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2023 HSR&D/QUERI National Conference Abstract

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4057 — The impact of temporary financial assistance on mortality, suicide attempt, and suicidal ideation among Veterans experiencing housing instability

Lead/Presenter: Richard Nelson,  COIN - Salt Lake City
All Authors: Nelson RE (IDEAS Center Salt Lake City VA, National Center on Homelessness Among Veterans, University of Utah School of Medicine), Montgomery AE (Birmingham VA, National Center on Homelessness Among Veterans, University of Alabama at Birmingham School of Public Health) Chapman A (IDEAS Center Salt Lake City VA, University of Utah School of Medicine) Suo Y (IDEAS Center Salt Lake City VA, University of Utah School of Medicine) Effiong A (IDEAS Center Salt Lake City VA, University of Utah School of Medicine) Pettey W (IDEAS Center Salt Lake City VA, University of Utah School of Medicine) Velasquez T (IDEAS Center Salt Lake City VA, University of Utah School of Medicine) Byrne TH (Bedford VA Medical Center, National Center on Homelessness Among Veterans, Boston University School of Social Work)

Objectives:
The goal of temporary financial assistance (TFA) for housing-related expenses is to prevent homelessness or to quickly house those who have become homeless. TFA may also improve health outcomes due to the tight link between housing stability and both mental and physical health. Since 2012, the US Department of Veterans Affairs (VA) has partnered with community organizations (grantees) to provide TFA to vulnerable Veterans through the Supportive Services for Veteran Families (SSVF) program. The goal of this study was to estimate the impact of TFA on mortality and suicide outcomes for Veterans in SSVF.

Methods:
We conducted a retrospective cohort study of Veterans who entered the SSVF program between 10/2015–9/2018. We examined the effect of receiving TFA on 3 outcomes both in the 365 and 730-day period following entry into the SSVF program: (1) all-cause mortality, (2) suicide attempt, and (3) suicidal ideation. We used an inverse probability of treatment weighting (IPTW) approach to assess the impact of TFA on stable housing using a Cox proportional hazards regression model. We created the propensity score for TFA to be used in the IPTW using multivariable logistic regression with demographic characteristics, monthly income and source, public benefits, health insurance, use of other VA homeless programs, comorbidities, and geographic characteristics as independent variables.

Results:
Our analysis cohort consisted of 41,969 unique Veterans with SSVF episodes with a mean (SD) duration of 90.5 (57.7) days. The mean (SD) age was 50.4 (12.9) while 87.3% were male. More than two-thirds of episodes (69.5%) were associated with TFA receipt; the mean (SD) amount of TFA was $6,070 ($7,272). Stable housing was achieved in 81.3% of the episodes. During the 730-day follow up period total of 1,575 (3.8%) Veterans died while 550 (1.3%) had a documented suicide attempt and 3,580 (8.5%) had documented suicidal ideation. Compared to those not receiving TFA, Veterans receiving TFA were substantially less likely to have died during the 365-day (HR = 0.70, 95% CI: 0.57-0.85) or the 730-day (HR = 0.81, 95% CI: 0.70-0.94) follow-up period. There was no detectable effect of TFA on suicide attempt. However, TFA was associated with a decrease in the risk of suicidal ideation at 365 days (HR = 0.79, 95% CI: 0.69-0.90). We also found a negative association between TFA and mortality and suicidal ideation regardless of the amount of TFA received, with HRs ranging from 0.60 (95% CI: 0.44-0.80) for $4,000-$6,000 to 0.75 (95% CI: 0.58-0.97) for $0-$2,000 for all-cause mortality and from 0.77 (95% CI: 0.65-0.90) for $0-$2,000 to 0.81 (95% CI: 0.68-0.96) for $4,000-$6,000 for suicidal ideation over the 365-day follow-up period.

Implications:
Our analyses indicate that receiving TFA through SSVF leads to reduced rates of all-cause mortality and suicidal ideation.

Impacts:
TFA through SSVF appears to improve important health outcomes. These results, along with previously published findings of improvements in housing outcomes and decreases in healthcare costs, suggest that this short-term financial support can have a significant impact on Veteran well-being.