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2015 HSR&D/QUERI National Conference Abstract

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3178 — Differential Risk for Homelessness among Veterans with a Positive Screen for Military Sexual Trauma

Brignone ET, Utah State University; Gundlapalli AV, Veterans Administration Salt Lake City Health Care System; Blais RK, Utah State University; Carter ME, Veterans Administration Salt Lake City Health Care System; Suo Y, University of Utah Division of Epidemiology; Samore MA, Veterans Administration Salt Lake City Health Care System; Fargo JD, Utah State University;

Objectives:
Military sexual trauma (MST) is associated with multiple adverse outcomes such as posttraumatic stress disorder, depression, and substance use disorders. In 2002, in response to a growing understanding of the seriousness of this issue during military service, VHA initiated MST screening of all Veterans seeking care in its medical facilities. Recent research suggests that MST may be a determinant in the constellation of factors associated with post-deployment homelessness. The objectives of this study were to systematically evaluate MST as an independent risk factor for post-deployment homelessness and to determine whether risk varied by sex.

Methods:
Using VHA administrative data from a national sample of OEF/OIF Veterans separated from the military over a 10-year observation period, initial MST screening results were combined with administrative evidence of homelessness. Three cohorts were constructed based on the length of follow-up from the first VA encounter following separation from the military: 30-days (N = 322,408), 1 year (N = 499,609), and 5 years (N = 603,275). For each cohort, a logistic regression analysis was conducted where the dependent variable was homelessness status and the independent variables were results of MST screening, sex, and their interaction, controlling for demographic and military-service characteristics

Results:
Veterans with a positive MST screen had an odds for homelessness that was more than two times greater than those who screened negative (adjusted odds ratio range across three cohorts = 2.06-2.21). The significant interaction between MST screening and sex in the 1-and 5-year follow-up cohorts suggested that risk for homelessness varied differentially for males and females depending on MST screen status, with a positive MST screen conferring greater risk for males.

Implications:
Results from this study suggest that positive MST screen is a strong independent risk factor for post-deployment homelessness among recently separated Veterans. While this effect exists for both sexes, male Veterans with a positive MST screen appear to be the most at-risk group, especially as the time since discharge increases.

Impacts:
Identifying and substantiating MST as a potential military-specific pathway to homelessness may aid in the early detection and mitigation of Veteran homelessness and help to explain the current overrepresentation of military Veterans in the US homeless population.