Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1001 — Correlates of Increased Risk of Housing Instability Among Women Veterans With Recent Experience of Intimate Partner Violence

Lead/Presenter: Ann Elizabeth Montgomery
All Authors: Montgomery AE (National Center on Homelessness Among Veterans & Birmingham VAMC & University of Alabama at Birmingham School of Public Health) Bellamy SL (Drexel University, Dornsife Scool of Public Health) Medvedeva E (Center for Health Equity Research and Promotion, Philadelphia) Roberts CB (Center for Health Equity Research and Promotion, Philadelphia) Butler A (Center for Health Equity Research and Promotion, Philadelphia) Cusack MC (Center for Health Equity Research and Promotion, Philadelphia) Dichter ME (Center for Health Equity Research and Promotion, Philadelphia & University of Pennsylvania Perelman School of Medicine)

Objectives:
To identify (1) the association between intimate partner violence (IPV) and housing instability (HI) among women Veterans Health Administration (VHA) patients and (2) characteristics associated with increased risk of HI among those who experienced past-year IPV.

Methods:
The study sample comprised 8,427 women Veterans who responded to VA's universal screen for past-year IPV. Veterans' experience of HI was assessed through several indicators in their VA medical records: ICD-9/10 codes indicating homelessness/inadequate housing; clinic stop codes indicating use of VHA Homeless Programs; and responses to VHA's universal screen for HI. A series of logistic regressions, controlling for race and age, estimated the relationship between past-year IPV and HI; a multivariable logistic regression assessed sociodemographic and clinical correlates of HI among Veterans who experienced past-year IPV.

Results:
Women Veterans who screened positive for past-year IPV (8.4%) had 2.74 times the odds of having any indicator of HI; a positive screen for current HI on VHA's universal screen had the largest effect size (aOR = 4.05). Among those who had experienced past-year IPV, the odds of experiencing HI were greater among Veterans who identified as Black/African American, were not receiving compensation for a service-connected disability, were unmarried, had a history of military sexual trauma (MST), and had a serious mental illness (SMI) or substance use disorder (SUD); controlling for each of these factors, odds were greatest for women Veterans with a SUD (aOR = 6.90).

Implications:
There is a significant coincidence of past-year IPV and HI among women Veterans; among women who experienced past-year IPV, the risk is particularly high among those reporting a history of MST and clinical indications of SMI and SUD. The VHA is uniquely positioned to identify--through routinely collected information stored in Veterans' electronic medical records--and intervene with women Veterans at increased risk of homelessness related to the confluence of these conditions.

Impacts:
Women are overrepresented among Veterans experiencing HI, due at least in part to their particularly high rates of IPV and MST. To prevent and end homelessness among women Veterans, particular attention must be paid to women with comorbid SMI and SUD.