Study Suggests Strong Association between Homelessness and Incarceration among Veterans with Bipolar Disorder
Bipolar disorder is a chronic mental illness associated with significant functional and social impairments, as well as poor overall health outcomes. Bipolar disorder also can worsen public health outcomes such as homelessness and incarceration. This study assessed the association between homelessness and incarceration in 435 Veterans with bipolar disorder who received inpatient or outpatient care at one large, urban VAMC from 7/04 to 7/06. Participating Veterans completed a survey, and investigators analyzed survey data to assess: homelessness, incarceration, socio-demographics, health behaviors (i.e., treatment adherence, substance use), treatment factors (i.e., beliefs, therapeutic alliance – comfort level with mental health treatment), and current bipolar episode (manic, mixed, depressed).
Findings show that homelessness and incarceration are common among Veterans with bipolar disorder, and share many risk factors. Among Veterans with bipolar disorder, 12% reported having been homeless in the previous four weeks, and 55% reported ever having been homeless or incarcerated. Results also show that lifetime experience of homelessness was associated with 4-fold increased odds of lifetime experience of incarceration. Moreover, recent homelessness was strongly related to recent incarceration. Potentially avoidable and treatable variables included current medication non-adherence and substance use. Thus, authors suggest that programs which better coordinate psychiatric and drug treatment with housing programs may reduce the cycle of incarceration, homelessness, and treatment disruption among this vulnerable patient population.
Copeland L, Miller A, Welsh D, McCarthy J, Zeber J, and Kilbourne A. Clinical and demographic factors associated with homelessness and incarceration among VA patients with bipolar disorder. American Journal of Public Health May 2009;99(5):871-877.
This study was funded by HSR&D. Drs. Copeland and Zeber are part of HSR&D’s Veterans Evidence-Based Research Dissemination and Implementation Center in San Antonio, TX. Drs. McCarthy and Kilbourne are part of HSR&D’s Center for Clinical Management Research in Ann Arbor, MI.