‘The silent battles’: exploratory study on substance use and mental health among homeless women accessing services from shelter homes in New Delhi, India

Background Homelessness is a complex, multidimensional and often underrecognised public health concern. Women experiencing homelessness are often vulnerable to chronic stress, violence, mental health problems, substance use and poorer quality of life. Despite these vulnerabilities, research on substance use and psychological well-being among homeless women are limited in the Indian scenario. Aims This study aimed to evaluate the patterns and proportion of substance use, as well as the psychological well-being and quality of life, among homeless women utilising services from shelter homes in Delhi. Method A cross-sectional observational study was conducted across five urban shelter homes in Delhi, providing a sample of 152 homeless women. Participants were interviewed using a semi-structured questionnaire designed for the survey, the Perceived Stress Scale, Patient Health Questionnaire-9 and -15, Generalised Anxiety Disorder-7, World Health Organization Quality-of-Life Scale and World Health Organization Alcohol, Smoking and Substance Involvement Screening Test Version 3.0. Statistical analysis was done using SPSS version 29. Results Among 152 homeless women, lifetime use of substances was reported as tobacco (48%), alcohol (9.2%), inhalant (4.6%), opioid (2.0%) and cannabis (0.7%). Tobacco was the most common substance used followed by alcohol. Only 4.2% of the participants had ever sought treatment for substance use. A higher percentage of homeless women reported intimate partner violence in the form of emotional abuse (60.9%), physical violence (59.6%) and sexual violence (41.7%). Clinically relevant symptoms of depression and anxiety were observed in approximately a quarter of the participants. Furthermore, over 80% of the participants exhibited moderate-to-severe perceived stress. Conclusions Homeless women are considered a hard-to-reach and vulnerable population. Although residing in shelter homes may alleviate some difficulties, challenges still persist. The study emphasises the need for integrated, gender-sensitive and context-specific interventions. To effectively address the multifaceted issues by this population, tailored intervention programmes and policies should be designed unique to this population.