Use of VHA Homeless Programs Decreases Suicide

BACKGROUND:
While 29% of the general homeless population has reported a suicide attempt over their lifetime, the proportion among homeless Veterans may be as high as 47%. VA has launched significant, system-wide initiatives to address suicide and homelessness—separately—among Veterans; however, there has been little research on the role that Veterans’ participation in VHA Homeless Programs may have on their suicide outcomes. This retrospective cohort study assessed whether participation in VHA Homeless Programs is associated with reduced risk of all-cause and suicide mortality among Veterans with housing instability. Using VA data, investigators identified 169,221 Veterans who self-reported housing instability between October 2012 and September 2016. The main outcomes for this study were all-cause and suicide mortality. Investigators also examined Veterans’ engagement in VHA Homeless Programs, including emergency housing services, domiciliary care, Supportive Services for Veteran Families, and permanent housing through the HUD-VA Supportive Housing program. Veterans’ socio-demographics also were assessed, as well as comorbidities

FINDINGS:

• The use of VHA Homeless Programs among Veterans reporting housing instability was significantly associated with reduced hazards of all-cause and suicide mortality.
  • More than one-half of Veterans reporting unstable housing on the Homelessness Screening Clinical Reminder accessed homeless services during the observation period, and the use of any homeless service was associated with a 6% reduction in risk for all-cause mortality.
  • The risk of both all-cause and suicide mortality was reduced significantly with each additional service used. With each additional VHA Homeless Program accessed, the risk of dying by suicide was lowered by 19%. Veterans who accessed 4 or more VHA Homeless Programs had 78% reduced hazards of suicide death compared with those who did not access any VHA Homeless Programs.
• As a group, Veterans who screened positive for housing instability and used a VHA Homeless Program during the study period were younger, female, black, and non-Hispanic compared with those who did not access a VA Homeless Program.

IMPLICATIONS:

• Veterans’ receipt of interventions to address housing instability may be particularly important for reducing suicide risk, perhaps by addressing unmet basic human needs such as housing.

LIMITATIONS:

• Mortality variables might be limited by data source, as people experiencing homelessness may less frequently have an accurate cause(s) of death recorded.
• This study did not assess whether particular services for the homeless (e.g., permanent supportive housing or temporary financial assistance) might confer more protection for suicide risk than a combination of other programs.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 13-334) and the National Center on Homelessness among Veterans, and Dr. Blosnich was supported by an HSR&D Career Development Award (CDA 14-408). Dr. Montgomery is part of VA’s National Center on Homelessness among Veterans. Drs. Dichter and Blosnich are part of HSR&D’s Center for Health Equity, Research and Promotion (CHERP), and Dr. Byrne is with HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR).

Montgomery A, Dichter M, Byrne T, and Blosnich J. Intervention to Address Homelessness and All-Cause and Suicide Mortality among Unstably Housed US Veterans, 2012-2016. Journal of Epidemiology & Community Health. November 18, 2020; online ahead of print.