Journal Article

Prevalence, correlates, and mental health burden associated with homelessness in U.S. military veterans

Tsai, Jack, Nichter, Brandon, Pietrzak, Robert H.

2023

Overview

Homelessness is a major public health problem among U.S. military veterans. However, contemporary, population-based data on the prevalence, correlates, and mental health burden of homelessness among veterans are lacking. Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative survey of veterans ( = 4069). Analyses examined the prevalence and correlates of homelessness, as well as the independent associations between homelessness and current probable psychiatric conditions, suicidality, and functioning. The lifetime prevalence of homelessness was 10.2% (95% confidence interval 9.3-11.2). More than 8-of-10 veterans reported experiencing their first episode of homelessness following military service, with a mean of 10.6 years post-discharge until onset (s.d. = 12.6). Adverse childhood experiences (ACEs), cumulative trauma burden, current household income, younger age, and drug use disorder emerged as the strongest correlates of homelessness (49% of total explained variance). Veterans with a history of homelessness had elevated odds of lifetime suicide attempt, attempting suicide two or more times, and past-year suicide ideation [odd ratios (ORs) 1.3-3.1]. They also had higher rates of current probable posttraumatic stress disorder, major depressive, generalized anxiety, and drug use disorders (ORs 1.7-2.4); and scored lower on measures of mental, physical, cognitive, psychosocial functioning ( = 0.11-0.15). One in ten U.S. veterans has experienced homelessness, and these veterans represent a subpopulation at substantially heightened risk for poor mental health and suicide. ACEs were the strongest factor associated with homelessness, thus underscoring the importance of targeting early childhood adversities and their mental health consequences in prevention efforts for homelessness in this population.

• Publisher: Cambridge University Press
• Subject: Adverse childhood experiences / Aftercare / Alcohol use / Anxiety / Anxiety disorders / Armed forces / Child, Preschool / Childhood / Childhood experiences / Childhood factors / Children / Cognitive ability / Cognitive functioning / Coronaviruses / COVID-19 / Depressive Disorder, Major - epidemiology / Disorders / Drug abuse / Drug use / Drugs / Health problems / Hispanic people / Homeless people / Households / Humans / Ill-Housed Persons / Low income groups / Mental depression / Mental disorders / Mental Health / Military reserves / Military service / Nicotine / Original / Original Article / Pandemics / Patient Discharge / Post traumatic stress disorder / Prevalence / Prevention programs / Preventive medicine / Psychosocial factors / Psychosocial functioning / Public health / Questionnaires / Resilience / Resilience (Psychology) / Self destructive behavior / Social interactions / Sociodemographics / Stress Disorders, Post-Traumatic - epidemiology / Substance use disorder / Substance-Related Disorders - epidemiology / Suicidal behavior / Suicidal Ideation / Suicide / Suicides & suicide attempts / Trauma / Urban development / Veterans / Veterans - psychology