Risk Factors and Propensity for Homelessness among Women Veterans

Washington DL, Yano EM, McGuire J, Hines V, Lee M, Gelberg L. Risk Factors and Propensity for Homelessness among Women Veterans. Paper presented at: VA HSR&D National Meeting; 2007 Feb 23; Arlington, VA.

Objectives: Women veterans are three to four times more likely to become homeless than are non-veteran women. However, their risk factors for homelessness have not been defined. Our objectives were to determine risk factors for homelessness in women veterans, and to estimate the proportion of women veterans at risk. Methods: We employed a case-control design in which non-institutionalized homeless women veterans (n = 33) in a large urban area were each matched with 5 housed women veteran controls (n = 165) from the same geographic area. Matching criteria were age and period of military service. Independent factors associated with homelessness were identified using multiple logistic regression with a Monte Carlo algorithm to estimate exact standard errors of the coefficients, and applied to a population-based cohort to derive propensity for becoming homeless. Results: Homeless women veterans reported a lifetime average of four entries into and exits from homelessness. Characteristics independently associated with homelessness were sexual assault during military service (adjusted odds ratio [OR] = 4.4; 95% C.I. 1.4-14.0), being unemployed (OR = 13.1; 2.7-63.0), disabled (OR = 12.5; 3.5-45.0), screening positive for an anxiety disorder (OR = 4.1; 1.3-13.2), and for post-traumatic stress disorder (OR = 4.9; 1.9-12.7). Protective factors were being a college graduate (OR = 0.2; 0.04-0.9) and married (OR = 0.1; 0.01-0.4). The mean propensity for homelessness was 48.6% for homeless and 2.8% for housed women veterans (difference 45.8%; 95% CI 42.9%-48.7%). Among currently housed women veterans, the mean propensity for homelessness was 9.9% for VA healthcare users. Implications: Homeless women veterans arise from a larger population of at-risk women. Though lack of financial resources, disability, and mental health disorders were the strongest predictors, a military sexual assault history also increased odds for subsequent homelessness, and may explain women veterans’ higher homelessness rates compared to non-veteran women. Impacts: Expanded availability of transitional housing, education, job training, and mental health treatment programs are needed to meet homeless women veterans’ needs, particularly programs addressing the gender-specific concerns of women with sexual trauma histories. Targeting these programs to also include at-risk women veterans may prevent tenuous living situations from deteriorating further into homelessness. Future research should be directed toward identifying the most cost-effective methods for providing these services.