse this situation.

Acknowledgment

SOS–Social Works Service of Sorocaba.

Conflicts of Interest

No conflicts to declare.

Author Contributions

Reinaldo José Gianini planned, supervised, analysed data, wrote the article. Abel Efraim and Kathleen Villarin collected and analysed dara, and colaborated on writing the article.

Ethics

This project was submitted and approved by the Research Ethics Committee of the Faculty of Medical Sciences of Sorocaba–Pontifical Catholic University of São Paulo, under registration CAAE 56407222.9.0000.5373. The interviewees were aware of the Free and Informed Consent Form, and expressly agreed to participate in the research.

Author Information

Reinaldo Jose Gianini is a Full Professor at the Faculty of Medicine of Sorocaba–Pontifical Catholic University of São Paulo; Abel Efraim Martuscelli Neto and Kathleen Villarim Villena are students of medicine who belong to the scientific initiation program.

Funding

Pontifical Catholic University of São Paulo, scientific initiation program.

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